MAJ. GEN. MERRiTTE W. IRELAND, M. C, CHIEF SURGEON, A. E. F., MAY 1, 1918,
TO OCTOBER 9, 1918
TShe
MEDICAL DEPARTMENT
OF THE UNITED STATES ARMY
IN THE WORLD WAR
VOLUME II
ADMINISTRATION
AMERICAN
EXPEDITIONARY
FORCES
PREPARED UNDER THE DIRECTION OF
MAJ. GEN. M. W. IRELAND
The Surgeon General
By
Colonel Joseph H. Ford, M. C.
UNITED STATES GOVERNMENT PRINTING OFFICE : 1927
■4
ADDITIONAL COPIES
OF TfflS PXTBLICA-nON MAT BE PROCtTRED FROM
THE SUPERINTENDENT OF DOCUMENTS
GOVERNMENT PRINTING OFFICE
WASHINGTON, D. 0.
AT
$3.40 PER COPY
LETTER OF TRANSMISSION
I have the honor to submit herewith a portion of the history of the
MEDICAL DEPARTMENT OF THE UNITED STATES ARMY IN THE
WORLD WAR. The portion submitted is Vokime II, and is entitled "AdMiN-
isTRATioN, American Expeditionary Forces."
M. W. Ireland,
Major General, the Surgeon General.
The Secretary of War.
3
Lieut. Col. Frank W. Weed, M. C, Editor in Chief
LoY McAfee, A. M., M. D., Assistant Editor in Chief
EDITORIAL BOARD"
Col. Bailey K. Ashford, M. C.
Col. Frank Billings, M. C.
Col. Thomas R. Boggs, M. C.
Col. George E. Brewer, M. C.
Col. W. P. Chamberlain, M. C.
Col. C. F. Craig, M. C.
Col. Haven Emerson, M. C.
Brig. Gen. John M. T. Finney, M. D.
Col. Joseph H. Ford, M. D.
Lieut. Col. Fielding H. Garrison, M. D.
Col. H. L. Gilchrist, M. C.
Brig. Gen. Jefferson R. Kean, M. D.
Lieut. Col. A. G. Love, M. C.
Col. Charles Lynch, M. C.
Col. James F. McKernon, M. C.
Col. R. T. Oliver, D. C.
Col. Charles R. Reynolds, M. C.
Col. Thomas W. Salmon, M. C.
Lieut. Col. G. E. de Schweinitz, M. C.
Col. J. F. SiLER, M. C.
Brig. Gen. W. S. Thayer, M. D.
Col. A. D. TUTTLE, M. C.
Col. William H. Welch, M. C.
Col. E. P. Wolfe, M. C.
Lieut. Col. Casey A. Wood, M. C.
Col. Hans Zinsser, M. C.
» The highest rank held during the World War has been used in the ease of each officer.
4
PREFACE
This volume considers only the more important administrative activities
of the Medical Department in the American Expeditionary Forces, for the
scope of these and their ramifications were such as to preclude, in the space
available, a more thorough discussion. On the other hand, since there is a
degree of overlapping of this and other volumes, for example. Volumes VI and
VIII, certain administrative matters already covered in these other volumes
are not taken up in detail herein. Thus the administrative matters which
related to the evacuation service of the Medical Department at the front are
considered in Volume VIII; the administrative matters closely connected with
sanitation will be found in Volume VI. The purely professional services,
though covered briefly in this volume, have been assigned greater space in
volumes appropriate to each subject. The fact that the service of but one
hospital center is discussed at some length, though such formations were
among the most important of the Medical Department enterprises, illustrates
the necessity for compressing the material available.
Certain subjects and activities may seemingly have been unduly slighted.
This has been due, on the one hand, to the necessity to avoid unnecessary
duplication, or, on the other hand, to the fact that official reports concerning
the subjects in question were too fragmentary. Thus, to the chief surgeon's
office, line of communications, the chief surgeon's office, American forces in
France, and the medical activities of some of the sections of the Services of
Supply it has been impossible to give the consideration which their importance
warrants.
Acknowledgment is made to Lieut. Frank Steiner, M. A. C, for arranging
the chapters on the brief histories of hospital centers, base, and camp hospitals.
» For the purpose of the history of the Medical Department of the United States Army in the World War, the period
of war activities extends from April 6, 1917, to December 31, 1919. In the professional volumes, however, in which are
recorded the medical and surgical aspects of the conflict, as applied to the actual care of the sick and wounded, this period is
extended, in some instances, to the time of the completion of the history of the given service. In this way only can the
results be followed to their logical conclusion.
TABLE OF CONTENTS
Page
Preface 5
Introduction I3
Section I. Organization and Administration of the Chief Surgeon's Office
Chapter I. General organization and development of the chief surgeon's office 39
II. Representation of the Medical Department on the general staff,
A. E. F 59
III. Liaison of the Medical Department, United States Army, with the med-
ical services of the Allies 71
IV. The administration division 85
V. The personnel division 89
VI. The dental section 105
VII. The nursing section; reconstruction aides 125
VIII. The division of sanitation and inspection 133
IX. The division of laboratories and infectious diseases ^ 137
X. The division of laboratories and infectious diseases continued — Central
Medical Department laboratorv 157
XI. The di vision of laboratories and infectious diseases continued — The sec-
tion of laboratories; technical work of laboratories 167
XII. The division of laboratories and infectious diseases continued — Section
of infectious diseases; section of wound bacteriology 203
XIII. The division of laboratories and infectious diseases continued — Section
of water supplies; section of food and nutrition; museum and art sec-
tion; laboratory of surgical research 213
XIV. The division of hospitalization 229
XV. The division of hospitaUzation continued — Hospital construction; pro-
curement 241
XVI. The di vision of hospitalization continued — Hospitalization of sick and
wounded 283
XVII. The division of hospitalization continued — Medical Department trans-
portation 317
XVIII. The division of hospitalization continued — The professional services 351
XIX. The finance and supply division 387
XX. The veterinary service 419
Section II. Medical Activities of Territorial Sections
Section III. Hospitals
Chapter XXI. Hospital centers ' 473
XXII. A typical hospital center 489
XXIII. Other hospital centers 537
XXIV. Base hospitals 629
XXV. Camp hospitals 749
Section IV. Evacuation of Patients to the United States; Discontinuance of
Hospitals
Chapter XXVI. Evacuation of patients to the United States 791
XXVII. Discontinuance of hospitals 807
7
8
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Section V. The Army of Occupation in Germany
Page
Chapter XXVIII. The American forces in Germany 813
XXIX. Department of sanitation and public health, German occupied
territory 821
Section VI. Medical Department Activities, American Forces in France
Appendix:
Report on organization, equipment, and functions of the Medical Department 835
Circulars promulgated by the chief surgeon, A. E. F 903
The more important memoranda promulgated by the division of laboratories and
infectious diseases, A. E. F 1057
The more important forms used in the laboratory service, A. E. F 1081
Index 1089
LIST OF TABLES
Table 1. Personnel, Medical Department, A. E. F., January 11, 1919 94
2. Personnel, Medical Department, A. E. F., July 12, 1919 96
3. Consolidated daily field report of Medical Department personnel, S. O. S.,
August 31, 1919 96
4. Types and numbers of laboratories in operation in the American Expedi-
tionary Forces, May, 1917, to April, 1919-. ■ 168
LIST OF PLATES
Frontispiece. Maj. Gen. M. W. Ireland, M. C, chief surgeon, A. E. F., May 1, 1918,
to October 9, 1918
Plate 1. Brig. Gen. Alfred E. Bradley, M. C, chief surgeon, A. E. F., to April 30, 1918. 40
2. Brig. Gen. Walter D. McCaw, M. C, chief surgeon, A. E. F., October 10,
1918, to July 15, 1919 41
LIST OF CHARTS
Chart I. Showing organization of chief surgeon's office, A. E. F., March 6, 1918 51
II. Scheme for organization of Medical Department, A. E. F., corrected to
November 11, 1918 55
III. Scheme for organization of division of sanitation and inspection, chief
surgeon's office, A. E. F 133
LIST OF FIGURES
Figure
1. Lines of communication, A. E. F., showing also the sections comprising the
Services of Supply Facing 31
2. Wing B, of group of three main buildings, general headquarters, A. E. F., in
which the office of the chief surgeon, A. E. F., was located prior to its removal
to Tours. This wing also was the location, subsequently, of the medical
group, G-4, general staff, A. E. F 4q
3. Headquarters, Services of Supply, A. E. F., at Tours. The chief surgeon's
office occupied practically the entire first floor of the wing on the right 53
4. Building in Tours in which the finance and accounting division of the chief
surgeon's office was located
5. Ground plan, headquarters, division of laboratories, A. E. F., and Central
Medical Department Laboratory, Dijon
6. Floor plan of the office of the director, division of laboratories, A. E. F . 148
7. Central Medical Department Laboratory, Dijon. The main building is in the
center of the background ^g-,
8. Diagram showing types of laboratories in the American Expeditionary Forces]] 168
9. Pathological room in the laboratory, Vichy hospital center ~ i7fi
TABLE OF CONTENTS 9
Page
10. Bacteriological laboratorj^ Vichy hospital center 178
11. Field laboratory car 183
12. Front of interior of field laboratory car 184
13. Rear of interior of field laboratory car 185
14. Interior of field laboratory car, showing water still, autoclave, and sterilizers 186
15. Transportable laboratory in eight chests 188
16 to 19. Chests of transportable laboratory opened to show contents 189-192
20. Showing preparations for shipping portable laboratories from the Central Medical
Department Laboratory, Dijon 193
21. General layout of hospital unit, type A (base hospital) with wards 20 feet wide.
Demountable buildings 242
22. General layout of hospital unit, type A, with wards 20 feet wide. Permanent
buildings 243
23. General layout of hospital unit, type A, with wards 36 feet wide 244
24. Ward building (20 feet wide), hospital unit, type A. Demountable 245
25. Ward building (36 feet wide), hospital unit, type A 245
26. Administration building, hospital unit, type A 245
27. Nurses' quarters, hospital unit, type A 246
28. Nurses' dining room and kitchen, hospital unit, type A; for use with demountable
buildings 246
29. Officers' quarters and dining room, hospital unit, type A; for use with demount-
able buildings 247
30. Officers ' quarters, hospital unit, type A; for use with permanent type of buildings. 248
31. Receiving and evacuating hall, hospital unit, type A; for use with demountable
buildings 249
32. Receiving and evacuating hall and patients' bath, hospital vmit, type A. Perma-
nent type 249
33. Patients' bath, hospital unit, type A, for use with demountable buildings 249
34. Recreation hall, hospital unit, type A; permanent building type 250
35. Nurses recreation club, hospital unit, type A; demountable 251
36. Laboratory and morgue, hospital unit, type A; demountable 251
37. Operating and X-ray building, hospital unit, type A; demountable 252
38. Operating, X-ray, and clinic building, hospital unit, type A 253
39. Dispensary and clinic building, hospital unit, type A; demountable 254
40. Clinic and surgical dressings building, hospital unit, type A 254
41. Patients' kitchen, hospital unit, type A; temporary type 254
42. Patients' kitchen and dining halls, hospital unit, type A; permanent type 255
43. Patients' dining hall, hospital unit, type A, for use only when demountable
buildings were furnished 256
44. Quartermaster's storehouse, hospital unit, type A; demountable 256
45. Quartermaster's and medical storehouse, hospital unit, type A; permanent 257
46. Barrack building, hospital unit, type A; demountable 258
47. Personnel dining hall, hospital unit, type A; demountable 258
48. Medical storehouse, hospital unit, type A; demountable 259
49. Disinfector building, hospital unit, type A; demountable 260
50. Ablution building, hospital unit, type A; demountable 260
51. General layout, hospital center, Bazoilles 261
52. General layout, hospital center. Mars 262
53. General layout, hospital unit, type B (camp hospital) 263
54. Ward, hospital unit, type B 264
55. Administration building and officers' quarters, hospital unit, type B 264
56. Patients' mess, hospital unit, type B 265
57. Bath and disinfector, hospital unit, type B 265
58. Operating and clinic building, hospital unit, type B 266
59. General layout, hospital unit, type C (convalescent camp), 2,000 beds 267
60. Administration and clinic building, hospital unit, type C 268
10 AD]\riNISTRATION, AMERICAN EXPEDITIONARY FORCES
Page
61. Officers' quarters and mess hall, hospital unit, type C
62. Standard barrack, hospital unit, type C
63. Kitchen, hospital unit, type C
64. Quartermaster building, hospital unit, type C
65. Shops and disinfector building, hospital unit, type C 272
66. Laundry building, hospital unit, type C
67. Dining hall, hospital unit, type C
68. Bathhouse, hospital unit, type C ^''^
69. Venereal and skin clinic, hospital unit, type C — 274
70. Perspective of a Bessonneau tent in a two-tent unit 275
71. Perspective of a Bessonneau tent, showing framing and double walls 275
72. Plan of a two-tent (Bessonneau) ward 275
73. Showing heating arrangements in a Bessonneau tent 276
74. Perspective of a marquee tent ward, showing a unit of three tents 277
75. Plan of a marquee tent ward of three tents 278
76. Showing heating arrangements in a marquee tent ward 278
77. Perspective of closet in a marquee tent, showing construction 279
78. Plan of a two-tent ward, United States hospital ward tent 279
79. Outhne map of France showing the location of the various fixed hospitals of the
American Expeditionary Forces Facing 288
80. American Red Cross Military Hospital No. 21, Paignton, Devon, England 289
81. American Red Cross Convalescent Hospital No. 101, Lingfield, Surrey, England
(for officers) 290
82. Hospital train obtained from the French, at Base Hospital No. 9, Chateauroux. _ 321
83. French hospital train, with continental type of carriage 322
84. Interior of one of our hospital trains (British built) 328
85. Hospital train at Base Hospital No. 27, Angers 331
86. Entraining class D patients at Base Hospital No. 30, Royat 335
87. Map of AUerey hospital center and vicinity 490
88. Reservoir, AUerey hospital center 492
89. Exterior view of warehouse, AUerey hospital center 501
90. Interior of receiving ward, AUerey hospital center 508
91. Delousing apparatus, AUerey hospital center 512
92. Clothing preparatory to delousing process, AUerey hospital center 513
93. Interior of one of the quarters for enlisted men, AUerey hospital center 514
94. Heating apparatus for patients' baths, AUerey hospital center 515
95. An operating room, AUerey hospital center 523
96. Sterilization room, AUerey hospital center 524
97. A surgical ward, AUerey hospital center 525
98. A psychiatric ward, AUerey hospital center 526
99. Eye and ear clinic in one of the hospitals, AUerey hospital center 527
100. Center medical laboratory, AUerey hospital center 529
101. View of Bazoilles hospital center 53g
102. Covered walk connecting the wards at Base Hospital No. 18, Bazoilles hospital
center g^j
103. Airplane view. Beau Desert hospital center g^g
104. Beau Desert hospital center, showing railway facilities 549
105. An operating room, Beaune hospital center
106. A view of part of Kerhuon hospital center gg-r
107. A view of part of Limoges hospital center g-r^
108. General view of Mars hospital center, looking northeast from tower at west end
of center
109. One of the operating rooms. Mars hospital center
110. View of convalescent camp (east end) looking north from water tower Mars
hospital center
111. A view of part of Mesves hospital center, during the construction period. . 580
TABLE OF CONTENTS 11
Page
112. A row of wards, Mesves hospital center, during construction period 581
113. Rock quarry, used in construction of Mesves hospital center 582
114. Base hospital. No. 99, Hyeres, Riviera hospital center 594
115. Base hospital No. 93, Cannes, Riviera liospital center 595
116. Evacuation Hospital No. 49, Menton, Riviera hospital center 596
117. Airplane view, Savenay hospital center 597
118. Hotel des Bains, part of Vichy hospital center 619
119. Hotel Lilas, part of Vichy hospital center 620
120. A ward. Base Hospital No. 1, Vichy hospital center 621
121. Officers' mess at the Hotel Sevigne, Vichy hospital center 622
122. Casino, used as the officers' club, Vichy hospital center 623
123. Building used as the noncommissioned officers' club, Vichy hospital center 624
124. Two small hotels used for the enlisted men, Vichy hospital center 625
125. Base Hospital No. 3, Vauclaire 631
126. Airplane view of Base Hospital No. 7, Joue-les-Tours 635
127. Base Hospital No. 9, Chateauroux 637
128. A general medical ward, exterior. Base Hospital No. 12, operating British
General Hospital No. 18 639
129. Exterior, surgical ward. Base Hospital No. 12 640
130. Base Hospital No. 15, Chaumont 643
131. Base Hospital No. 17, Dijon 644
132. A view of part of Base Hospital No. 21, operating British General Hospital No. 12,
Rouen 648
133. A view of part of the temporary buildings. Base Hospital No. 27, Angers 653
134. Base Hospital No. 28, part of Limoges hospital center 654
135. Surgical building. Base Hospital No. 29 656
136. Airplane view. Base Hospital No. 30, Royat 657
137. Base Hospital No. 33, Portsmouth, England 660
138. Contagious disease ward. Base Hospital No. 40, Sarisbury Court, Hants, England- 666
139. A view of the grounds, Base Hospital No. 41, St. Denis, Paris 667
140. View of part of Base Hospital No. 43, Blois 669
141. Base Hospital No. 57, Paris 682
142. Base Hospital No. 85, Paris 704
143. Part of Base Hospital No. 94, Pruniers 713
144. Main building. Base Hospital No. 103, Dijon 721
145. Main kitchen. Base Hospital No. 106, Beau Desert hospital center 724
146. Interior, detachment mess. Base Hospital No. 106 725
147. Base Hospital No. 236, Carnac 747
148. Camp Hospital No. 2, Bassens 750
149. Camp Hospital No. 4, Joinville 751
150. A ward interior. Camp Hospital No. 7, Humes 752
151. Camp Hospital No. 22, Langres 757
152. Camp Hospital No. 24, Langres 759
153. Interior, officers' ward. Camp Hospital No. 28, Nevers 760
154. A group of wards, Camp Hospital No. 29, Le Courneau 761
155. Camp Hospital No. 33, Camp Pontanezen l 762
156. Camp Hospital No. 41, Is-sur-Tille 766
157. Camp Hospital No. 42, Bar-sur-Aube 767
158. Camp Hospital No. 45, Aix-les-Baines 769
159. Camp Hospital No. 46, Landerneau 770
160. Camp Hospital No. 48, Recey-sur-Ource 771
161. One of the buildings. Camp Hospital No. 56, Avoine 774
162. Camp Hospital No. 59, Issoudun 776
163. Camp Hospital No. 64, Chatillon-sur-Seine 777
164. Camp Hospital No. 68, Bourges 779
165. Camp Hospital No. 72; Chateau-du-Loir 780
f
INTRODUCTION
MILITARY ATTACHES AND OBSERVERS, MEDICAL OFFICERS WITH
SPECIAL DUTIES, HOSPITAL UNITS AND CASUAL PERSONNEL
ON DUTY WITH ALLIES
MILITARY ATTACHES AND MILITARY OBSERVERS
When war was declared by Germany on July 30, 1914, there were on duty
with the principal American embassies and ministries accredited to European
governments military attaches who were charged with the duty of procuring
and forwarding military information to the chief of the War College division of
the Army General Staff. ^ In some countries their efforts were supplemented
later by those of military observers — officers who occupied a status somewhat
different from that of attaches but who, like them, w^ere assigned to duty with
the respective embassies and accredited to the governments concerned.^ Gen-
erally speaking, the observers enjoyed greater opportunities for investigations
at the front than did the attaches, for they were .assigned, as their designation
would indicate, with that end in view, though in some instances the opportu-
nities afforded them were strictly limited by the government to which they were
accredited.^ Though the military attaches were the military advisers of the
ambasssadors under whom they served, and were charged more definitely with
reporting to the Army War College current military events and military policies
in so far as these were divulged,^ they also submitted many reports covering a
wide range of other subjects.
On August 12, 1914, the Secretary of War requested the Secretary of State
to learn whether or not England, France, Germany, and Austria would accept
as observers six officers of the line and two of the Medical Department.^ The
Secretary of War was notified, on August 17, that the Austro-Hungarian
Government was willing to accept two line officers and two medical officers.^
Later this authorization was so modified as to replace one medical officer by
another officer from a different branch of the service.^ On August 19 the
military attache in London notified the War College division of the General
Staff that two military observers, in addition to the military attaches, would be
permitted to accompany the British Army in the field. ^
The Chief of Staff informed the Surgeon General, on August 12, 1914, that
medical officers who might be detailed as observers should be governed by
General Orders, No. 60, War Department, August 8, 1914, which requested and
advised all officers to refrain from public comment upon the military or political
situation where other nations were involved.''
On September 1, 1914, an officer of the Medical Corps, then in Europe,
together with three officers from other branches of the Army, was directed to
report to the American ambassador in Vienna for duty as military observer
with the Austro-Hungarian Army.''' He served in this capacity at various places
along the Russian and Serbian fronts until October 27, 1915.
14
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
On September 9, 1914, another officer of tlie Medical Corps, then in London,
was assigned as military observer with the French Army,'- and served in that
capacity until November 23 of that year.'^
On January 30, 1916, Sir William Osier, regius professor of medicine, Oxford
University, England, recommended that three medical officers of our Army and
and an equal number of our Navy be detailed to study professional procedures
in British base hospitals.'^ The recommendation, having been referred to him,
the Surgeon General, on March 6, 1916,'" selected three members of the Medical
Corps, who were then assigned and accredited as military observers."^ After
reporting in London in May, these officers made extensive observations in
matters pertaining to the British medical service both in England and on the
continent.
No officer of the Medical Corps w^as a member of the group assigned as
military observers with the German Army.'^
The medical officers assigned as military observers w^th the British Army
remained in this status until the arrival of General Pershing in June, 1917,''*
when they vacated their assignments and joined the American Expeditionary
Forces,'^ except one, who retained his status as observer and his consequent
affiliation with the American Embassy,-" on June 9, 1917, in addition to his
other duties, being made liaison officer for our Medical Department with the
British forces, with office in London.^' Shortly thereafter he was assigned as
chief surgeon of the American forces serving with the British, his status in this
matter being analogous to that of a department surgeon in the United States.
Another of these medical officers, after joining the American Expeditionary
Forces, was assigned, on July 4, to duty at Base Section No. 1 (St. Nazaire),
where he had been conducting an inspection when headquarters, A. E. F.,
arrived;^* the third or senior medical officer become chief surgeon, A. E. F., on
May 26, 1917, by General Orders, No. 1, headquarters, A. E. F., Washington,
D. C.
Meanwhile, on February 23, 1917, the British had recommended that a
veterinary officer of the United States Army be detailed to observe the oper-
ations of his branch of the service in their army.^^ Accordingly, a veterinarian
attached to the 6th Field Artillery, who had been assigned as a military observer
with the French Army, December 27, 1915,^*^ was relieved from further duty
in France on March 10, 1917, and directed to report to the American ambas-
sador at London for the purpose of carrying out instructions of the War Depart-
ment.^^ On June 14, 1917, this officer was relieved from further duty in London
ordered to Paris, and assigned to duty in the American Expeditionary Forces.-*
These several observers with the British Army submitted numerous reports
many of which w-ere very thorough and elaborate, and all of w^hich were tech-
nical, concerning organization, administration, equipment, and tactics of the
British Army medical service, sanitation, preventive and curative medicine
surgical and orthopedic technique, offensive and defensive measures in gas
warfare, transportation of wounded, care of animals, and many other subjects.
A few^ of their reports pertained to the British Navy; e. g., hospital ships
On June 5, 1915, the chief of the War College division of the General
Staff approved and forwarded to the Surgeon General a letter from the Amer-
INTKODUCTION
15
ican military attache, Paris, requesting detail of a medical officer as an observer
with the French Army.^* On June 12, the Surgeon General, concurring in this
proposal, recommended a medical officer,^" who was assigned on November 15,
1915, as military observer with the French armies in the field.^^
In conformity with a request from the German Government dated Sep-
tember 1, 1916, that two medical officers of the United States Army be detailed
to inspect depots for prisoners of war in France,^^ the Surgeon General, on
September 12, recommended that a medical officer be assigned to that duty to
supplement the activities of the one who already was available for that service.^^
On September 25, 1916, the newly assigned medical officer was detailed as a
military observer.^* This was not in order that he might perform the functions
of an officer regularly so accredited, but in order that his status might be fixed
while on detached duty, and that he might receive an allotment from the appro-
priation for military observers abroad.^^ The primary purpose in sending him
to France was that he might assist in the inspection of depots for military
prisoners, but in point of fact he not only did this but also made a number of
such observations as were regularly incumbent upon a military observer.
In addition to the two medical officers referred to above other officers
belonging to different branches of our Army were serving as military observers
accredited to the French Government.^^ On July 19, 1916, six of these officers
joined in signing a letter addressed to the chief of the War College division,
General Staff, recommending that they be organized into a mission.^^ This
letter noted the advantages that would accrue from the recognition of an
American military mission by the French War Department and stated that
they were all recognized as being members of such a group but that they had
no designated head who could represent them in their transactions with the
French Government.^^
The mission was organized by authority of the following letter of November
21, 1916, from the acting chief of the War College division. General Staff
By authority of the Secretary of War, the officers now on duty in Paris as military ob-
servers have been organized into a mission of which you are hereby appointed chief.
The Secretary of War directs that in the performance of your duties as chief of this
mission you be guided by the following instructions:
(a) You will cooperate in the fullest possible manner with the military attache at Paris
in the work of procuring military information, to the end that there be no duplication of work.
(b) You will show to the military attache all reports of the military observers prepared
for transmittal to the War College division. Such reports will be numbered serially in the
office of the military observers in such a manner that they will not be confused with the
numbered reports of the military attache. Reports of the military observers will be acknowl-
edged by the War College division directly to the chief of the military mission once a month.
(c) All requests from the War College division for information to be compiled by the
military observers will be directed to you, and it will be your duty to inform the other military
observers of the information that is desired.
(d) All the arrangements between the office of military observers covering all questions
or requests will be carried on directly between you as chief of the mission and the military
attache.
(e) The retained reports of the individual military observers will be accessible at all
times to the military attache, and conversely all reports of the military attache covering mat-
ters of routine military interest will be open to the military observers.
13901—27 2
16
ADMINISTRATION, AMERICAN EXPEDITIONARY KOHCES
(/) As chief of this mission you are authorized to coiuinuiiicate directly with tlie trench
War Department to such an extent as may be permitted by the hitter department. ou will,
liowever, keep the military attache informed of such matters as are taken up directly by you
with the French War Department.
(g) In order that the greatest possible advantage may be taken of all possible channels to
procure military information, you are directed to cooperate to the fullest extent with the
military attache.
(h) Instructions have been issued to the military attache at Paris to officially present you
to the chief of the second bureau of the French General Staff as chief of the American military
mission upon the receipt of the acknowledgment by the French authorities of your assignment
as such, which is being communicated to them through the Department of State.
(i) The Secretary of War authorizes you as chief of this mission to issue such instructions
to the members thereof as may be necessary for the proper performance of their duties.
Before the severance of the diplomatic relations between the United
States and Germany, February 3, 1917, members of the mission were not
given such opportunities as they later enjoyed,^* for prior to that event the
French were not certain where the sympathies of our Government lay, and
naturally hesitated to permit American officers to make thorough inspections.^
During that period, nevertheless, members of the mission did enjoy certain
facilities and submitted a number of reports on many subjects.^ After Feb-
ruary 3, 1917, the mission's facilities for study of military methods and activi-
ties were greatly extended and it forwarded to the War College a great quantity
of information, much of it highly technical in character.^ Revised instructions
for the guidance of Medical Department military observers were sent to the
chief of the mission and to the medical observers in England on February 10,
1917.^^
On February 14, 1917, the chief of the mission reported that at his request
General Lyauty had given directions so greatly amplifying the privileges here-
tofore granted the American mission that it enjoyed practically ''blanket"
permission for obtaining any information it might seek.^^ It was arranged
that the two medical members would visit the French Army school of asphyx-
iating gases and all medical depots, and would study on the ground the whole
system of evacuation of wounded from the trenches to the base hospitals.^*
Accordingly, these medical officers took the full course of instruction at the
French gas school and submitted a voluminous report covering confidential
matters concerning the chemistry of gases employed, their manufacture,
tactical employment, defenses against them, and the organization of the gas
services of the French and German Armies. A study of the evacuation service
was prosecuted, but as indicated below was not completed until after the
United States entered the war. On February 9, one of the medical officers in
question reported at length, among other subjects, on the organization of the
French sanitary service and the operation of that service in campaign. He
also compiled additional data concerning French and British defensive gas
service which he later submitted to the chief of the Gas Service, A. E. F., when
headquarters arrived in France.
A report submitted by the two medical members of the American military
mission April 25 gave the results of a study of Medical Department organi-
zation required for any expeditionary force that might be sent to France.
This document included statistics of wounded and a detailed description of
INTRODUCTION
17
the i-adical reorganization of our service that would be required, and was
accompanied by inclosures which discussed the general organization and admin-
istration of French medical service, with particular reference to their depots
for the slightly sick and wounded and convalescent camps. Another report
considered the utilization of volunteer American sanitary units in France.
Following the declaration of war, on April 6, 1917, the War Department
called upon the mission through the miUtary attache for specific information
on many subjects, and the facilities afforded members of the mission by the
French, in order that they might furnish promptly and thoroughly any data
required, were further extended by the detail to service with it of several
officers of the French General Staff.^ They assisted in preparing surveys of
ports, reports on condition and capacity of railways, location of training camps,
depots, and other installations.
The mission reported to the War Department, on June 1, that for various
reasons St. Nazaire and Nantes appeared to offer the best facilities for debarka-
tion for the first American forces, and recommended on that date that such
troops should be disembarked at St. Nazaire.*" Accordingly, the French
were requested to construct at this place a cantonment adequate to shelter a
division of 20,000 men.^ It was also reported that because of the great con-
gestion of this port it was advisable that our main central supply stations be
located at Nevers where the French were prepared to transfer the station ware-
houses to the United States forces.^ It was recommended that training camps
be located in the vicinity of Nancy and Toul. The following day two officers
of the mission left for St. Nazaire to lay out the camp site and establish water
supply services.^ The explicit applied problems of the Medical Department
in France now began, for the water supply at St. Nazaire was not sufficient for
the number of troops to be encamped here, and provision had to be made to
overcome the deficiency.^ This was accomplished temporarily by placing
water boats in service on the Loire to carry water from points some miles
inland.^ One of the medical members of the mission had been charged with
initiating necessary measures for rendering potable the water supply for our
forces in France, and on May 19 had reported on the service of water in the
French Army. As soon as the provision of a suitable water supply at St.
Nazaire was settled the French harvested such of the crops on the prospective
camp site as were sufficiently matured and began to erect the huts required
and to install the camp water system.^ It was arranged that the sick would be
cared for in a double-walled barrack hospital accommodating 300 beds, but
after construction was well advanced word was received that the strength of a
division had been increased to some 28,000 men, and it became evident that
the buildings intended for hospital purposes would have to be utilized as bar-
racks by the incoming troops.^ In this emergency the French were appealed
to and at once turned over in St. Nazaire a military hospital with a capacity
of 250 beds, the only military hospital in that community, and another of 500
beds at Savenay, a few miles inland.^ Arrangements w^ere also made for the
transfer of a hospital of 500 beds at Nantes and for the eventual transfer of
several others, notably one of 1,100 beds at Bordeaux, but, as no personnel had
yet arrived, definite arrangements concerning the latter institutions were held
in abeyance until after the arrival of the commander in chief.^
18
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Meanw hile, other activities also engaged members of the mission. A medical
member of the mission, continuing investigations begun several months pre-
viously, visited the front, where he made an exhaustive stud}^ of the organiza-
tion of the French Medical Department, its system of field hospitalization,
classification of nonevacuable sick, evacuation of wounded by hospital tram,
medical supply, use of motorized sanitary organizations of various kinds
(e. g. ambulance companies, surgical hospitals, radiologic, laundry, and other
units) and related subjects. On May 31, he reported his observations, but the
most valuable result of this study accrued from the fact that when our troops
began their offensives, in May of the following year, he was able, because of
his then assignment with G-4, G. H. Q., to give direct application to the results
of these observations, and thus secure to the medical service at the front better
cooperation than might have been possible from others not personally acquainted
with the study made at this time.^' With a view of avoiding delay when our
troops would begin to arrive, studies by the members of the American military
mission, accompanied by officers of the French General Staff, were continued
and new ones undertaken. These included further inspections of the railway
systems and selection of locations for temporary supply depots.^ It was also
decided, tentatively, that the first division that arrived should go into the
training area around Gondrecourt. Here a small barrack hospital w^as taken
over from the French who evacuated their patients.^ Construction to expand
this unit to 300 beds was begun immediately and the French reequipped it with
new material throughout, for it was realized that our own supplies would not
at once be available.^
The members of the mission continued their activities in their assigned
capacities until the arrival of General Pershing in Paris on June 13. In con-
formity with instructions received by the chief of the mission on June 5,*^
that officer reported at the time in question to General Pershing with a view of
informing him as fully as possible concerning existing conditions.^ At this
time all members of the mission joined the staff of the commander in chief
and began the performance of new duties, continuing, however, a number of
investigations which they had commenced prior to his arrival.
MEDICAL OFFICERS CHARGED WITH SPECIAL DUTIES IN FRANCE
On October 18, 1916, the Surgeon General requested that he be authorized
to detail one of our medical officers for duty as superintendent, or officer in
charge of a hospital at Passy, France, which was under the direction of the
French Benevolent Society of New York, and requested that this officer be
granted leave of absence for four months for that purpose.*^ The leave was
granted,*^ and the officer in question was informed that he would go to France
in a personal capacity, would have no connection with the United States Service
and could not wear the uniform while in that country.*^ On May 7, 1917 the
United States having declared war, he was formally assigned to duty at the
hospital mentioned,*^ but on May 22, the Surgeon General notified the French
Benevolent Society that this officer had been placed on a duty status, the
United States having entered the war, and that all officers were needed.*"' He
also requested information as to when he might be replaced. This officer
INTBODUCTION.
19
retained this assignment until October 3, 1917.^^ A few days later he was
transferred to Blois and assigned as sanitary inspector of the line of com-
munications, A. E. F."
Previous, but unsuccessful, efforts had been made by the Surgeon General
to have another medical officer assigned to duty at the above-mentioned hospital
at Passy, but at that time (June, 1916) this assignment was disapproved by
the President on the ground of neutrality. The officer, however, was selected
later to serve as chief medical officer of a hospital at His Orangis, France.
This officer was instructed to apply for leave and was assigned in the same status
as the one referred to in the preceding paragraph, but while en route his orders
were changed because of the entry of the United States into the war,^° and he
was definitely assigned to duty at this hospital May 7, 1917.^^ Here he served
as chief medical officer and conducted a large surgical clinic until assigned to
duty at general headquarters, A. E. F., on March 7, 1918,^^ meanwhile dis-
charging a number of other duties pertaining to the standardization and pro-
curement of splints, manufacture of nitrous oxide, and instruction of newly
arrived medical officers in surgical technique.
On April 9, two additional medical officers ^^-^^ were granted leave for service
in the hospital at Ris Orangis." On May 7, they were definitely assigned
thereto," but on July 6, one was made one of the assistants to the chief surgeon,
A. E. F.," and on August 15, the other was detailed as commanding officer of
United States Army Hospital No. 2.^^
BASE HOSPITAL PERSONNEL AND CASUAL MEDICAL OFFICERS, UNITED
STATES ARMY, WHO SERVED WITH THE BRITISH EXPEDITIONARY
FORCE BEFORE THE ARRIVAL OF HEADQUARTERS, A. E. F.
Prior to the entrance of the United States into the war a number of Amer-
ican citizens served individually in various capacities in the allied armies. A
number of others were members of organizations, composed largely, if not
entirely, of Americans, which were under the military control of some European
government.^' Several of these formations were later absorbed or taken over
by the American Expeditionary Forces (e. g., the Ambulance Americaine, later
American Red Cross Hospital No. 1, the ambulance field service, and American
Red Cross Ambulance, later incorporated in the United States Army Ambulance
Service), but until that time were not a part of our forces.^°
The elements of the American Army, other than the military attaches,
military observers, and the military mission to France (discussed above),
which first served in Europe after the declaration of war, were six base hospitals
which had been organized by the American Red Cross, and inducted into
service soon after the United States entered the war,''' and were now assigned
to duty with the British Expeditionary Force in France.^^ Also certain casual
medical officers were assigned to duty with the British or French armies.®^
The circumstances which led up to the rendition of such prompt service
and the composition and equipment of these units are discussed in Volume I,
Chapter II, of this history.
When the British and French missions arrived in Washington in April,
1917, Col. Thomas H. Goodwin, of the Royal Army Medical Corps, requested
20
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCEJ?
that six base hospitals and 116 casual medical officers be assigned to the British
Expeditionary Forces.''* The War Department called on the American Red
Cross to furnish the hospital units for immediate transportation to France.''^ On
May 1, 1917, the Surgeon General wrote The Adjutant General that it was the
former's expectation that in the next three or four months, his department
would send about 1,000 medical officers to Europe for service with the British
Army and that they would begin to go over as rapidly as the Quartermaster
Department could furnish transportation.'*'' The hospitals selected sailed in the
following order, between the 8th and 25th of May:
Base Hospital No. 4, organized at the Lakeside Hospital, Cleveland, Ohio.
Base Hospital No. 5, organized at Harvard University, Boston, Mass.
Base Hospital No. 2, organized at the Presbyterian Hospital, New
York City.
Base Hospital No. 10, organized at the Pennsylvania Hospital, Phila-
delphia.
Base Hospital No. 21, organized at the Washington University, St.
Louis, Mo.
Base Hospital No. 12, organized at the Northwestern University, Chicago.
To some of these units additional personnel was attached; e. g., a group
of orthopedic surgeons was attached to Base Hospital No. 21.^^
After arrival in France the hospitals operated until after the signing of
the armistice as general hospitals, British Expeditionary Force in France.
They were located as follows:"^
No. 4, Rouen — operating British General Hospital No. 9.
No. 21, Rouen — operating British General Hospital No. 12 .
No. 2, Etretat — operating British General Hospital No. 1.
No. 10, Treport — operating British General Hospital No. 16.
No. 12, Dannes Camiers — operating British General Hospital No. 18.
No. 5, Dannes Camiers — operating British General Hospital No. 11.
On November 1, 1917, Base Hospital No. 5 was transferred to Boulogne
where it operated as British General Hospital No. LS."^
On May 21, 1917, the American attache at London recommended that our
senior medico-military observer there be designated as chief surgeon for all
American medical units and personnel serving with British medical service,
such assignment being urgently indicated in order to coordinate and systematize
the relations which must exist between the two services."**
Some weeks prior to the arrival of General Pershing, the medical officer
referred to in the preceding paragraph reported to the Surgeon General that he
had assumed an unauthorized supervisory control over the American Medical
Department personnel which had arrived in England before the commander
in chief, for service with the British forces."^ He stated that his position under
these circumstances was such that he could neither act nor advise in any
authoritative manner, and that his relation with British authorities had been
purely advisory."^ No instructions of any kind concerning this personnel had
been received from Washington, though by June 11, 1917, 6 base hospitals
and 52 casual medical officers had reported.^^
INTEODUCTIOX
21
On May 26, 1917, by General Orders No. 1, headquarters, A. E. F.,
Washington, D. C, he was designated as chief surgeon of the United States
forces in Europe,^" to exercise over the forces under his control the same author-
ity as the Suregon General holds over the entire Medical Department.'''
Control of the Medical Department personnel serving with the British
was taken up by the chief surgeon, A. E. F., with General Pershing after the
latter's arrival, and this responsibility, on June 25, was vested in the liaison
officer for the Medical Department with the British.
GENERAL ORGANIZATION AND DEVELOPMENT OF THE AMERICAN
EXPEDITIONARY FORCES
The provision of a suitable organization for the American Expeditionary
Forces by the creation of a staff which could give it intelligent direction was
one of the first subjects that, from the outset, had engaged the attention of
the commander in chief."' He had formulated a tentative plan for this essen-
tial even before he embarked, and his headquarters had continued to study
this subject while on shipboard and after arrival in Paris.'- Our Field Service
Regulations provided certain guiding principles, but the experience and theory
upon which they were based antedated the beginning of the war in Europe,
and it was necessary that they be revised in the light of its developments."
It was essential not only that the necessary staff services, as determined by
developments of the war, be created, but also that the general scope of their
individual and collective activities be defined, that the responsibilities of each
staff service be fixed specifically, that overlapping or conflict of jurisdiction be
eliminated, and that work be decentralized and individualized in designated
offices.
In several important respects our position was different from that of any
of the allied nations, and this fact had its influence in the application of the
results of the comprehensive study, begun on the S. S. Baltic and now inten-
sively continued, of British and French staff" organizations.^' The French
Army was fighting on its own soil, had immediate access to its War Depart-
ment and to its civil government, and was close to the territory from which it
procured most of its supplies."' The British Army, though organized on an
overseas basis, was also in close contact with its home Government and base."'
But the American Army was based on a continent 3,000 miles distant, with
which communication was much more difficult; its organization, administra-
tion, and supply, therefore, offered peculiar problems.
It was foreseen that the uncertainties incident to ocean transport in the
face of the growing submarine menace, the limited, though yet unknown,
quantity of ship tonnage that would be available, and a line of land commu-
nications some 400 miles in length through a foreign country already strained
by protracted war, would give rise to problems of organization, administration,
and supply that would be almost insuperably difficult." At the outset the
commander in chief had made the announcement that the expedition was to
be under control of its general staff, which was charged with its orderly, sym-
metrical, and balanced development.^^ No one arm, bureau, or department
was to be developed in advance of its needs or at the expense of others, but, as
shown below, this ideal had to be modified because of military necessities."^
22
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Study of present and prospective problems in their intrinsic and extrinsic
aspects led to the promulgation, on July 5, 1917, of General Orders, No. 8,
G. H. Q., A. E. F., which provided for the creation of a general staff and technical
administrative bureaus of the American Expeditionary Forces. This order,
which was to form the basis of coordinated activities, directed that the general
staff be divided into three major sections, intelligence, operations, and admin-
istration, each under an assistant chief of staff; apportioned various duties
among them ; provided for an administrative and technical staff, consisting of
the chiefs of nine staff departments — adjutant general, inspector general, chief
surgeon, and others — created the line of communications, and specified the
duties of the American Red Cross. The organization of the American Expe-
ditionary Forces was yet in a formative state, however, and a corrected copy
of General Orders, No. 8, G. H. Q., A. E. F., published August 14, 1917 (but
as of July 5), provided for a chief of staff, a secretary to the general staff, a
general staff divided into 5 sections, an administrative and technical staff
consisting of 15 departments, and a headquarter's command.
Both editions of this order provided that the distribution of staff duties at
the headquarters of subordinate commands should conform in principle to the
distribution of duties prescribed for headquarters. It is sufficient here to
state that duties assigned to the several sections of the general staff at this time
were as follows: First section, administration; second, intelligence; third, opera-
tions; fourth, training; fifth, coordination. The duties of the several sections,
as they applied especially to the Medical Department are discussed more fully
below.
The administrative and technical staff designated by this order consisted
of the following: Adjutant general, inspector general, judge advocate, chief
quartermaster, chief surgeon, chief engineer officer, chief ordnance officer, chief
signal officer, chief of Air Service, general purchasing agent, chief of Gas Serv-
ice, director general of transportation, commanding general line of communi-
cations, chief of Red Cross, provost marshal general.
The chiefs of the administrative and technical staffs were the local repre-
sentatives of those bureaus of the War Department who were entitled to mem-
bership in the headquarters of our forces in the field or the chiefs of several
newly created staff organizations, viz, the general purchasing board, the
department of transportation, the line of communications, the American Red
Cross." These services were given staff representation in order that new situa-
tions might be met. Like the heads of other bureaus composing the technical
staff, their chiefs were equivalent in rank, and were coordinated with one
another, and with the chiefs of previously existing staff departments whom
they divested of some of their duties." Activities of ah these administrative
staff b ureaus were directed and coordinated by the general staff, whose mem-
bers as representatives of the commander in chief, communicated his plans
with a view to their execution to the chiefs of the bureau concerned." By
analogy to bureau chiefs in the War Department, their similars in the American
Expeditionary Forces were charged with duties incident to administration
statistics, records, inspection, construction and operation in their respective
jurisdictions, including the procurement of the necessary supplies and material
INTRODUCTION
23
and forwarding these as required to the forces in the field/^ They were the
advisers and executives of the commander in chief and his general staff in all
matters, including those of a technical character incident to the operation of
their respective departments.^^
In the early period of the American Expeditionary Forces the Medical
Department was concerned chiefly with the first and fifth sections of the general
staff/* The first, among its other duties pertaining to general matters of
administration, was then charged with replacements, evacuation of sick and
wounded, the ratio of combat troops to those serving on the line of com-
munications, the respective ratios of staff and combat troops, supplies and
transportation.^* The fifth was charged at this time with coordination and
application of administrative staff policies.^* The importance to the Medical
Department of the first section was incident especially to its control of allow-
ances of ocean transport for personnel and supplies, and that of the fifth to its
control of all hospitalization and depot projects — determining their need, size,
location, installation, and other attributes.^* Not infrequently several staff
departments sought the same facilities and the fifth section coordinated these
conflicting demands.^*
The duties of the several sections of the general staff and of the technical
staff departments varied somewhat in accordance with successive reorganiza-
tions, especially those prescribed by Memorandum 129, published November
19, 1917; General Orders, No. 31, published February 16, 1918; General Orders,
No. 114, published July 11, 1918; and General Orders, No. 130, published
August 6, 1918.
Coincident with the organization of the general staff of the American
Expeditionary Forces reorganization of the Army units was effected. As
such units provided by our Tables of Organization when we entered the war
were so small that they were quite inadequate for the service now required,
an entirely new organization was prescribed. This provided that an Infantry
combat division should consist of 28,172 officers and men, and should be com-
posed of 2 infantry brigades, 1 field artillery brigade, 1 machine-gun battalion,
1 regiment of engineers, 1 field signal battalion, military police, train
headquarters, and ammunition, supply, and sanitary trains." The sanitary
train originally consisted of train headquarters, 4 field hospitals, 4 ambulance
companies, and 8 infirmaries,^^ but from time to time other organizations and
equipment were added, e. g., a medical supply depot, a mobile laboratory,
and as occasion required and resources permitted a mobile surgical unit and
professional teams were attached to it." Similarly there later developed great
expansion in corps and armies and in organizations which served in the line of
communications."" For example, the depot division at Aignan (the 41st Divi-
sion) attained a strength of over 50,000 officers and men,^^ and the capacity
of base hospitals was increased from 500 to 1,000 beds, or to 2,000 beds in
emergencies — the so-called ''crisis" expansion. In point of fact many of
these hospitals exceeded 3,000 beds during the Meuse-Argonne operation.
New agencies in practically all services were developed and some reached a
degree of importance which caused them to be made autonomous staff depart-
ments, their chiefs becoming members of the administrative staff of the Ameri-
24
ADMINISTRATION, AMERICAN KXPEDITIONAHV FORCES
can Expeditionary Forces, e. g., the Motor Transport Corps. Throughout
its history there was a progressive development of the administrative services
of the American Expeditionary Forces, the direction of this evohition being,
with but one exception and that transient, toward decentraUzation.**"
The prospective disembarkation of several million men, their movement
to training areas, provision for their shelter and the handling, storage, and
distribution of the supplies and equipment required, called for an extraordinary
and immediate effort in construction.*'
To provide the organization for this purpose, a project for engineer services
of the rear, including railw^ays, docks, depots, hospitals, etc., was cabled to
Washington, August 5, 1917, followed on September 18, 1917, by a complete
project for the rear, which listed by item the troops considered necessary for
the Services of Supply.*' Under this project the strength of the rearward
services, from the firing line to base ports, w^ould constitute about 35.5 per
cent of the entire expeditionary force, for it included divisional, corps, and
army trains and similar noncombatant organizations at the front, as well as
the personnel operating ports, depots, transportation, and other facilities.**^
Despite our longer line of communications this percentage was less than that
of the British whose rearward services absorbed 37.5 per cent of their total
expeditionary strength, while steps were being taken to increase this to 40 per
cent.^^ To the strength called for by the organization project (1,000,000 men),
this project added 329,653 men, bringing the total for a balanced force, con-
forming to the organization project, to 1,328,448 men.*- The line of com-
munications projects called for approximately 25 per cent of this total, but
because of military exigencies that command never received the full quota of
troops required for its installations and activities. *-
Beginning on July 6, 1917, a series of cables was sent to the War Depart-
ment fixing the order in which troops should arrive, but it was evidenct that these
cables were of but transient value and that the W^ar Department should be
furnished a comprehensive statement of the personnel and supplies needed, in
order that there might be built up a balanced and symmetrical force, appro-
priately supplied and equipped.*' Therefore, a schedule of priority shipment of
personnel was prepared covering the order in which the troops should be sent
to Europe.*' This schedule, approved by General Pershing and forw^arded to
the War Department on October 7, divided the initial force called for into six
phases, corresponding m general to combatant corps of six divisions each.*^
The French minister of war assigned to duty with headquarters of the
American Expeditionary Forces, than at Chaumont, a special liaison officer
who w^as the channel of communication between his office and the commander
in chief, A. E. F.*^ The French high command also estabhshed at Chaumont
a French mihtary mission which was organized with the same divisions or
bureaus as the French General Staff.** One of its sections was charged with
Medical Department matters. This mission had full authority to act for the
French Ministry of War and the French commander in chief in all matters
concerning the relations of the various American services and those of the
French armies, both in the French zone of the armies and the zone of the in-
terior.»* The chiefs of the administrative and technical services of the Ameri-
INTRODUCTION
25
can Expeditionary Forces were authorized to communicate directly with this
French mission in all matters that concerned the operation of their particular
services, except such as involved questions of policy. Communications on
subjects in that category were prepared for the signature of the chief of staff
and submitted to him.^^ All questions of whatever nature affecting the medical
services in the zone of the army were handled through the office of the medical
member of this mission.^'
The commanding general, Services of Supply, A. E. F., the general pur-
chasing agent and the director general of transportation were authorized to
communicate directly with the various services in the French zone of the in-
terior in all matters coming under their own particular control providing such
correspondence did not involve questions of policy.^^ If it did, they prepared,
initialed, and submitted letters for the signature of the chief of staff, A. E. F.,
but when the question at issue required the action of any French service in
the French zone of the armies, the letter was prepared for the signature of the
commander in chief.
Both before and after the provision of our liaison service, conferences con-
cerning problems of importance, were held from time to time between high
officers of our service and those of our allies. Among these were the confer-
ences held by General Pershing with the commander in chief of other forces
and those conducted by members of the general staff or the chiefs of admin-
istrative staff departments.^"
The American forces were also represented on a number of interallied
councils which were chiefly concerned with procurement. The Allied Mari-
time Transport Council was engaged primarily in provision of tonnage in relation
to the four main requirements, viz, food, munitions, raw materials, and fuel
supply of the American Expeditionary Forces during 1918-19.*^
The resources of our allies in men and material had been taxed to very
grave limits, but they always stood ready to furnish us with needed supplies,
equipment, and transportation when these were at all available. The develop-
ment of our program for construction, transportation, hospitalization, and other
essential activities predicated the highest degree of cooperation between the
American and allied services.**
With the growth of the American Expeditionary Forces the activities of
the several sections of the general staff not only became greatly intensified but
also widely extended in scope. The first section engaged in development of
policies, and the fifth (which, as is explained below, later became the fourth
charged with supply and coordination) continued to be of special interest to the
Medical Department.*' The fifth section necessarily supervised more and more
closely the activities of the various supply bureaus with a view of balancing
effort and keeping all establishments on a corresponding footing.*' As problems
increased in number and complexity it developed that the division of duties
• and responsibilities between the coordination and administration sections were
not fully understood outside of the sections themselves.*^ These were redis-
tributed to a degree, by Memorandum No. 129, H. A. E. F., November 19,
1917, in which the duties of each of these sections were carefully defined.*^
The same order which decentralized and simplified staff methods of adminis-
26
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tration, also indicated the direction in which the fifth, or coordination section,
was developing by specifying its duties as follows: ^°
All questions concerning supply and transportation in France. Operations of the
technical services except the Red Cross, Y. M. C. A., and other similar agencies, the General
Pershing Board, War Risk Bureau, auditors, and Field Ambulance Service. Operations of
the line of communications and the transportation department. Statistics concerning
supply, construction, and transportation. Supply and transportation arrangement for com-
bat. Assignments of labor and labor troops. Location of railway and supply establish-
ments. Hospitalization and evacuation of sick and wounded. Orders for assignment of
new units.
In the meantime, studies of the British and French systems of staff organiza-
tion as well as our own were continued with the result that a system giving
more thorough staff coordination and control of the important services of con-
struction, transportation, and supply was evolved.^*' Among other changes,
the evolved system restricted the jurisdiction of the coordination section in
the supply of the American Expeditionary Forces to matters intrinsic to that
command and delegated to the first (administrative) section the supervision
of procurement from the United States, the allotment of tonnage, and the
arrangements for transportation to France, while the coordination section con-
tinued to deal with questions of supply and transportation in France.^" Matters
arising under these two latter subjects included operations of the technical and
supply services, operations on the line of communications, and activities of the
transportation department. Studies and recommendations for the location
and character of railway and other establishments required for the transporta-
tion and service of our troops continued to come to this section for appro val.^^
The same was true with regard to all depot and hospitalization projects, includ-
ing not only the location of these installations, but also the storage capacity
of depots and the bed capacity of hospitals. Arrangements for the evacua-
tion of sick and wounded and orders for the original assignment of troops
arriving in France were also made in this section. In the course of time, how-
ever, as the armies began to take shape, the procedure involved in such assign-
ment became practically automatic.
By the middle of January, 1918, it became evident that some important,
if not radical, reorganization of general headquarters was necessary.^^ Accord-
ingly, on January 22, 1918, the following letter was sent by direction of the
commander in chief to the heads of all staff departments
1. General Orders No. 8, G. H. Q., A. E. F., 1917 (corrected), prescribing the distri-
bution of staff duties at these headquarters has been in operation long enough to give the
system a fair trial. While it is believed that the fundamental principles of the order are
generally sound, cases have arisen where there is an overlapping of functions. In some cases
experience may have shown that certain subjects have been incorrectly assigned or not
distinctly defined.
2. The principles of the order seem to be well understood by those primarily concerned
with its operation, but, on the other hand, it does not seem to be so drafted as to give a clear
presentation of the system to the outsider.
3. With a view of taking advantage of the experience thus far gained in the operation of
this order, it is desired that you submit, not later than February 5, a report with vour recom-
mendations embodjdng the following:
(a) What changes, if any, do you recommend for your own section or department?
INTRODUCTION
27
(6) What changes, if any, do you recommend in any section or department, other than
your own, which would facilitate the work of your section or department?
(c) Any suggestions which would make the order more clear to an outsider who has to
deal with the system.
(d) Any other suggestions or recommendations on the subject of organization of these
headquarters and the line of communications.
To the questions raised in the foregoing, the chief surgeon, A. E. F., under
date of February 4, 1918, replied as follows:
1. It is believed that the assignment of duties in tWs order so far as it concerns the Medi-
cal Department are substantially correct, and so far as can be ascertained there is no over-
lapping of functions. Some of the duties which were not exactly clear when the orders
were issued have been settled completely, and it is believed that the assignments are satis-
factory to the Medical Department at present. Since the order was issued much of the
technical work of the Medical Department has been assigned to the coordinating section of
the general staff instead of the administrative section. This is perfectly satisfactory to the
Medical Department. Frankly, it is believed to be a step in advance.
2. The chief surgeon is pleased to present certain recommendations in regard to the work
of his office:
(A) 1. Since headquarters have come to Chaumont, we have been handicapped in the
hospitalization section of this office by reason of the fact that our hospital construction is
done by the chief engineer, line of communications, and the running repairs and certain
materials for these hospitals are furnished by the chief quartermaster, line of communications,
and by further fact that we must correspond with those officers through their chiefs at these
headquarters. There has also been a delay in the transaction of business by reason of the
fact that investigation from this office of contemplated hospital sites and of construction, the
making of leases, etc., is diflRcult by reason of the great distance to many of our hospital-
ization sites. For this reason it is believed to be good administration to remove a part
of the hospitalization section from this office to the line of communications, and to request
authority to transact business with the chief engineer, line of communications, and the chief
quartermaster, line of communications, through this branch of the hospitalization service.
This, it is believed, will facilitate business and lessen to a great extent the necessary official
correspondence. This part of the hospitalization section can make a great many of the
inspections of contemplated hospital sites, inspections of construction, leases, etc., without
taking an officer from this office — a saving of time and mileage.
2. It is believed that the statistical section of the sanitary and statistical division (the
sick and wounded) of this office can be detached from this office without loss of efficiency.
In my opinion this section should be in Paris where it will be in close touch with the French
bureau of statistics where necessary data for American patients in French hospitals must
be obtained. If for any good and sufficient reason this location can not be approved it should
be separated from general headquarters and attached to chief surgeon's office, headquarters,
line of communications.
3. The time has come when the question of general sanitary inspectors for the American
Expeditionary Forces must l)e taken up. This subject has not been presented before,
because suitable officers were not available for this very important work. As officers with
the required cjualifications will soon arrive in France this question will be presented in a very
short time.
(B) 1. The coordinating section of the general staff is modeled after the fourth bureau
of the French War Department, but in accepting this organization, a very important part
of the fourth bureau, as far as the Medical Department is concerned, was omitted, namely.
Medical Department representation. The fourth bureau of the French War Department
works in a most satisfactory manner to its medical department for several medical officers
are constantly on duty at general headquarters with that bureau. I strongly urge that the
Medical Department be given representation on the general staff. It seems so clear that
this should be done that it is believed specific failures of coordination under the present
organization need not be presented. Moreover the time is rapidly approaching when the
demand for this representation will become more urgent.
28
ADMINISTRATION, AMERICAN EXPEDITIONARY ?T)R('ES
2. It is believed a part of the hospitalization section should be sent to the line of commu-
nication and that this office should be authorized to transact business direct through this
section with the chief engineer, line of communications, and chief ciuartermastcr, line of
communications, in regard to all cjuestions of approved hospitalization.
3. It is believed that the activities of the American Red Cross so far as they relate to
the Medical Department should be transacted through the coordinating section instead of
the administrative section of the general staff.
(C) 1. No suggestions to make under this heading.
(D) The following recommendations are made:
1. It is strongh^ urged that the Medical Department be given representation on the
general staff.
2. That an officer of the Medical Department be appointed liaison officer with the
French service de sante. Practically all the hospitals that we possess to-day in France
have been transferred to us by this service and ^ve have been greatly handicapped by not
having a liaison officer in the office of the sous-secretaire du service de sante. They consider
this of such great importance that they have repeatedly asked for this representation from
the Medical Department.
3. That the supervision of the activities of the American Red Cross so far as they relate
to the Medical Department be transferred from the administrative section to the coordinating
section, general staff.
4. That authority be given for the transfer of a unit of the hospitalization office to the
line of communications and that this office be authorized to conduct its correspondence
with the chief engineer, line of communications, and chief quartermaster, line of communi-
cations, on all approved projects through this unit.
5. That the statistical section of the sanitary and statistical division of this office be
transferred elsewhere.
6. That a statistical unit be stationed in Paris in close liaison with the statistical division
of the French War Department for the collection and transmission to Washington of the
sick and wounded data required by the Pension Bureau. This is believed to be necessary
by reason of the great number of sick we will have in French hospitals for many months
to come and by the further fact that we will also have in our hospitals many French patients.
A board appointed to meet and consider the replies of the various staff
chiefs met on February 8 and heard the chiefs of staff departments and other
interested officers. It reduced all views and suggestions to the following
questions :
(1) What changes, if any, should be made in the administration of supply in order to
reheve the commander in chief from the immediate direction thereof, and place direct and
complete responsibility therefor upon some competent authority?
(2) What changes, if any, should be made in the organization of the General Staff, in
order to insure greater efficiency and more harmonious relations?
(3) What further changes, if any, should be made as a result of the disposition of the
foregoing questions?
An analysis of the situation as developed by these inquiries was made with
a view of effecting necessary improvements. It was found that diversity of
opinion and practice existed among the different chiefs of the administrative
services with respect to the degree of personal responsibility assumed and
methods employed in details of supply; also, in decentralizing to secure a dis-
tribution of the heavy burdens of administration and the execution of the
tasks incident thereto, there had been an undesirable division of responsibility
and authority which at times led to uncertainty and hesitancy which might
prove disastrous in an emergency The analysis also indicated the immediate
necessity for providing a single and direct line of responsibility for all matters
INTRODUCTION
29
of supply with coincident full utilization of the services of the experienced chiefs
of the various administrative and supply departments. The board made a
number of important findings and recommendations, which were approved by
the commander in chief and given practical application by the publication of
General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918.'^ Other impor-
tant recommendations having been submitted later, a corrected copy of this
order was published March 13, 1918, but as of the date of the original.^^ Some
of its most important provisions may be mentioned here; e. g., control of com-
batant troops was separated from that of all supply departments and of miscel-
laneous organizations in rear of them, the whole American Expeditionary Forces
being divided into the zone of the armies and the Services of Supply (designated
in the first copy of this order as the Service of the Rear). Over the former,
comprising the organizations at the front (armies, corps, divisions, etc.) the
general staff exercised direct control while over the latter its control was indirect,
through the commanding general, Services of Supply. The general staff
remained at headquarters, A. E. F., at Chaumont, but headquarters of the
Services of Supply was located at Tours where it absorbed headquarters of the
preexisting line of communications.
The general staff was reconstructed as follows: A chief of staff, secretary
of the general staff, and five sections of the general staff, each under an assistant
chief of staff, were provided for, and among these specific duties were allocated.
The numerical designation of each section now corresponded closely to that of
the section of the French General Staff which was charged with similar duties.
Though this correspondence was incidental to the reorganization, it facilitated
the transaction of business between the two armies.
The administration section became the first section, the intelligence section
became the second, and the operations, coordination, and training sections
became, respectively, the third, fourth, and fifth sections of the general staff.
For convenience the names of the sections were abbreviated to G-1, G-2, and
so forth.
As to the duties assigned to these several sections it is sufficient here to
state that G-1 was charged, among other duties, with ocean tonnage, priority
of overseas shipments, replacements, organization, and equipment (in consulta-
tion with G-3) and with control of the American Red Cross, Young Men's
Christian Association, and similar agencies; G-2 was charged with procurement
of information, secret service, topography, and censorship; G-3 with operations,
liaison, general organization, and equipment; G-4 with supply, construction,
and transportation in France, statistics concerning the above, supply and
transportation for combat, hospitalization, and evacuation of the sick and
wounded, all operations of the Services of Supply not assigned to other sections
of the general staff and assignment of all new units arriving in France; G-5 was
charged with all activities pertaining to training, and it cooperated with the
third section in matters affecting organization and equipment.
As the first, fourth, and fifth sections of the general staff were now of
especial interest to the Medical Department, some further discussion concerning
them is deemed necessary.
It was not intended that the administrative section of the general staff
should directly control an}' of the supply bureaus, nor supplant the executive
30
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
heads of these important services, nor Hniit them in the exercise of their authority
in the internal administration of their own departments."^ The sole function
of this section of the general staff was to supervise the general policies of the
American Expeditionary Forces, in so far as this section was concerned, to
coordinate the activities of those departments and troops wliich were engaged
in the services of administration, supply, and evacuation, to preserve a just
balance between them, and to insure that their operations as a whole har-
monized with one another and w^ith the plans of campaign.
The fourth section of the general staff was the connecting link betw een the
general staff on the one hand and the Services of Supply on the other in all
matters affecting the Services of Supply w^hich were not assigned to other sec-
tions of the general staff. Its functions in maintaining intimate relations
between the office of the chief of staff, G. H. Q., and these various agencies in
the Services of Supply were both executive and advisory. It kept available
the latest information regarding supplies, state of construction, and efficiency
of rail transportation, studying and frequently reporting upon the practical
working of all technical staff and supply departments. Projects of any impor-
tance, especially those involving location of facilities, were examined by this
section to assure their harmony with the general scheme.^^ This section, which
had become of especial interest to the Medical Department after the publication
of Memorandum No. 129, H. A. E. F., 1917, which charged it, among other
duties, with, the provision of hospital facilities and the evacuation of sick and
wounded, continued to exercise jurisdiction over a larger number of the interests
of the Medical Department than did any other section of the general staff.^^
Its greatest importance to the Medical Department arose from its control of
policies and programs for hospitalization, storage, transportation and supply,
evacuation of wounded, assignment of units newly arriving in France, and staff
control of labor.^*'
Also, the fact that it was charged with supervision of all operations of the
Services of Supply, not assigned to other sections of the general staff, brought
under its control a number of other matters, in which the Medical Department
was interested.®^ Because of the importance to the Medical Department of the
American National Red Cross, particularly in matters pertaining to hospitaliza-
tion and supply, an effort was made to have control of this society transferred
to this section, but this was unsuccessful.®"
The fifth section, general staff, was charged with instruction and training
throughout the American Expeditionary Forces.®^ These included technical
training, preparation of manuals on that subject, promulgation of training
bulletins and courses of instruction, supervision of centers of instruction, and
staff schools. After the armistice was signed it was vested with control of edu-
cation, athletics, and entertainment.®^ This section w^as of especial interest to
the Medical Department through the supervision it exercised over the Army
sanitary school at Langres, the Joinville training area, where medical units
awaiting assignment were concentrated, and over the training of medical units
and detachments in divisional training areas.®^
After the reorganization prescribed by General Orders, No. 31, the general
staff continued to concern itself with the broader phases of control. Under the
13901—27. (Face p. 31.)
Fig. 1.— LilH■^^ of comnviinicfition, A. E. F., showing also the sections comprisinR the Sei vices of Supply
INTRODUCTION
31
supervision of the commander in chief and pursuant to clearly determined
policies, the assistant chiefs of staff at the head of their respective sections, sever-
ally coordinated by the chief of staff, issued instructions and gave general
direction to the great combat units and to the Services of Supply, keeping always
in close touch with the manner and promptness of compliance.^^ Thus a
system of direct responsibihty was put into operation which contemplated
secrecy in preparation, prompt decision in emergency, and coordinate action in
execution.^^ This supervision by the general staff included matters relating to
new troops and new equipment, excepting only such details as pertained to the
troops in the Services of Supply.''^ General headquarters, A. E. F., also retained
immediate control of military transportation and supply in the zone of the
armies and control of war material required in the conduct of military
operations.
The plans for operations of the Allies were communicated only to the com-
mander in chief and by him to a small number of higher staff officers under his
immediate command.^^ Arrangements for the employment of American troops
in conformity therewith were necessarily made at general headquarters, and
G-4 being responsible for supply and transportation arrangements for combat,
was obliged to keep in close touch with the Services of Supply in order that the
activities of that command might be fully coordinated with the prosecution of
the plans of the commander in chief.^'
The chiefs of the three purely administrative staff services were retained
with the general staff at general headquarters, which remained at Chaumont,
but the chiefs of the other staff departments were transferred to headquarters
of the Services of Supply at Tours.^^ The departments whose chiefs were re-
tained at general headquarters were those of the adjutant general, the inspector
general, and the judge advocate.
As previously stated, the jurisdiction known as the line of communications
was replaced by the Services of Supply.®^ The commanding officer of this
jurisdiction, whose headquarters remained at Tours and whose official status
remained unchanged, was charged with transportation, construction, territorial
command, and control of supply, sanitary, and telegraph service throughout the
territorial area of the Services of Supply. The Services of Supply was divided
for administrative purposes into an advance section, an intermediate section,
eight base sections in France, England, and Italy, the district of Paris, and the
Arrondissement of Tours. After the armistice was signed a ninth base
section was established with headquarters at Antwerp for the service of the
Third Army."^
While the chiefs of the purely administrative services (the adjutant general,
the inspector general and the judge advocate general) were retained with the
general staff at headquarters, A. E. F., at Chaumont, the chiefs of what were
now designated the "technical and administrative" staff departments, were
transferred to the headquarters of the Services of Supply at Tours.^^ The de-
partment whose chiefs were thus transferred were the following: The Quarter-
master Corps, Medical Corps, Corps of Engineers, Ordnance Department,
Signal Corps, Air Service, general purchasing board, Gas Service, service of
utilities (newly created by this order) and the provost marshal service. The
13901—27 3
32
ADMINISTRATION, ArVFEHICAN EXPEDITIONARY FORCES
chiefs of these staff departments retained their former duties and authority as
members of the staff of the commander in chief but exercised their duties in
matters of procurement, transportation, and construction and supply under the
direction of the commanding officer, Services of Supply, who coordinated their
activities in these matters. They were directed so to organize their offices that
the efficiency of their service would not be impaired by necessary absences for
conferences with the commander in chief or for other duty assigned them by
him.
Each was authorized and expected to travel throughout the American
Expeditionary Forces to supervise and direct the activities of his department in
all its elements, including combat units. The duties of these chiefs of staff
departments were therefore of a dual character. Thus the chief surgeon,
A. E. F., was, on the one hand, the chief surgeon of the Services of Supply,
supervising Medical Department activities throughout its area, and, on the
other, w^as the chief surgeon of all the American troops in Europe from the
Murman coast to Italy.
In so far as the Services of Supply is concerned, it is sufficient to state here
that the staff organization of that jurisdiction consisted of a general staff,
divided into four sections (later reduced to three), and of an administrative
staff whose departments rapidly increased in number.^^
Besides effecting the changes already mentioned, General Orders, No. 31,
G. H. Q., A. E. F., February 16, 1918, further directed that the distribution of
staff duties in army, corps, divisions, and other commands subordinate to
general headquarters, correspond in principle to that prescribed for general
headquarters. General Orders, No. 9, G. H. Q., A. E. F., January 15, 1918,
which had created the First Army had provided for that organization a chief
of staff, a general staff of 4 sections and 12 administrative and technical serv-
ices, but by General Orders, No. 120, G. H. Q., A. E. F., July 24, 1918, its
staff was made to consist of a chief of staff, 5 general staff sections, a chief of
artillery, and 13 administrative and technical services. The same organization
was prescribed for the Second Army, created by General Orders, No. 175,
G. H. Q., A. E. F., October 10, 1918, and for the Third Army, created by
General Orders, No. 198, G. H. Q., A. E. F., November 7, 1918, except that for
the last mentioned no tank service was provided.
The headquarters staff of the First Corps as organized by General Orders,
No. 9, G. FT. Q., A. E. F., January 15, 1918, consisted of a chief of staff, a
general staff of 4 sections (administrative, intelligence, operations, and training,
and coordination), and 12 administrative and technical services. The same
organization was prescribed for the Second, Third, and Fourth Corps by Gen-
eral Orders, No. 102, G. H. Q., A. E. F., June 25, 1918, but by General Orders,
No. 136, August 19, 1918, the organization of a corps was made to conform to
Tables of Organization 102, series B, War Department, corrected to April 20,
1918. Thereafter the headquarters staff of each corps consisted of a chief of
staff, 3 general staff sections (1, operations; 2, administration and coordination;
and 3, intelligence), and 12 administrative and technical services until a
thirteenth staff service (the motor transport) was added, by General Orders,
No. 219, G. H. Q., A. E. F., November 29, 1918. Similarly, the headquarters
INTRODUCTION
33
of an Infantry division as prescribed by Table 2, series A, Tables of Organiza-
tion, dated October 1, 1918, provided for a general staff with the same sections
as those authorized for the corps and for nine administrative and technical
staff departments.
The system of general staff control and subdivision prescribed for head-
quarters of the American Expeditionary Forces thus was applied to lower
echelons of the field forces, except that in corps and divisions, the fourth section
was merged with the first and the fifth section with the third. Control of
the field activities of the Medical Department which were vested in the fourth
section of the general staff at headquarters, A. E. F., was thus assigned to the
control of G-1 in corps and divisions — a circumstance which proved to be
undesirable and confusing.®*
REFERENCES
(1) List of militarj^ attaches. On file, Army War College (2279).
(2) Personnel cards of officers assigned as military observers, filed under the individual's
name. Card index. Army War College.
(3) Wadhams, Sanford H., Col., M. C, and Tuttle, Arnold D., Col., M. C: Some of the
Early Problems - of the Medical Department, American Expeditionary Forces.
The Military Surgeon, Washington, D. C, December, 1919, xlv, No. 6, 636.
(4) Instructions to military attaches, as of various dates. On file, Armv War College
(2279 and 8679).
(5) Memorandum from the Secretary of War, to the Secretary of State, August 12, 1914.
Subject: Military Observers. On file. Army War College (8679).
(6) Cablegram from the Military Attache, London, to the Secretary of War, August 17,
1914. On file. Army War College (8679).
(7) Based on card index, showing details to the Austrian Army. On file, Army War College.
(8) Cablegram from the Military Attach^, London, to Chief of the War College Division,
General Staff, August 19, 1914. On file. Army War College (8679).
(9) Memorandum from the Chief of Staff, to the Surgeon General, August 12, 1914, Subject
Medical Officers as Observers. On file, Record Room, S. G. O., 150021 (Old Files).
(10) Letter from The Adjutant General, to Maj. J. H. Ford, M. C, September 1, 1914.
Subject: Detail as military observer. On file, Commissioned Personnel Division,
S. G. O.
(11) Special Orders No. 250, War Department, October 27, 1915. Paragraph 15.
(12) Telegram from Assistant Secretary of War, to American Ambassador, Paris, September
9, 1914. On file, Commissioned Personnel Division, S. G. O.
(13) Letter from the chief of the War College Division, General Staff, to the Surgeon General-
January 15, 1915. Subject: Report of Maj. P. L. Boyer, M. C, from September
12, 1914, to November 23, 1914. On file. Record Room, S. G. O. 150021 (Old Files) .
(14) Letter from Sir William Osier, to the President of the United States, Woodrow Wilson,
January 30, 1916. Subject: Detail Medical Officers. On file. Army War College
(8679).
(15) Memorandum from the Surgeon General, to the Chief of Staff, March 6, 1916. Subject:
Submitting names of officers. On file. Record Room, S. G. O. (150021).
(16) Letter order from The Adjutant General, to the Surgeon General, April 10, 1916.
Subject: Assignment of Lieut. Col. A. E. Bradley, M. C, Maj. Clyde S. Ford,
M. C, and Maj. W. J. L. Lyster, M. C. On file, Commissioned Personnel Division,
S. G. O.
(17) Based on card index, showing details to the German Army. On file, Army War College.
(18) Letter from Col. A. E. Bradley, M. C, to the Surgeon General, June 11, 1917. Subject:
Medical personnel serving with British Forces. On file, Record Room, S. G. O.,
9795 (Old Files).
34 ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
(19) Letter orders from The Adjutant General, to Col. A. E. Bradley, M. C, and Maj.
Clyde S. Ford, M. C, May 29, 1917. Subject: Assignments. On file, Record
Room, S. G. O., 9795 (Old Files).
(20) Personal report of Maj. W. J. L. Lyster, M. C, to the Surgeon General, June 30, 1917.
On file, Commissioned Personnel Division, S. G. O.
(21) Telegram from chief of staff, A. E. F., to Maj. W. J. L. Lyster, M. C, Paris, June 9,
1917. On file, Record Room, S. G. O., 9795 (Old Files).
(22) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, liaison officer,
London, June 25, 1917. Subject: Instructions. The administration of American
medical personnel with the British in relation to the A. E. F. On file. Record Room,
S. G. O., 76278 (Old Files).
(23) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., June 21,
1917. Subject: Report of personnel of chief surgeon's office. On file, A. G. O.,
World War Division, chief surgeon's files, 321.6.
(24) Special Orders No. 26, Headquarters, A. E. F., July 4, 1917. Paragraph 2. On file,
A. G. O., World War Division, A. E. F. Records, Special Orders.
(25) Letter from the British War Office, to the American Ambassador, London, February 23,
1917. Subject: Veterinary observer. On file, x\rmy War College, 6467.
(26) Letter from The Adjutant General, to Veterinarian William P. Hill, 6th Field Artillery,
December 27, 1915. Subject: Detail. On file, Army War College, 9244.
(27) Letter from The Adjutant General to Veterinarian William P. Hill, March 10, 1917.
Subject: Orders. On file, A. G. O., 2547294 (Old Files).
(28) Special Orders, No. 7, Headquarters, A. E. F., Paris, June 14, 1917. Paragraph 1.
On file, A. G. O., World War Division, A. E. F. Records, Special Orders.
(29) Letter from Chief of War College Division, General Staff, to the Surgeon General,
June 5, 1915. Subject: Detail of medical observer with French armies. On file,
Record Room, S. G. O., 150021 (Old Files).
(30) Second indorsement from the Surgeon General to The Adjutant General, June 12, 1915,
on letter from Chief of War College Division, General Staff, to the Surgeon General,
June 5, 1915. Subject: Detail medical observer with French armies. On file,
Record Room, S. G. O., 150021 (Old Files).
(31) Letter Order from The Adjutant General to Maj. James R. Church, M. C, November
15, 1915. Subject: Detail. On file, Commissioned Personnel Division, S. G. O.
(32) Letter from the Secretary of State to the Secretary of War, September 1, 1916. Subject:
Request medical officer visit prisoners of war in France. On file, Record Room,
S. G. O., 150021 (Old Files).
(33) Second indorsement from the Surgeon General to The Adjutant General, September
12, 1916, on letter from the Secretary of State to Secretary of War, September 1,
1916. Subject: Request medical ofl^icer visit prisoners of war in France. On file,
Record Room, S. G. O., 150021 (Old Files).
(34) Letter from The Adjutant General to Maj. S. H. Wadhams, M. C, September 25, 1916.
Subject: Detail as military observer. On file, Record Room, S. G. O., 76283 (Old
Files).
(35) Letter from Acting Chief, War College Division, General Staff, to Maj. S. H. Wadhams,
M. C, January 10, 1917. Subject: Detail. On file, Record Room, S. G. O., 76283
(Old Files).
(36) Letter from Maj. James Robb Church, M. C, Maj. James A. Logan, jr., Q. M. C, Capt.
J. M. Barker, 3d Inf., Capt. Frank Parker, 11th Cav., Capt. M. Churchill, Field
Art., Veterinarian W^m. P. Hill, 6th Field Art., to Chief, War College Division,
General Staff, July 19, 1916. Subject: Recommendation as to organization of
militarj^ observers. On file, Army War College (8679).
(37) Letter from Acting Chief of War College Division, General Staff, to Maj. James A.
Logan, jr., Q. M. C, Paris, November 21, 1916. Subject: Organization of military
mission. On file. Army War College (8679).
• (38) Letter from the chief of the American military mission, Paris, to the Chief of the War
College, General Staff, February 14, 1917. Subject: Increased opportunities for
military observers. On file. Army War College (8719).
INTRODUCTION
35
(39) Letter from officer in charge of military intelligence to Col. A. E. Bradley, M. C,
Maj. Clyde S. Ford, M. C, Maj. W. J. L. Lyster, M. C, Maj. Sanford H. Wadhams,
M. C, and Maj. James A. Logan, jr., Q. M. C, February 10, 1917. Subject: Medico-
military information. On file. Army War College (8679).
'^10) Memorandum from Chief of the War College Division, General Staff, to the Chief of
Staff, June 9, 1917. Subject: Ports of debarkation. On file. Army War College,
10132.
(41) Report from chief of medical group to assistant chief of staff, 4th section of general
staff, December 31, 1918. Subject: Activities of medical group, 4th section, general,
staff, General Headquarters, A. E. F. Copy on file, Historical Division, S. G. O.
(42) Cablegram from the Chief of Staff to Maj. James A. Logan, jr., Q. M. C, June 5,
1917, Subject: Reporting to General Pershing. On file. Army War College (10050)
(43) Letter from the Surgeon General to The Adjutant General, October 18, 1916. Subject:
Detail. On file, Record Room, S. G. O. 104882 (Old Files).
(44) Special Orders No. 244, War Department, October 18, 1916. Paragraph 21. On file,
Commissioned Personnel Division, S. G. O.
(45) Telegram from the Surgeon General to Maj. Robert M. Culler, M. C, October 27,
1916. On file. Record Room, S. G. O., 104882 (Old Files).
(46) Special Orders No. 105, War Department, May 7, 1917. On file. Record Room,
S. G. O., 104882 (Old Files).
(47) Letter from the Surgeon General to Mr. L. Jouvard, president of French Benevolent
Society, French Hospital, New York City, May 22, 1917. Subject: Major Culler's
status. On file. Record Room, S. G. O., 104882 (Old Files).
(48) Special Orders, No. 115, Headquarters, A. E. F., October 3, 1917. Paragraph 6.
(49) Special Orders, No. 60, Headquarters, Line of Communications, A. E. F., October 7,
1917.
(50) Personal report from Maj. William L. Keller, M. C, to the Surgeon General, April 3,
1923. On file. Commissioned Personnel Division, S. G. O.
(51) Special Orders, No. 105, War Department, May 7, 1917. Paragraph 28.
(52) Special Orders, No. 66, Headquarters, A. E. F., March 7, 1918. Paragraph 48.
(53) Special Orders, No. 81, War Department, April 9, 1917. Paragraph 17.
(54) Special Orders, No. 81, War Department, April 9, 1917. Paragraph 18.
(55) Telegram from The Adjutant General, to Superintendent, U. S. Military Academy,
West Point, N. Y., April 7, 1917. Copy on file. Record Room, S. G. O., 128346
(Old Files).
(56) Special Orders, No. 105, War Department, May 7, 1917. Paragraph 28.
(57) Special Orders, No. 28, Headquarters, A. E. F., July 6, 1917. Paragraph 9.
(58) Special Orders, No. 68, Headquarters, A. E. F., August 15, 1917. Paragraph 11.
(59) Annual Report of the Surgeon General, U. S. Army, 1916, 18-19; 1917, 22.
(60) Report from Col. Percy L. Jones, M. C, Chief of the U. S. Army Ambulance Service
with the French Army, to the Surgeon General, U. S. Army, April 15, 1919. Subject:
U. S. Army Ambulance Service with the French Army. On file, Historical Division,
S. G. O.
(61) Memorandum from Col. Jefferson R. Kean, M. C, to the Surgeon General, April 4,
1917. Subject: Organization of base hospitals. On file, Record Room, S. G. O.,
15542 (Old Files).
(62) Report on origin and organization of base hospitals and other sanitary units (undated)
by Col. Jefferson R. Kean, M. C. On file. Historical Division, S. G. O.
(63) Xetter from Col. A. E. Bradley, M. C, A. E. F., to the Surgeon General, June 11, 1917.
*" Subject: Medical personnel serving with British forces. On file, Record Room,
S. G. O., 9795 (Old Files) ; also, telegram from the Surgeon General to Maj. Robert M.
Culler, M. C, October 27, 1916. On file, Record Room, S. G. O., 104882 (Old Files);
also, personal report from Maj. William L. Keller, to the Surgeon General, April 3,
1923. On file, Historical Division, S. G. O.; also. Special Orders No. 81, War
Department, April 9, 1917.
36 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(64) Letter from the Surgeon General to the Chief of Staff. May 1, 1917. Subject: Memo-
randum from Col. T. H. Goodwin, R. A. M. C. Copy on file, Record Room, S. G.
O., 172158 (Old Files).
(65) Report from the chief surgeon, A. E. F., to secretary, general staff, A. E. F., May 31,
1918. Subject: The Medical Department in the A. E. F. to May 31, 1918. Copy
on file. Historical Division, S. G. O.
(66) Letter from the Surgeon General to The Adjutant General, May 1, 1917. Subject:
Medical officer for duty in Euorpe. Copy on file. Record Room, S. G. O., 172158
(Old Files).
(67) Report of Base Hospital No. 21 (not dated) by Maj. Walter Fischel, M. C. On file.
Historical Division, S. G. O.
(68) Cablegram from the miUtary attach^ at London, to the Surgeon General, May 21,
1917. On file, A. G. O., World War Division, chief surgeon's files, 201 (Bradley,
A. E.).
(69) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, American
Embassy, London, June 11, 1917. Subject: Administration of American medical
personnel serving with British Forces. On file. Record Room, S. G. O. 9795 (Old
Files) .
(70) Letter from The Adjutant General to Col. A. E. Bradley, M. C, May 28, 1918. Sub-
ject: Designation as chief surgeon, U. S. Forces in Europe. On file, A. G. 0.,
World War Division, chief surgeon's files, 201 (Bradley, A. E.).
(71) Final report of Gen. John J. Pershing, September 1, 1919, 11.
(72) Report from the assistant chief of staff, fourth section, general staff, General Head-
quarters, A. E. F., to the chief of staff, A. E. F., June 1, 1919, 12. On file. General
Headquarters, A. E. F. Records.
(73) Report from the assistant chief of staff, Fourth Section, G. H. Q., A. E. F., 11.
(74) General Orders, No. 8, General Headquarters, A. E. F., July 5, 1917 (corrected copy).
(75) Tables of Organization No. 1, Series "A," W. D., August 27, 1918.
(76) Tables of Organization No. 28, Series "A," W. D., April 17, 1918.
(77) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, to May 1, 1919. On file
Historical Division, S. G. O.
(78) Medical History of the 41st Division (undated). On file. Historical Division, S. G. 0.
(79) Report from Col. S. H. Wadhams, M. C, chief of medical group, fourth section, gen-
eral staff. General Headquarters, A. E. F., to chief of fourth section, general staff,
Headquarters, A. E. F., December 31, 1918, 17. Copy on file. Historical Division,
S. G. O.
(80) Organization of the Services of Supply, A. E. F., Monograph No. 7, prepared by
Historical Branch, War Plans Division, General Staff, June, 1921, Washington,
Government Printing Office. War Department, Document No. 1009, 17.
(81) Final report of Gen. John J. Pershing, September 1, 1919, S.
(82) Memorandum from Gen. John J. Pershing, to The Adjutant General, U. S. Army,
September 18, 1917. Subject: Service of the Rear and Line of Communications.
On file, General Headquarters, A. E. F. Records.
(83) Memorandum from the commander in chief to The Adjutant General, U. S. Armv,
October 7, 1917. Subject: Priority of shipment (personnel). On file. General
Headquarters, A. E. F. Records.
(84) General Orders, No. 40, G. H. Q., A. E. F., September 20, 1917.
(85) Organization of the Services of Supply, A. E. F., Monograph No. 7, 19.
(86) Statement based on the final report of General Pershing, September 1, 1919, and report
of the assistant chief of staff, fourth section, general staff. General Headquarters,
A. E. F.. to the chief of staff, June 1, 1919. On file. General Headquarters, A. E. I- '
Records. '
(87) Minutes of the Allied Maritime Transport Council, September 27 1918 On file
Historical Branch, War Plans Division, General Staff.
(88) Final report of Gen. John J. Pershing, 90.
INTRODUCTION
37
(89) Report from the assistant chief of staff, fourth section, G. H. Q., A. E. F., appendix "J."
(90) Ibid., 15.
(91) Ibid., 16.
(92) Letter from commander in chief, to chiefs of staff departments, A. E. F., January 22,
1918. Subject: Reorganization. On file, A. G. O., World War Division, chief
surgeon's file, A. E. F. (321.6).
(93) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., February
4, 1918. Subject: Reorganization. On file, A. G. O., World War Division, chief
surgeon's file, A. E. F. (321.6).
(94) Report from the chief surgeon, A. E. F., to the commanding general, S. O. S., A. E. F.,
July 1, 1918. Subject: The medical department in the A. E. F., to May 31, 1918.
Copy on file, Historical Division, S. G. O.
(95) General Orders No. 31, General Headquarters, A. E. F., February 16, 1918.
(96) Final report of Gen. John J. Pershing, September 1, 1919, 12.
(97) Ibid., 68.
(98) Organization of the Services of Supph', A. E. F., Monograph No. 7, 25.
(99) Reports from the assistant chief of staff, fourth section. General Headquarters,
A. E. F., 22.
SECTION I
ORGANIZATION AND ADMINISTRATION OF THE CHIEF
SURGEON'S OFFICE
CHAPTER I
GENERAL ORGANIZATION AND DEVELOPMENT
On May 10, 1917, the Surgeon General wrote The Adjutant General of
the Army as follows: ^
I recommend:
That Col. Alfred E. Bradle}- , Medical Corps, in addition to his present duties as observer
with the English Army, be designated as chief surgeon United States forces in Europe.
That, as chief surgeon of United States forces in Europe, Colonel Bradlej^ be authorized
to exercise over the forces under his control the same authority as the Surgeon General
holds over the entire Medical Department. Similar authority was granted, on the approval
of the Secretary of War February 18, 1899, to the chief surgeon of the Department of the
Pacific and Eighth Army Corps (now the Philippine Department) .
In conformity with the foregoing request, The Adjutant General wrote to
the officer in question, on May 28, as follows: ^
The Secretary of War designates you, in addition to your present duties as chief surgeon,
United States forces in Europe.
The Secretary authorizes you, as chief surgeon of the United States forces, to exercise
over the forces under your control the same authority as the Surgeon General holds over the
entire Medical Department.
Meanwhile, on May 26, 1917, this officer had been designated chief surgeon
of the American Expeditionary Forces in General Orders, No. 1, of that organi-
zation, which was published in Washington, D. C, but neither the foregoing
letter nor a copy of the order mentioned was received by him prior to the
arrival of headquarters, A. E. F., in London, on June 9, 1917.^
The Medical Department personnel which accompanied the commander
in chief consisted of 4 officers, 2 enlisted men, and 4 civilian clerks.* On
arrival in London they were joined by the chief surgeon, who had been serving
as military observer with the British, but who, on May 29, had been relieved
from that assignment.^ One of his first duties as chief surgeon, A. E. F., was
the formulation of instructions for the liaison officer for the Medical Depart-
ment with the British, who also had been serving as a military observer and
who was now charged with supervision of the base hospitals and casual per-
sonnel of the American Expeditionary Forces which were under British control.^
On June 13, headquarters, A. E. F., moved to Paris,^ where, by the 17th,
it was joined by three other medical officers who had been serving as military
observers with the French or British forces.^ When headquarters, A. E. F.,
established itself in Paris the chief surgeon's office force, now consisting of
39
PLATE I
PLATE 2
42
ADMIXISTHATIOX, AMERICAX EXPEDITIONARY FORCES
seven medical officers and about twice that number of clerks, was located,
with other bureaus, in a small residential building where it occupied three
small rooms. ^ Almost immediately the chief surgeon and certain members of
his staflf began tours of inspection in order to determine matters concernmg
hospitalization at base ports and along the line of communications.^" On
July 4, a medical officer was relieved from duty in the chief surgeon's office
and assigned as surgeon of base section No. 1 (St. Nazaire), w-here the first
contingent of troops was expected to debark.
When the staff of the American Expeditionary Forces was organized
and its several duties were defined by General Orders, No. 8, Headquarters,
A. E. F., July 8, 1917, the functions assigned to the Medical Department
were as follows:
Sanitation of camps, quarters, and occupied territory; health of command; care of sick
and wounded; collection and evacuation of sick and wounded; medical personnel; medical
supplies; veterinary personnel; veterinary supplies; laundries and baths (medical aspect);
disinfection of clothing, etc.; supply of personnel and material for gas defensive under super-
vision of director of gas service; technical inspection of medical organizations and estab-
lishments, etc., etc.
Until the administrative structure of the American Expeditionary Forces
was radically changed, as noted in the preceding chapter, by General Orders,
No. 31, General Headquarters, A. E. F., February 18, 1918, the staff organi-
zation in general was comparable to that existing in the War Department.
The relationship of the chief surgeon's office to the general staff and to the
chiefs of administrative staffs was similar to that existing between the Surgeon
General's office, on the one hand, and the General Staff and the several bureaus
of the War Department, on the other."
Until the American Expeditionary Forces w^as reorganized by the order
mentioned the chief surgeon w^as located at headquarters with the general
staff and the chiefs of other administrative staff departments, and he or his
assistants, therefore, were enabled to transact business directly with the staff
offices concerned.
As the general staff w^as charged with approval and coordination of all
policies and projects for the American Expeditionary Forces the chief surgeon
or his assistants took up directly with appropriate sections of that body all
matters pertaining to the medical service which required its authoritization,
coordination, or execution.
The more important policies usually were placed on record and then dis-
cussed verbally. 12 It was quickly realized that very close cooperation of all
elements was necessary at general headquarters and that only through cen-
tralized control could prompt results be secured conforming to changing con-
ditions.** Careful studies w^ere made of future needs and these after being
approved by the general staff, w^ere cabled to the United States. «
Communication between the chief surgeon's office and that of the Surgeon
General was carried on by letter direct, or, if circumstances required, through
official channels, or by cable. Communications cabled from one office to the
other passed through the respective cable offices in headquarters, A. E. F., and in
° Such relationship is described in Volume I of this history.—
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 43
the War Department. Copies of cables which the chief surgeon's office
wished to send were submitted to the adjutant general, A. E. F., if they
pertained to administrative matters, or if to other matters, to the Chief of Staff
who referred them for examination to the appropriate section of the General
Staff. A section in the office of the adjutant general edited all cables for
clearness, arranged them for logical sequence with previous telegrams, and
incorporated them with drafts of other cables on the same subject from other
departments into one long message signed, "Pershing." The avenues for
transaction of business with the medical service of the Allies are discussed in
Chapter III.
After the arrival of headquarters of the 1st Division on June 26, 1917, and
that of considerable casual personnel, the work of the chief surgeon's office had so
multipled that the office space in headquarters, A. E. F., had become over-
taxed.® Therefore, about the middle of July that office, with some other
special branches of the headquarters group, moved to more commodious
in the Hotel St. Anne, in the street of that name.*
Here some of the more important policies of the Medical Department
were developed and adopted and considerable creative and constructive work
was accomplished.® Problems which arose during the earlier stages of the
American Expeditionary Forces when headquarters was located at Paris, and
later at Chaumont, included determination of general policies, such as location
and size of hospitals, percentage of hospital beds to total strength of the Ameri-
can Expeditionary Forces; estimates of quota, distribution and training of
personnel; amount and character of Medical Department supplies required;
relative priority of Medical Department personnel and supplies in shipments
from the United States; the tonnage such supplies would require; character and
quantities of supplies that could be procured advantageously overseas; size and
location of storage depots; provision of hospital trains; arrangements for care
of casualties at the front, for their removal from the lines, distribution and
treatment in the rear, and, if need be, sending them home; organization of gas
defense; standardization of splints; provision of agencies for transaction with the
Allies of business which was of mutual interest, e. g., procurement of sites for
hospitals and other installations; procurement of facilities from or through the
American Red Cross; control of infectious diseases, especially of venereal
diseases; organization of the laboratory system and of the professional services;
and many cognate subjects.'^ These policies of the Medical Department were
determined at conferences attended by the few medical officers available at
headquarters, or at more general conferences in which representatives of the
Medical Department participated with those of other staff departments of the
American Expeditionary Forces or with representatives of the French Army.®
A long step toward decentralization of medical service was taken when a
chief surgeon was designated for the line of communications.'® The necessity
for such an organization arose when the 1st Division arrived in July, and moved
to its training area in the Vosges. The geographical limits of the line of com-
munications extended from the sea to the point where supplies were delivered
to the field transportation of the combat forces less such areas as might be
excepted. Headquarters of this jurisdiction, while undergoing organization,
was located in Paris, whence it moved January 13, 1918, to Tours.®
44
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
A colonel, Medical Corps, who arrived with a small force on July 18 was
assigned as chief surgeon, line of communications,'^ and was vested with immedi-
ate supervision of Medical Department personnel and transportation, base
hospitals, sanitation, and suppHes, in its jurisdiction. As his office was
located in the same building as that occupied by the chief surgeon, A. E. F .,
numerous conferences occurred between their representatives'® until September
1, when the latter's office moved with headquarters, A. E. F., to Chaumont.''
A medical supply officer for the American Expeditionary Forces arrived
on July 20 and proceeded to the base medical supply depot being established
at Cosne.'^ As additional personnel was now^ necessary in the office of the
chief surgeon, A. E. F., and that of the chief surgeon of the line of communica-
tions the adjutants of the six American base hospitals already serving with the
British (as mentioned in Chapter I) were relieved from duty therewith and
ordered to Paris, where two of them were assigned to the office of the chief
surgeon, A. E. F., and four to the office of the surgeon, line of communications.*
Also an American medical officer who had been serving at a French hospital at
Ris Orangis and one who had been studying the organization of gas warfare
in England were ordered to join the office of the chief surgeon, A. E. F.^°
Until the latter part of Juh^, 1917, the chief surgeon's office, A. E. F., had
not been divided into sections and none of its personnel had been assigned to
particular duties exclusively.'^ Nearly all of the work transacted had been of
a character which required determination of broad general policies which were
part of or conformed to the three important basic projects of the American
Expeditionary Forces discussed in the preceding chapter.
As troops began to arrive in increasing numbers, more specific alloca-
tion of duties became necessary in the chief surgeon's office, in order that proper
action might be taken promptly both on routine reports and on a number of
diversified matters.'' For example, base hospitals which were arriving con-
stantly had to be promptly and suitably located, arrangements had to be made
with the French for the care or evacuation of American sick until our Medical
Department establishments could care for them, the considerable numbers of
casual personnel who were arriving had to be suitably classified and assigned,
and many questions of policy on a w^ide range of subjects were now pressing
for decision.^
After the arrival of a number of casual medical ofiicers in the latter part
of July the chief surgeon's office, A. E. F., was organized on the 28th of that
month, as follows :
(1) An executive officer, who assisted the chief surgeon in supervision and coordination
of the sections of his office, represented him when absent at conferences or on tours of inspec-
tion, and under the chief surgeon was in general charge of the administration of the medical
service, A. E. F.
(2) Hospitalization.— In charge of location, construction, and repair and all other ques-
tions relating to hospitals; hospital trains; and the care of sick and wounded.
(3) Sanitation and statistics. — Sanitation of camps, quarters, and occupied territory,
laundries, disinfection and disinfestation, collection and evacuation of sick, health of com-
mand, reports of sick and wounded, statistics and sanitary reports.
(4) Personnel— Medical, Medical Reserve, Dental, and Veterinary Corps, enlisted force,
schools of instruction, and civilian emploj^ees. '
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 45
(5) Supplies. — Hospital equipment, medical, dental, and veterinary supplies, settlement
of accounts, ambulances, and all motor transportation.
(6) Records and correspondence.
(7) Chemical Warfare Service. — Defensive gas, gas school, and all professional questions
relating to gas.
There was but one officer on duty with each of the sections mentioned above
except that the head of the hospitalization section (who was also charged with
Franco-American liaison which is discussed in Chapter III) had a commissioned
assistant.^ These officers also handled general estimates of personnel and
equipment.^ Associated with this headquarters group was another officer who
had been designated attending surgeon.^
During the week ending August 4, 1917, a liaison officer was appointed to
function between the Medical Department and the coordination section of the
general staff, an innovation which it was anticipated would greatly promote
transaction of business between the two offices.
The chief surgeon was also represented by a liaison officer at the head-
quarters of the American Red Cross and of the Young Men's Christian Associa-
tion in Paris. He also maintained close contact with the other societies serving
the American Expeditionary Forces and availed himself of their cooperation as
circumstances indicated.
So much of the American Red Cross in Europe as was called into the service
of the American Expeditionary Forces came under the immediate jurisdiction
of the chief surgeon, A. E. F., though in the last analysis that and other hke
societies serving the American Expeditionary Forces were under the control of
the first section of the general staff The activities of the American Red Cross
in the military service were quite diversified, but in very general terms they
pertained especially to hospitilization and medical supply.
On August 23 a dental officer was assigned to duty in the chief surgeon's
office and began, in the personnel division, the organization of the dental
service of the American Expeditionary Forces.^*
After the chief surgeon's office had been moved from Paris to Chaumont,
September 1, 1917, in the zone of the armies, it occupied the upper floors in the
west end of the south barracks at that place. The floor space allotted here
to the chief surgeon's office was many times as great as that which had just
been vacated in Paris, for it was appreciated that a large increase in its personnel
would soon be necessary.^ The chief surgeon's office when established in
Chaumont included 10 commissioned officers of the Medical Department."
Before leaving Paris, 4 officers were detached to remain in that city, 1 with the
water service of the line of communications, 2 as liaison officers with the Ameri-
can Red Cross and the Young Men's Christian Association, respectively, and
1 who served both as the medical member of the general purchasing board,
A. E. F., and later as liaison officer with the French Medical Department."
The Chemical Warfare Service was established as a separate bureau by
General Orders, No. 31, G. H. Q., A. E. F., September 3, 1917, and to this a
medical officer in close touch with the chief surgeon's office was later assigned.
On September 13, 1917, the chief surgeon was directed to submit at as
early a date as practicable a project for the Medical Department for the next
46
ADMIXISTRATIOX, AMEHICAX EXPEDITIOXAK Y FORCES
six months covering the proposed location of medical depots, laboratories,
hospitals, other establishments, and sanitary units, and his project for supplies
and material.
On October 9, 1917, the chief surgeon submitted the following plan of
organization of his office and that of the army surgeon at army headquarters
in the field: "
Fig 2.-M-ing B of group of three iiiaiii buildings, general headquarters, A. E. F., in which the ofRce of the chief surgeon
^roup, geSftafl!°I ^'""^ subsequently, of the Sai
Chief surgeon
Assistant to chief surgeon
Personnel division
Sanitation and statistics
Records and correspondence
Hospitals, construction and assignment
Supplies
Major
general
Total.
Briga-
dier
general
Colonel
Lieuten-
ant
colonel
Major
Captain
or lieu-
tenant
Clerks
or
soldiers
22
.50
80
100
3
Dental and veterinary service to be represented in this personnel section by an officer
ot the highest rank in these corps.
1 brigadier general.
1 colonel.
1 lieutenant colonel.
FOR ARMY HEADQUARTERS
1 major.
7 soldiers.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 47
In reply to a communication from the adjutant general, the chief surgeon,
on November 7, 1917, submitted the following statement of the subdivision of
duties in his office, and of the personnel that would be requu-ed to staff them,,
viz, chief surgeon (1 officer), assistant to chief surgeon (1 officer), personnel
division (5 officers, including 1 dental and 1 veterinary, and 22 clerks), sani-
tation and statistics (3 officers and 50 clerks), records and correspondence
(1 officer and 80 clerks), hospital construction and administration (6 officers
and 100 clerks), supplies (1 officer and 3 clerks).-*
On November 13, 1917, a chief nurse of the American Expeditionary Forces
was designated and was assigned, with an assistant, to duty in the office of the
chief surgeon, line of communications. She and her assistant were not incor-
porated in the office of the chief surgeon, A. E. F., until it moved to Tours.
This designation of the chief nurse later was changed to "director of nursing
service," but her duties remained unchanged.
The fofiowing data concerning the chief surgeon's office formed a part of
the table of organization for headquarters, A. E. F., office of the commander
in chief, approved by General Pershing on December 22, 1917:
Tables of organization, general headquarters, A. E. F.
CHIEF SURGEON'S SECTION
1
2
3
4
5
6
7
Remarks
Unit
OflBcers
Inter-
preters
Clerks
Sol-
diers '
Sol-
diers <•
Total
1
3
5
9
12
2
General officer
1
3
5
9
12
(o) Carried in headquarters battalion.
(6) 1 chauffeur, 1 orderly for general
officer.
(c) All from Medical Department but
attached to headquarters battalion for
rations, pay, and clothing.
(d) Clerks.
(e) 3 chauffeurs, 5 clerks.
(/) 5 motorcyclists, 5 chauffeurs.
ig) Pistols for 9 chauffeurs, 5 motor-
cyclists, 15 orderlies.
f
Colonels
Lieutenant colonels
Majors
Captains or lieutenants
Commissioned interpreters
2
Total commissioned. -
Field clerks
30
2
32
5
5
M. H. sergeants
5
5
5
5
5
25
58
28
73
52
Hospital sergeants
Sergeants major or bat-
talion sergeants major
Sergeants, first class
25
52
20
63
40
Sergeants
o 4
h 2
•8
no
* 5, 12
Corporals
Privates, first class
Privates
Total enlisted _
4
210
37
251
Aggregate
30
5
210
37
288
Closed cars.— _
1
3
5
1
3
5
2
3
5
15
29
Touring cars
Light cars
Motor cycles, with side cars
2
3
5
5
' 29
Horses, riding
10
Pistols
RED GROSS SECTION (SERVICES VOLUNTEERED)
1
2
3
4
Remarks
Unit
Officers
Others
Total
Captain -
1
1
Total commissioned
Not commissioned ..-
1
I
1
1
Aggregate-- -
1
I
2
1
1
13901—27 4
48
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
With the development of the American Expeditionary Forres, decentraliza-
tion had been necessary in practically every department. This movement was
investigated and the following report on this subject in so far as it pertained to
the chief surgeon's office w^as forwarded to it by the adjutant general, A. E. F.,
on January 10, 1918:=^'
Statement of organization and personnel
Division
Officers
1
•5
5
2
2
2
2
2
Clerks
Soldiers
MO
3
2
10
18
9
2
4
21
4
54
"»Two Veterinary Corps (temporary duty). ''Sorting mail.-
Personnel division. — This division keeps record of all the personnel of the Medical Corps,
regular or otherwise, hospital corps sergeants, and nurses, on duty in France. Most of the
records concerning personnel are kept on cards; these cards give name of college, date of
graduating; whether medicine, dental or veterinary surgery; previous military service and
date of appointment and call into active service; and special character of professional work;
also specialty and ability to speak or translate French. These cards are made out in cases
of all Medical Reserve Corps men. All medical personnel arriving in France are now
assigned to duty from this office. When the system of automatic replacements is put into
effect this work should be decentralized to the line of communication .
Hospitalization. — This division handles all questions relating to the establishing of hospi-
tals in France. The selection of sites are passed upon by the general staff at these headquarters
after conference with the French mission. It is not seen how this can be divorced from the
office of the chief surgeon. The actual building and plans, etc., are now decentralized to the
line of communications.
Sanitation and statistics. — All reports concerning sanitation, sick and wounded, etc., from
the medical sections of all units come to this office. Statistics and reports are made up
concerning them; also the weekly report to the commander in chief. If the statistical bureau
is established at these and other headquarters, it is believed with representative of the Medical
Department serving thereat that most sanitary reports and reports of sick and wounded
could come to this bureau.
There is a certain amount of data though which should, in my opinion, come to the chief
surgeon, who after all is responsible for the evacuation of sick and wounded and their care, and
it is beheved that in case of heavy casualties or epidemic the chief surgeon at these head-
quarters should receive the necessary data in order to enable him to understand the situation.
Practically, the evacuation of sick and wounded will be automatic, but in times of emergency,
the chief surgeon may have to act and exercise supervision over situations, and he must be
kept informed as to the general situation. It is not necessary for him to have all the informa-
tion in detail that is required for final reports to Washington. Data required for furnishing
reports to the commander in chief should come to the statistical bureau at these headquarters.
Others which are only required for the chief surgeon's office in Washington could be sent to
the statistical bureau at the headquarters, line of communications, it is believed.
Records and correspondence. — When the automatic replacement is put into effect much of
the records and correspondence work will naturally go from the chief surgeon's office to the
depots of the line of communications.
There is a post office here in which is distributed all the mail for the personnel of the Medical
Department serving in France. It is recommended that immediate steps be taken to have
the mail distributed elsewhere, and that only mail for the personnel on duty in the Medical
Department at these headquarters be forwarded here.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 49
To this the chief surgeon rephed as follows, on January 12:
1 . The receipt is acknowledged of your letter of January 10th (4773-F) .
2. Personnel division. — -Every effort has been made since arriving in France to keep the
amount of work in the personnel division in this office down to the minimum. As the inspector
says, there is a card in this office for everj^ member of the Medical Department. It contains
only the minimum amount of information. I protest most emphatically against any proposi-
tion to remove this information from my office. It is utterU^ impossible for the chief surgeon
of the American Expeditionary Forces to administer his office without knowing the personnel
he has available. I am not at all concerned in regard to the automatic assignment of
personnel arriving in France except in such instances where it is absolutely necessary that it
shall be done from these headquarters. It wish to emphasize again that I would consider it
the greatest misfortune to bring details into my office which can be handled elsewhere: These
details have been given to the line of communications and to the different divisions wherever
it was possible to do so. This has been carried to such an extent that personal complaints
have actually been made from two of the divisions that they felt very materially the loss of
contact with the chief surgeon's office.
3. Hospitalization. — This paragraph hardly calls for remark except that I am not
prepared to state now that I agree with the statement of the inspector that the hospital divi-
sion should rest entirely in this office. This is a question that had been up many times since
these headquarters moved to Chaumont. It is being studied now and if improvement on
present conditions can be made it will be promptly reported to proper authorities.
4. Sanitation and statistics. — I am perfectly willing to remove from this office as much of
this division as is possible, having in mind particularly routine sick and wounded reports, with
the understanding that I be furnished with the information necessary to administer the office.
Attention is invited to the fact that the chief surgeon can not carry out his functions without
knowing the sick rate, the prevalence of epidemic diseases and the sanitary conditions of the
troops.
5. Record and correspondence. — It is hoped that the automatic replacement will relieve
this office of a great deal of the record and correspondence, and I will welcome any change in
this respect which will not decrease efficiency,
6. Mail. — The distribution of mail which is being done in this office was not of my choice;
it was forced upon the Medical Department. The condition which exists in this respect
to-day is almost intolerable and I will welcome any proposition which will take this matter out
of my office. It appears to me that this is a serious matter in the American Expeditionary
Forces. Attention is invited to the great dissatisfaction which will be continued throughout
the command if the delivery of mail, now so much delayed, is not accomplished with greater
expedition.
Until February 14, 1918, there had been no general medical inspectors in the
American Expeditionary Forces, but on that date two experienced officers were
assigned to this duty. Though these officers functioned in the division of
sanitation, chief surgeon's office, their reports considered the entire range of
Medical Department responsibilities.^*
On February 16, the date General Orders, No. 31, was pubhshed, reorganiz-
ing the American Expeditionary Forces, the chief surgeon's office included 19
officers, 55 clerks, and 4 orderlies. These were distributed as follows : Chief
surgeon; personnel section, 2 officers, 11 clerks; dental, 1 officer, 1 clerk; hospi-
talization, 5 officers, 5 clerks; supplies, 1 officer, 3 clerks; sanitation and statistics,
4 officers, 13 clerks; records and corespondence, 2 officers, 17 clerks, 4 orderlies;
veterinary, 2 officers; mail, 4 clerks; property, 1 officer, 1 clerk.
On February 22, the chief surgeon's office reported that in conformity with
the order mentioned above, 16 officers, 47 enlisted men, and 4 civilians, would
move to Tours.'^
50
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
By General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918, the
Medical Department was charged with the following duties : Sanitary inspection ;
health of command; care of sick and wounded; collection and evacuation of sick
and wounded; medical supplies; veterinary supplies; supply of personnel and
material for gas defense under supervision of director of gas service; technical
inspection of medical organizations and establishments.
In reply to a query from the general staff, A. E. F., concerning the personnel
that would be required by the chief surgeon's officers the tables of organization
for the Services of Supply, the chief surgeon, on March 8, 1918, submitted the
following estimate:
Tables of organization, chief surgeon's office, A. E. F., Services of Siipplij
Unit
Officers
Inter-
preters
Clerks
Sol-
diers '
Sol-
diers
Total
Remarks
General officer.
1
15
20
15
1
15
20
15
2
(a) Carried in headquarters battalion.
(b) 1 chauffeur, 1 orderly for general
OffiCGI".
(c) All from Medical Department, but
attached to headquarters battalion for
rations, pay, and clothing.
(d) Clerks.
(e) 3 chauffeurs, 5 clerks.
(/) 5 motorcyclists, 5 chauffeurs.
(g) Pistols for 9 chauffeurs, 5 motor-
cylists, 15 orderlies.
Colonels and lieutenant col-
onels.
Majors
Captains or lieutenants
Commissioned interpreters -
Total commissioned..
Field clerks
2
51
2
53
1- -
5
Master hospital sergeants
5
5
5
5
5
25
58
28
73
52
Sergeants major or battalion
•i 5
25
52
20
63
40
Sergeants
»4
1. 2
« 8
rio
12
Total enlisted
4
210
37
251
Aggregate
Closed cars..-
51
6
5
210
37
309
1
3
5
1
3
5
2
3
5
15
27
Touring cars __
Light cars
Motor cycles with side cars.
Motor cycles
2
3
I
'27
Bicycles
Horses, riding
10
Pistols
In compliance with General Orders, No. 31, G. H. Q., A. E. F., February
16, 1918, the chief surgeon's office arranged for removal of most of its personnel,
records, and property, on the night of March 20, to Tours, where it was installed
March 21.^^ Here it absorbed and superseded the office of the chief surgeon,
line of communications. On March 24, the office force of the chief surgeon,
A. E. F., included 33 officers and 2 nurses.
The organization prescribed by the chart approved by the commander in
chief on March 6, 1918, was in general that followed in subsequent develop-
ments.^'' The section charged with combat organization and new equipment
was taken over by the representatives whom the chief surgeon left with the gen-
eral staff at Chaumont, before he moved his office to Tours on March 21.*'*
The nomenclature of the records division was later changed to administrative
division, but its duties were unchanged.*^
52
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The chiefs of the 10 technical staff departments of headquarters, A. E. ¥.,
who were transferred by General Orders, No. 31, 1918, to Tours, were now
under the immediate jurisdiction of commanding general, Services of Supply,
in all matters pertaining to procurement, supply, transportation, and construc-
tion, but retained their titles and authority as members of the staff of the
commander in chief, A. E. F.*^ They were directed so to organize their offices
that the efficiency of their departments would not be impaired by absences for
conferences or other duties assigned them, and though their headquarters were
at Tours they were authorized and expected to travel throughout the American
Expeditionary Forces to investigate, direct, and supervise the work of all ele-
ments of their services, including those with combat units. The chief surgeon
thus occupied a dual status, for he was at once the chief surgeon of the American
Expeditionary Forces and of the Services of Supply.
In the Services of Supply the position of the chief surgeon in relation to
the general staff of that command, and with the heads of its administrative
staff departments, was altogether analogous to that which as chief surgeon, he
formerly had held with the corresponding departments of general headquarters,
A. E. F., at Chaumont.^^ In fact, as stated in the preceding chapter, the chiefs
of all administrative staff departments, A. E. F., except the adjutant general,
the judge advocate, and inspector general, A. E. F., had also been transferred
to Tours where they had the same dual status as had the chief surgeon.*^ With
the adjutant general, judge advocate, and inspector general of the Services of
Supply his relations were the same as with the chiefs of the other staff depart-
ments, but the scope of the Medical Department matters upon which they
took definitive action pertained to the Services of Supply only.*^ Though the
chief surgeon was represented on the general staff, A. E. F., at Chaumont, by
medical officers assigned to several of its sections, he was not represented on
the general staff of the Services of Supply at Tours except for a short period
when a medical officer was assigned to its first section.*^ Over his subordinates
in the several geographical sections (advance, intermediate, and base) into
which the Services of Supply was divided, the chief surgeon exercised super-
vision through the section surgeons who were members of the staffs of the
officers commanding those sections.^^ His office had direct control, except in
a few matters (especially discipline) over certain Medical Department forma-
tions which were removed from the jurisdiction of the commanding officer of
the section in which they were located; e. g. hospital centers, detached base
hospitals, medical supply depots, the central Medical Department laboratory,
Dijon, and such hospital trains as were assigned to his office.
The chief surgeon's office, after its location at Tours and its absorption of
the office of the surgeon, line of communications, was organized into the
following divisions (1) General administration, records and correspondence ;
(2) hospitalization, evacuation, and hospital administration; (3) sanitation,
sanitary inspection, and medical statistics; (4) personnel; (5) medical supplies';
(6) finance and accounting.
Under the chief surgeon and his executive officer, the commissioned per-
sonnel of the chief surgeon's office was distributed among its several divisions
on March 24, 1918, as follows Sanitation, 7; hospitalization, 6; personnel
4; supplies, 4; records and correspondence, 4; finance and accounts, 6.
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 53
A chief nurse and assistant chief nurse were at the head of the nursing
service in the personnel division, but members of the nursing staff were not
yet commissioned.
The assistant to the chief surgeon examined all papers going to the chief
surgeon for his signature and was authorized to sign these in his absence."
The finance and accounting section was composed of personnel recently arrived,
who had been selected from a unit that had been organized in the United
States to audit property and money accounts of the Medical Department in
France."
By June 3, 1918, the clerical force in the office of the chief surgeon had
grown materially, but was inadequate and on that date he recommended that
because of the great number of technical questions reaching his office and the
Fig. 3. -lleadnuartirs, Sirvicos of Supply, A. E. F., at Tours, viewed from within. The chief surgeon's office occupied
practically the entire first floor of the wing on the right
consequent necessity for trained noncommissioned officers, the enlisted per-
sonnel on duty therein should be authorized in the following proportions:*^
Master hospital sergeants, 2; hospital sergeants, 12; sergeants, first class, 35;
sergeants, 60; corporals, 26; privates, first class, 40; privates, 27; total, 202.
This number was exceeded by the latter part of July, 1918, for at that time
the personnel then on duty in the chief surgeon's office was 43 officers and 220
clerks.*^
A seventh section ,of the veterinary service, was organized in the chief
surgeon's office after the promulgation of General Orders, No. 139, on August
29, 1918.^" Before publication of that order, this activity had been under the
control of the remount service of the Quartermaster Department, its chief being
54
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
without administrative authority and having virtually the status of a technical
adviser only.'"' The general order mentioned, provided that the veterinary
service be transferred to the Medical Department and that a new section
charged with direction of veterinary affairs be created in the chief surgeon's
office of which the chief veterinarian was, therefore, placed in charge.^"
After its expansion by the addition of the veterinary division the chief
surgeon's office retained the general organization then provided though its
personnel steadily increased in number until after the armistice was signed.^"
On November 9, 1918, 58 officers were on duty in the chief surgeon's office,
distributed as follows: Chief surgeon, 1; assistant to chief surgeon, 1; general
administration, 1 ; detachment of enlisted men, Medical Department, 1 ; records,
1; library, 4; hospitalization, 13 (transportation, 7; sick and wounded, 5);
Fig. 4.— Building in Tours, in which the finance and accounting division of the chief surgeon's office was located
sanitation, 4 (sanitary inspection, 1); personnel, 4 (dental, 5; promotions, 1);
supplies, 5; finance and accounts, 4; veterinary, 6.
Other personnel who were in charge of specialties in the chief surgeon's
office but who were not commissioned included nurses and dietitians. It will
be noted that 25 of the 61 officers whose duties were classified above i. e.
more than 40 per cent — were serving in the hospitalization division.*^
The personnel serving in the chief surgeon's office or in immediate con-
nection therewith on November 11, the date the armistice was signed were
distributed by rank as follows Officers: Brigadier generals, 2; colonels (one
being the chief surgeon, later promoted), 6; lieutenant colonels,' 12 ; majors 6;
captains, 9; first lieutenants, 27; second heutenants, 6. Total, 68.
56
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Nursing service: Nurses, 2; enlisted men: Master hospital sergeants, 1;
hospital sergeants, 21; sergeants, first class, 55; sergeants, 83; corporals, 46;
cooks, 3; privates, first class, 26; privates, 43. Total, 278. Civilian em-
ployees, 76; grand total, 424.
PERSONNEL
(July 28, 1917, to July 15, 1919)
CHIEF SURGEON, A. E. F.
Brig. Gen. Alfred E. Bradley, M. C, to April 30, 1918.
Maj. Gen. Merritte W. Ireland, M. C, May 1 to October 9, 1918.
Brig. Gen. Walter D. McCaw, M. C, October 10, 1918, to July 15, 1919.
DEPUTY CHIEF SURGEON
Brig. Gen Jefferson R. Kean, M. C.
Brig. Gen. Francis A. Winter, M. C.
REFERENCES
(1) Letter from the Surgeon General, U. S. Arm\', to The Adjutant General of the Army,
May 10, 1917. Subject: Designation of Col. Alfred E. Bradley, M. C, as chief
surgeon. United States forces in Europe. On file, Record Room, S. G. O. (9795).
(2) Letter from The Adjutant General of the Army, to Col. Alfred E. Bradley, M. C,
American Embassy, London, May 28, 1917. Subject: Designation as chief surgeon
of the United States forces in Europe. On file, Record Room, S. G. O. (9795).
(3) Letter from the chief surgeon, A. E. F., to the Surgeon General, S. Army, June 11,
1917. Subject: Status. On file. Record Room, S. G. O. (9795).
(4) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F. (undated).
Subject: Outline report of chief surgeon, A. E. F., for use in preparation of the
report of the commander in chief. On file. Historical Division, S. G. O.
(5) Letter from The Adjutant General of the Army, to Col. A. E. Bradley, M. C, May
29, 1917. Subject: Assignment. On file, Record Room, S. G. O. 9785 (Old Files).
(6) Memorandum from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, American
Embassy, London, June 11, 1917. Subject: Administration of American medical
personnel serving with British Forces. On file. Record Room, S. G. O., 9795 (Old
Files).
(7) Final report of Gen. John J. Pershing, September 1, 1919, 5.
(8) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., June 21,
1917. Subject: Report of personnel of chief surgeon's ofl^ice. On file, A. G. O.,
World War Division, chief surgeon's files (321.6).
(9) Wadhams, Sanford H., Col., M. C, and Tuttle, Arnold D., Col., M. C: Some of the
Early Problems of the Medical Department, A. E. F. The Military Surgeon, Wash-
ington, D. C, 1919, xlv, No. 6, 636.
(10) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 14,
1917. Subject: Weekly war diary. Copy on file, Historical Division, S. G. O.
(11) Special Orders, No. 26, Headquarters, A. E. F., July 4, 1917, par. 2.
(12) Report from Col. Sanford H. Wadhams, M. C, the Representative of the chief surgeon,
A. E. F. with the General Staff G-4-"B" to the chief of the fourth section, general
staff, general headquarters, A. E. F., December 31, 1918. Subject: Activities of
the medical group, fourth section, general staff, A. E. F., for the period embracing
the beginning and end of America's participation in hostilities. Copy on file,
Historical Division, S. G. O.
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 57
(13) Final report from the adjutant general, A. E. F., to the commander in chief, A. E. F.,
from May 28, 1917, to April 30, 1919. On file, General Headquarters, A. E. F.
Records.
(14) General Orders, No. 42, G. H. Q., A. E. F., September 26, 1917.
(15) Memoranda from the chief surgeon, A. E. F., to the chief of staff, A. E. F., from July
14, 1917, to and including December 29. 1917. Subject: Weekly war diaries. On
file, Historical Division, S. G. O.
(16) General Orders, No. 20, G. H. Q., A. E. F., August 13, 1917; also memorandum from
the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 21, 1917. Subject:
Weekly war diary. On file, Historical Division, S. G. O.
(17) War diary, chief surgeon's office, A. E. F., July 21, 1917.
(18) Report of medical activities, line of communications, A. E. F., during the war period
(undated), by Brig. Gen. Francis A. Winter, M. C. On file. Historical Division,
S. G. O.
(19) Report on medical supply, A. E. F. (not dated), by Maj. A. P. Clark, M. C. On file,
Historical Division, S. G. O.
(20) War diary, chief surgeon's office, A. E. F., July 28, 1917.
(21) War diary, chief surgeon's office, A. E. F., August 4, 1917.
(22) War diary, chief surgeon's oflfice, A. E. F., September 2, 1917.
(23) General Orders, No. 8, G. H. Q., A. E. F., July 8, 1917.
(24) War diary, chief surgeon's office, A. E. F., August 26, 1917.
(25) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file, Historical Division, S. G. O.
(26) Memorandum from the adjutant general, A. E. F., to the chief surgeon, A. E. F.,
September 13, 1917. Subject: Project of Medical Department. On file, A. G. O.,
World War Division, chief surgeon's files (321.6).
(27) Memorandum from the chief surgeon, A. E. F., to the chief of staff, October 9, 1917.
Subject: Tables of organization. On file, A. G. O., World War Division, chief
surgeon's files (320.2).
(28) Memorandum from the chief surgeon, A. E. F., to the adjutant general, A. E. F.,
November 7, 1917. Subject: Chart showing subdivisions in his office. On file,
A. G. O., World War Division, chief surgeon's files (320.2).
(29) Personnel records. On file. Army Nurse Corps, S. G. O. (Bessie S. Bell).
(30) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April
17, 1917. Subject: Activities of the Medical Department, A. E. F., to November
11, 1918. On file. Historical Division, S. G. O.
(31) Tables of organization for general headquarters, A. E. F., in France, approved by
Gen. John J. Pershing, December 22, 1917. On file, A. G. O., World War Division,
chief surgeon's files (320.2).
(32) Letter from the adjutant general, A. E. F., to the chief surgeon, A. E. F., January 10,
1918. Subject: Report on investigation of methods of decentralization. On file,
A. G. O., World War Division, chief surgeon's files (321.6).
(33) Letter from the chief surgeon, A. E. F., to the adjutant general, A. E. F., January 12,
1918. Subject: Report of investigation of methods of decentralization. On file,
A. G. O., World War Division, chief surgeon's files (321.6).
(34) List of officers and clerks on duty in the chief surgeon's office, February 16, 1918. On
file, A. G. O., World War Division, chief surgeon's files (321.6).
(35) Memorandum from the chief surgeon, A. E. F., to the post quartermaster, February 22,
1918. Subject: Transfer to Tours. On file, A. G. O., World War Division, chief
surgeon's files (321.6).
(36) Memorandum from assistant chief of staff, G-3, A. E. F., to the chief surgeon, A. E. F.,
February 26, 1918. Subject: Tables of [organization for the service of the rear.
On file, A. G. O., World War Division, chief surgeon's files (320.2).
(37) Letter from the chief surgeon, A. E. F., to the commanding general, S. O. R., A. E. F.,
March 8, 1918. Subject: Tables of organization. On file, A. G. O., World War
Division, chief surgeon's files (320.2).
58 ADMINISTRATION, AMKKICAN EXPEDITIONARY FORCES
(38) War diary, chief surgeon's office, A. E. F., March 24, 1918.
(39) Scheme for organization of the medical department, submitted by the chief surgeon,
A. E. F., February 22, 1918, and approved by the commander in chief, A. E. F.,
:March 6, 1918. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(40) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., March 15,
1918. Subject: Organization. On file, A. G. O., World War Division, chief sur-
geon's files (320.2).
(41) Report on the administrative section of the chief surgeon's office, A. E. F., by Capt.
R. A. Dickson, M. A. C. On file. Historical Division, S. G. O.
(42) General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918.
(43) Report from Col. N. L. McDiarmid, M. C., to the Surgeon General, U. S. A., May 1,
1919. Subject: Activities of the supply division, chief surgeon's office, A. E. F.
On file, Historical Division, S. G. O.
(44) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., July 1,
1918. Subject: The Medical Department in the American Expeditionary Forces to
May 31, 1918. On file. Historical Division, S. G. O.
(45) First indorsement from the chief surgeon, A. E. F., to the assistant chief of staff, G-1,
A. E. F., June 3, 1918, on memorandum from assistant chief of staff, G-1, A. E. F.,
to chief surgeon, A. E. F., May 31, 1918. Subject: Table of organization. On
file, A. G. O., World War Division, chief surgeon's files (320.1).
(46) Memorandum from the chief surgeon, A. E. F., to assistant chief of staff, G-4, A. E. F.,
July 4, 1918. Subject: Office personnel and space. On file, A. G. O., World War
Division, chief surgeon's files (321.6).
(47) Circular No. 54, chief surgeon's office, A. E. F., November 9, 1918. On file, Historical
Division, S. G. O.
(48) Memorandum from the chief surgeon, A. E. F., to assistant chief of staff, G-1, A. E. F.,
December 2, 1918. Subject: Personnel and transportation. On file, A. G. O.,
World War Division, chief surgeon's files (321.6).
CHAPTER II
REPRESENTATION OF THE MEDICAL DEPARTMENT ON THE
GENERAL STAFF, A. E. F.
Before the organization of the American Expeditionary Forces little atten-
tion had been given to the subject of Medical Department representation on the
general staff, but as early as July, 1917, it became apparent that such repre-
sentation was essential for coordinated action.' A memorandum was formu-
lated on this subject at this time but no action resulted.' In February, 1918,
in conformity with a request of the commander in chief for frank discussion,
another memorandum was prepared, again inviting attention to the necessity
for Medical Department representation on the general staff and stating the
reasons for this.' But until February 16, 1918, when General Orders, No. 31,
general headquarters, A. E. F., was published, representatives of the chief
surgeon's office continued to take up with the section of the general staff con-
cerned, all Medical Department matters which required their coordination or
execution.'
When the American Expeditionary Forces were reorganized, as described
in Chapter I, the chiefs of the 10 technical staff services (including the Medical
Department) which were transferred from headquarters, A. E. F., at Chaumont,
to that of the Services of Supply at Tours, were authorized in their discretion
to designate officers of their respective services to represent them with each
general staff section at general headquarters.^ In conformity with this plan
the chief surgeon, on February 22, 1918, recommended that certain officers of
the Medical Department remain at general headquarters to represent him with
the several sections of the general staff.^ As his immediate representative he
designated a medical officer who was also the liaison officer with the central
bureau of the Franco-American section and with the French mission at general
headquarters. The office force left to assist this officer consisted of two officers
of the Sanitary Corps and eight clerks.^ The medical officers who were assigned
as assistants to the chief surgeon's representative were attached to the several
sections of the general staff as follows: One to G-1, 1 (who was also attending
surgeon at general headquarters) to G-2, 1 to both G-3 and G-5, and 2 to
G-4.^ The chief surgeon stated that when more medical officers were available
one would be attached to G-3 and another to G-5 instead of having one officer
attached to both these sections, but this plan was never realized.^ By May,
1918, representation with the second section of the general staff was found
to be unnecessary and was discontinued.*
There was also assigned to duty with the chief surgeon's representative
at Chaumont, an officer who was designated director of professional services.*
He was not attached to any section of the general staff, but was stationed
at Chaumont largely to lend him the facilities needed in administering his
important activities.*
60
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Technically the medical officers who were assigned to duty with the
several sections of the general staff at general headquarters were assistants to
the chiefs of those sections, but from another point of view they were, as
stated above, assistants to the chief surgeon's representative there.'
On March 15, 1918, the chief surgeon endeavored to have created a Medical
Department section of the general staff. His letter on the subject is as follows
Recently there has been a considerable readjustment in the organization of these head-
quarters. It is stated in General Orders, 31, c. s., that the organization there prescribed
had been arrived at after a careful study of both the French and British Armies. The
American Expeditionary Forces organization recently adopted resembles very closely the
French organization which has been in existence for some time.
It is pertinent to review briefly a few of the more important steps in the development
of the French organization since the beginning of the war especially in reference to its sani-
tary service. It was early found necessary to provide for Medical Department representation
in the Government, and this was done by creating the office of sous secretaire d'etat du service
de sante. Gradually it was learned by bitter expeiience that in order to insure coordination
of effort and the prevention of unnecessary sacrifice of life actual medical department par-
ticipation in the plans for combat activities was necessary; that is, representation on the
general staff. Consequently, several medical officers were assigned to the general staff of
the G. Q. G. and one to the general staff of each army.
While better coordination was secured the results were not entirely satisfactory. Since
the Champagne offensive of April, 1917, which was accompanied with a terrible death toll
and very great unnecessary suffering there has been a growing feeling that steps should be
taken to prevent the recurrence of a similar catastrophe. It was well recognized that a repe-
tition of this unfortunate occurrence might well have a profound and possible disastrous
effect on the morale of a people already exhausted and harassed by the unavoidable
hardships of a long war.
During the past three and one-half years many changes in organization have been found
necessary, changes which viewed in the light of pre-war days seem radical. All of these
changes have tended toward a more complete autonomy of the medical service, and it is
believed by the best thinkers in the French Army that a high degree of autonomy is essential
if the Medical Department is to successfully meet the conditions which modern warfare have
imposed upon it.
The latest change in the Medical Department organization in the French Army has very
recently been published under date of February 26, 1918 (see inclosures). This change is so
fundamental in character and so far-reaching in its consequence that I feel impelled to bring
it to your attention. By this change the Medical Department had been removed from the
close administrative control of the fourth bureau of the general staff. I am informed that
M. Clemenceau and General Petain have decided, in order that the medical service may
have everjr possible opportunity to accomplish the difficult task with which it is confronted,
to constitute a new section of the general staff of the G. Q. G. This section is designated
the service de sante, and has as its chief an experienced officer of the Medical Corps who
is an assistant chief of staff.
It seems particularly fitting at this time that inasmuch as our present organization is
modeled so closely on that of the French that we should not appear as having begun our mili-
tary effort with a medical organization which has been found wanting and has been discarded
by the French. Undoubtedly this step has been taken by the French after most mature
study, and with the experience of three and a half years of war as a guide. I feel it incumbent
upon me to urge careful consideration of this matter and to recommend that a similar organiza-
tion be adopted for the A. E. F. If this recommendation is approved, as I feel it must be
sooner or later, it is my intention to request the detail of one of the several experienced
senior officers of the Medical Corps now in France as chief of this section. I am convinced
that while the recently prescribed organization is a vast improvement over that which has
been in effect, the gain in saving of life and the prevention of unnecessary suffering which
may reasonaVjly be expected from adopting the proposed change will be immeasurably
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 61
greater. The present organization in the American Expeditionary Forces places a line officer
of the general staff in position to pass upon or present for higher consideration all matters of
fundamental policy affecting the Medical Department. He can nullify the most carefully
worked out program having for its object Medical Department efficiency. I am convinced
that proper coordination of the medical service with the troops in the zone of the armies can
be secured in no other way than that outlined above.
This matter was referred to the chief of the fourth section, general staff,
who reported upon it adversely;^ however, the chief surgeon, on April 30,
renewed his recommendation in the following letter:^
On the 15th of March, 1918, a letter was sent you from this office calling attention to the
fact that the Medical Department was handicapped in its extensive and complex operations
by being cut off from direct access to the chief of staff and having to operate through two
divisions of the general staff, and suggesting that a remed\' be found in the creation of a
medical section of the general staff.
In the six weeks which have elapsed since that letter was forwarded, the transfer of the
chief surgeon's office to the Services of Supply has been tested in actual operation, and has in
many ways greatly facilitated the transaction of business, especially in matters concerning
supplies, the distribution and training of personnel, and the construction of the hospital
accommodations for the great Army which is being transferred from the camps of mobilization
at home to France.
It Vjecomes daily more apparent, however, that it has resulted in a disconnection of the
chief surgeon's office from the medical administration of the front to an extent which makes
it practically impossible for the chief surgeon to meet his responsibility for the conduct of
medical affairs in the zone of the army.
It is requested, therefore, that a reply be made to this letter, stating the action taken with
regard to it and, if unfavorable, the reasons which rendered favorable action inexpedient.
It is hoped that by a study of these reasons a solution may be arrived at which may be accept-
able to the commander in chief and may relieve the very serious administrative difficulties
which now exist.
As the chief surgeon was never informed officially of the objections, he was
not in a position to discuss them. This matter lapsed and no Medical Depart-
ment section of the general staff, comparable to that of the French Army was,
created at this time or later. ^
None of the medical officers attached to the general staff became members
of that body until some time later. By General Orders, No. 73, G. H. Q.
A. E. F., May 10, 1918, two of them were detailed acting general staff officers,
and by General Orders, No. 138, G. H. Q., A. E. F., August 23, 1918, the same
official status was given two others.
The representative of the chief surgeon, at general headquarters, established
his office with that of the two medical officers assigned to the fourth section of
the general staff This section as described in Chapter I, was concerned with
supply and transportation in the American Expeditionary Forces, initial troop
movements, hospitalization, evacuation, utilities, and labor. ^ It formulated
policies in these matters; the Services of Supply or other agency executed them.^
The assistant chief of staff, G-4, organized in his office a subsection, the medical
section, designated "G-4-B." which was charged with Medical Department
affairs, and it was with the group composing this section that the chief surgeon's
representative identified himself.^
Composition of the medical section, G-4, varied according to circumstances,
but on the average included four medical officers of field rank, two officers of
the Sanitary Corps for office management, and a small clerical force. ^
62
ADMINISTRATION, AMERICAN KXI'EDITIONARV FORCES
On May 2, 1918, the Medical Departmont officers on duty at head-
quarters consisted of the representative of the chief surgeon and one assistant,
one officer attached to G-1, one attached to G-3 and to G-5, two attached to
G-4, an assistant to these last mentioned, who was in charge of records, a
director of professional services and his assistant.*
With the separation of the chief surgeon's office from general headquarters,
A. E. F., the chief surgeon's relations with the combat forces virtually ceased,
but no agency was formally provided for the control, direction, or supervision
of Medical Department activities in the zone of the armies.' Therefore, his
representative at general headquarters supervised all activities of the Medical
Department during combat.' Demands upon the medical section, G-4, con-
stantly grew, for it soon became the center to which were referred all matters
affecting the Medical Department, whether they arose at headquarters, A. E. F.,
or were referred to it from other sources for recommendation or suitable
action.' Except in matters pertaining to priority shipments of supplies and
personnel from the United States, training, equipment, and operations, this
fourth section controlled most of the policies of the Medical Department, not
only in the Services of Supply, but throughout the American Expeditionary
Forces, including the zone of the armies.' It was for this reason that the repre-
sentative of the chief surgeon had identified himself intimately with this
section.' Gradually nearly all the Medical Department activities at general
headquarters were coordinated under the medical section, G-4, and no impor-
tant questions of policy were decided until they had been examined by this
group.' The medical officer assigned to G-1 actually served as a member of
this group, but was placed with G-1 to handle certain specific problems per-
taining to ocean tonnage which were under control of that section.' All
actions initiated in the group were of course executed over the signature of
the assistant chief of staff, G-4. This system was followed, even with questions
involving another section.' In this case a memorandum was usually prepared
for the other section of the general staff involved, and transmitted to it through
the assistant chief of staff, G-4.'
Orders affecting Medical Department activities in the Services of Supply
were promulgated from that headquarters at the direct instance of the chief
surgeon, A. E. F., while those affecting service of the Medical Department in
the American Expeditionary Forces as a whole, as well as in the zone of the
armies, were issued, on request of the chief surgeon's representative, from
general headquarters at Chaumont.^
Before they made recommendations concerning the establishment of
pohcies or took action upon them, the representatives of the chief surgeon
mvariably submitted them to him for approval.* Daily at 8 a. m., andoftener
in emergencies, the chief surgeon and his deputy discussed by long-distance
telephone the problems demanding solution.* Mail sent by courier from one
office to the other reached its destination in 12 hours. By these means and
by semimonthly visits to Chaumont for the purpose of attending conferences,
the chief surgeon kept constantly in touch with the activities and interests
of the Medical Department at general headquarters, and was able to supervise
Medical Department activities in the zone of the armies and in the American
Expeditionary Forces as a whole.*
ORGANIZATION AXJ) ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 63
The medical officers assigned to duty with G-4 previously had been iden-
tified with the hospitalization division of the chief surgeon's office, and in that
capacity had dealt with G-4 directly in matters pertaining to hospital procure-
ment.' As a part of such procurement they had sought to make provision for
field and evacuation hospitals as well as for the base hospitals in the Services of
Supply.' Also they had supervised and directed evacuation of patients from
divisions in training areas and in quiet sectors. Therefore, it developed that
the medical section, G-4, handled all questions relating to hospitalization,
evacuation, ■ and other interests of the Medical Department throughout the
American Expeditionary Forces which required the attention of general head-
quarters.' One very important detail of its service was the prosecution of
construction and procurement program, in its relation to hospitalization and
depot policies of the chief surgeon's office.' Another was support of Medical
Department interests when in certain projects these conflicted with those of
another branch of the service.' After American troops began to participate
in active operations the duties of this group underwent a tremendous increase
in scope for it was then charged with general control of Medical Department
activities in the field.' Questions continued to arise in connection with the
hospitalization and evacuation policies of the Services of Supply, but aside
from these the group now became occupied chiefly with matters pertaining to
field operations and combat activities.'
When the medical section, G-4, was organized it had not been anticipated
that control of field operations of the Medical Department would devolve upon
it, but no other agency was provided and such devolution was in fact a logical
development for the reasons noted above.** The deputy of the chief surgeon
at general headquarters, and the other members of the group attached to G-4,
constituted the only connecting link between the chief surgeon, A. E. F. and
the medical service of armies, corps, and divisions.^
From the beginning of our military operations the medical section, G-4,
was called upon to meet the daily emergencies of battle situations as they arose,
and to cooperate in developing and applying the general policies of the entire
Medical Department of the rapidly growing American Expeditionary Forces.^
During the more important operations two officers of the group were almost
constantly at the front where they represented G-4 in the coordination of hos-
pitalization, evacuation, and medical supply.^ Before corps and armies of
the American Expeditionary Forces were organized they performed, in addition
to their other duties, duties comparable to those of a corps or army surgeon,
for at that time there was no other agency through which the higher coordi-
native functions of the Medical Department could be exercised during combat.
For example, representatives of the medical section, G-4, supervised and
directed hospitalization and evacuation of the 1st Division at Cantigny; of
the divisions and corps constituting the Paris group in the Marne area; and of
the 42d Division in the Champagne sector.^ Before a chief surgeon for the
First Army was designated in July, 1918, members of G-4-B, therefore, dis-
charged such duties as then devolved upon that office.^ They also effected
evacuation from corps and divisions serving under control of the French or
British and provided for their supply of Medical Department materiel.^
13901—27 5
64
ADMINISTRATION, AMERICAN EXPEDITIONARY' FORCES
So far as their jurisdiction extended the chief surgeons of the First, Second,
and Third Armies relieved the deputy of the chief surgeon at G-4 of the duties
pertaining to hospitalization, evacuation, and medical supply which the latter
previously had discharged for corps and divisions at the front.
The hospitalization and evacuation plans for the St. Mihiel and Meuse-
Argonne operations, in so far as procurement and evacuation were concerned,
were largely prepared in G-4-B and placed into effective operation through
personal consultation with the chief surgeons of the First and later the Second
Armies.' Careful estimates of prospective battle casualties were formulated
and every available resource drawn upon to care for them. Owing to limited
resources, it frequently became necessary to move sanitary formations and
resources from one army to another, or to the service of detached divisions.'
The difficulties of contact, between the general staff and the Medical
Department engaged in the service of the front, which had occurred during
the battles in the Marne area, were greatly ameliorated when medical officers
were detailed to the various sections of the general staff at general headquarters,
and when a newly appointed assistant chief of staff took over the duties of G-4.*
This officer now uniformly acquainted members of the medical section G-4 with
plans, situations, and policies so that they were able to make preliminary arrange-
ments to the best advantage and to promote intelligently the efforts of the
chief surgeons of the various armies, corps, and divisions concerned.^ As the
group kept in close contact with those officers, and learned their facilities and
needs for future requirements it was thus in a position to render them prompt
assistance when required.*
The machinery for coordination of effort, consolidation of resources, and
elasticity of control of limited resources, as reffected in the authority of the
assistant chief of staff, G-4, permitted the maximum utilization of facilities.*
Without the interest which was manifested by the assistant chief of staff, G-4,
in the activities of this subsection and his practice of notifying it of impending
battles, or movements of troops, it would have been impossible for G-4-B to
have met emergencies which continually arose.*
The geographical location of general headquarters permitted the mainte-
nance of close contact between members of G-4-B and the surgeons of divisions,
corps, and armies.* It was possible for a member of this group not only to
reach rapidly almost any part of the front occupied by American troops, but
also through an excellent system of telephone and telegraph communication to
know at all times exactly the conditions to be met.* Largely because of this
fact the representatives of the chief surgeon with G-4 were able to meet the
daily problems which arose from the lack of authorized personnel, sanitary units
and equipment with the troops; such problems they met by moving from one
sector to another, on orders which G-4 initiated, casual personnel, operating
teams, and sanitary units, ambulance companies, field, evacuation, and mobile
hospitals.* Limitations of personnel were such that without this machinery for
coordination of effort and consolidation of resources, evacuation, and hospitafiza-
tion of battle casualties would have been well nigh impossible.* The activities
of this group which pertained to supervision of medical service at the front are
further discussed in Volume VIII of this history.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 65
G-4-B was also closely in touch with the American Red Cross, especially
in projects concerning hospitalization, and convalescent homes.* The relations
of that society to G-4-B were so intimate and so important that an attempt was
made to have it transferred from the jurisdiction of G-1 (which had control of
all such societies operating in the service of the American Expeditionary Forces),
to that of G-4, in order to expedite transaction of business between the two of-
fices, but this was unsuccessful.^ The representative of the Medical Depart-
ment with G-1 coordinated the activities of the American Red Cross with the
policies of the Medical Department, in so far as they pertained to that depart-
ment, the hospitalization enterprise of the American Red Cross being under-
taken in conformity with requests of the medical group with G-4.*
On September 20, 1918, the chief surgeon's deputy, general headquarters,
submitted the following memorandum to the acting chief of staff, G^, concern-
ing the organization of the medical section, G-4 : ^
The following table exhibits the personnel that I believe will be necessary to carry on the
functions now devolving upon this subsection of your office. It contemplates no radical de-
parture from the organization which has been in effect.
Brigadier general, 1; colonels, 2; lieutenant colonels, 2; majors, 2; captains or first
lieutenants, 4; total commissioned, 11. Civilian clerk, 1; master hospital sergeant, 1; hospital
sergeants, 2; sergeants, 1st class, 3; sergeants, 3; corporals, 2; privates, 1st class, 4; pri-
vates, 1; total enlisted, 16.
The table proposed off hand may appear to be top heavy. As a matter of fact the
personnel estimated will barely be sufficient to carry on the work which is now coming to this
subsection. As G-4 handles practically all the medical matters coming to general head-
quarters; it is believed that all technical matters affecting the Medical Department should
be referred to this subsection. While General Orders 31, contemplated that we should have
a representative in each section of the General Staff, it is believed that better results will
accrue if we concentrate all the authorized personnel in this section excepting the officer
assigned to G-5 for training purposes. Until recently we had attached to G-1 a medical
officer who was assigned to the General Staff. Instead of replacing him in that section it is
believed that the work carried on by him there should be performed by an officer in this sub-
section of G-4.
Until the organization of the First Army headquarters, this office was in fact the office
of the chief surgeon of the army. At the present time it is carrying some of the duties of that
army, and all of such duties in connection with certain other more or less detached combat
units. The chief surgeon's office is, from the point of view of distance, remote from the front,
and its contact with combat units is correspondingly slight. The necessity of providing the
details of organization, instruction, mobilization of new equipment and personnel for combat
units, the initiation of movement orders, etc., must all originate from this section. As a matter
of fact the duties which have devolved upon and are now being performed by this subsection
have been much broader in scope than it was believed by the chief surgeon was contemplated
in the plan of organization at the time General Orders 31 was adopted.
Every effort has been made to decentralize, as far as possible, all details concerning the
Medical Department and to devote the time of officers on duty here to constructive work,
which is gradually assuming greater and more pressing proportions. Up to the present,
with the number of officers now available this has practically been impossible, as the entire
time of officers now connected with the subsection have been taken up with routine daily
matters. It is daily becoming more evident that the chief surgeon's office, per se, has become
what might properly be called a surgeon's general's office in France, and is occupied with the
provision of materiel and personnel necessary to secure proper functioning of the Medical
Department of the American Expeditionary Forces. There is another and most important
side to the Medical Department's activities, and this is the relation of the department to
combat operations. From a Medical Department viewpoint, supply is a comparatively
66
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
minor consideration. The care of the sick and wounded and the evacuation and h(jsi)itali-
zation of these cases is always more or less an emergency measure and recj wires very com-
plicated machinery to secure the desired results. The present organization, as prescribed by
General Orders 31, does not provide the elasticity or necessary facilities for this most impor-
tant part of the Medical Department duties. It is understood that General Orders 31 is
now being rewritten with a view of correcting its organizational defects and incorporating
features which have been the outgrowth of our experience under its operation.
The necessity of having a deputy of the chief surgeon at these headquarters has become
generally recognized. Under our present scheme of organization it is necessary that the
chief surgeon should have at these headquarters an officer who truly represents him and
whose duties are more particularly those which pertain to Medical Department functions
with and relations to combat troops. To produce satisfactory results requires a considerable
organization. In every action of magnitude representatives from these headquarters must
leave for the front for the purpose of coordinating hospitalization and evacuation until
activities again assume a normal trend. It seems only logical that, inasmuch as all Medical
Department activities are coordinated by G-4 of the general staff, its senior medical officer
with that section of the general staff should be the chief surgeon's deputy. That is the
situation which has gradually evolved since the chiefs of the services were divorced from
these headquarters. As stated above, the desirabihty of not only continuing this organiza-
tion, but recognizing the responsibilities and duties of the senior medical member of G-4
seems apparent. Because of the nature of the work and responsibilities devolving upon the
chief surgeon's deputy, it is believed that the officer who occupies that position should have
the rank of a general officer. On a recent visit to these headquarters the chief surgeon an-
nounced that it was his intention to recommend that his deputy here be a brigadier general.
For that reason one brigadier general is shown on the above table. If the functions to be
carried out b^* this subsection of your office are to be successfully accomplished the personnel
indicated will be absolutely essential. The enlisted personnel given function largely in the
same capacity as do field clerks in other subsections.
On August 14, 1918, the commander in chief, upon being advised by the
chief of staff that the Medical Corps had asked for fuller representation on the
general staff, stated he desired this request to be complied with.^" Accordingly,
a medical officer who had been on duty with G-1 was made an acting general
staff officer," and all divisions of the general staff were advised that he should
be consulted on:
(a) All affairs of the Red Cross that have any possible connection with the Medical
Department; (6) all Tables of Organization of medical units or which should show medical
personnel attached; (c) changes in the type of equipment or clothing or ration, so far as they
may affect health, or where, in the case of equipments, it is for the Medical Corps; (d) miscel-
laneous questions affecting the Medical Department.
The representative of the Medical Department with G-3 was concerned
chiefly with movement of medical units ; e. g. , evacuation hospitals. It appeared
advisable that the Medical Department should be represented on G-3 in order
that its plans might be coordinated with combat operations in general.^ This
representative of the chief surgeon also served with G-5, and, in that assign-
ment, was in charge of the training of Medical Department personnel whether
they were members of units in the Joinville training area, of units or detach-
ments with divisions, or in attendance at the Sanitary School at Langres.'
In his final report the deputy of the chief surgeon at General Headquarters
wrote concerning Medical Department representation on the general staff
with especial reference to that with its fourth section as follows: ^
ORGANIZATION AND ADMIN'ISTBATION OF CHIEF SURGEON'S OFFICE 67
Tlie jiresent method of providing for Medical Department representation on and with
the general staff is ideal, and is favored over all other previous propositions. Medical
Department representation on the general staff as conceived by the acting chief of staff,
G-4, more nearh" approaches the ideal of organization than any other plan which has been
proposed. It is hoped that the policy inaugurated by the chief of the fourth section in this
respect will have demonstrated its value, and will be perpetuated in any future reorganiza-
tion of the general staff. It is also hoped that the results obtained by this section of the
general staff have amply demonstrated the wisdom of having adequate Medical Department
representation on the general staff.
Under this organization (General Orders, No. 31) the chief surgeon's office became
merely an agency for the procurement and distribution of supplies and personnel and wa^
completely separated from the Medical Department activities connected with the Zone of
.\ctive Operations.
The classification of the Medical Department among the supph' services is question-
able. Its functions are so intimately connected with combat activities that it becomes a
very difficult matter to administer this branch of the service if it is placed on the same basis
as the purely supply departments.
In providing the necessary medical supplies for an army only one of the comparatively
unimportant functions of the Medical Department has been fulfilled. The demands made
upon the Medical Department by combat activities can not be satisfied if the prevailing
conception of that department as a supply department is adhered to.
The organization of headquarters, general headquarters, A. E. F., as first outlined in
General Orders, No. 8, 1917, followed very closely that in operation in the French Army at
the time, except that for the latter army generous provision was made in the way of Medical
Department representation on the fourth bureau of the general staff and none was provided
for ours. As stated above, this defect was corrected some months later, after representation
had again been made by the chief surgeon.
In the meantime a reorganization of the French general staff went into effect in March,
1918. This change created an additional or fifth bureau of the general staff, which was made
up entirely of medical officers and was known as the Medical Department bureau. The
senior officer of the section was a major general, with the title of assistant chief of staff, with
the same responsibilities and privileges as his brother officers of the line of other bureaus of
the general staff.
A short time before the French had published this change in staff organization, a memo-
randum for the commander in chief had been prepared in the office of the chief surgeon
recommending this identical organization. This recommendation was never approved or
disapproved, and the lack of action in the matter was a source of bitter disappointment to
tlie chief surgeon.
In so far as general representation on the general staff is concerned, not only
at headquarters, A. E. F., but also at headquarters, Services of Supply, the chief
surgeon expressed his opinion on March 24, 1919, as follows
It is not believed at this time that a separate or medical section of the general staff
should be created, but the medical services of the American Expeditionary Forces should be
placed under G-4, general headquarters. The chief surgeon should be represented by a
fleputy on G-4, of high rank. In his relations with the general staff, general headquarters,
he should be represented by one or more assistants on G-1, G-3, and G-5, as well as the
necessary additional medical officers on G-4. It is not believed that there is any necessity
for representation on G-2, general headquarters.
The chief surgeon has no executive jurisdiction over his own corps in the armies except
through the executive branches of the general staff, general headquarters. He also is so
dependent upon the other supply departments for operating hospitals, supplies, and evacua-
tion as to make it impossible for him to function without the executive assistance of the
general staff. Services of Supply.
Therefore, in order to make the machinery move rapidly and smoothly, it is absolutely
necessary to have general staff representation in both general headquarters and Services of
68
ADMIXISTRATION, AMERICAN EXPEDITIONARY FORCES
Supply so as to insure the rapid and coordinate dissemination of information of daily changes
at the front and to meet all demands intelligently and rapidly with the proper cfiuipnient,
personnel, etc.
Under the present arrangement, in which the deputy chief surgeon is attached to G-4,
general headquarters, the operation has functioned in an admirable manner, but this is
recognized as being due in a large measure to the admirable cooperation given to the deputy
chief surgeon on G-4 by the assistant chief of staff, G-4.
In this connection, attention is called to the fact that there was no medical representative
on G-3, the G-4 group performing the functions that should have been delegated to the G-3
representatives. It is believed that representation on G-3 is necessary.
In connection with the headquarters, Services of Supply, the chief surgeon should have
had an office with a deputy in charge to operate the Services of Supply activities of supply,
hospitalization, statistics, finance and accounting. Services of Supply personnel, dental service,
and veterinary service.
The office of the chief surgeon should be represented by assistants on G-1 and G-4 of
the general staff. Services of Supply, this in view of the fact that the hospitalization division
is intricately connected with and dependent upon every other supply department, and in
order to maintain the proper service, should be represented on G-1 and G-4 of the general
staff with such executive power as to be able to secure hospital construction or procurement
by lease or rent, as well as transportation of supplies, personnel, and sick and wounded.
THE CHIEF SURGEON IN CONNECTION WITH THE ARMIES
It is well understood that orders of execution can only be given to the army through the
different sections of the general staff at general headquarters, but in view of the chief sur-
geon's responsibility for the sanitary personnel, equipment, professional services, hygiene,
etc., of the armies, he should be in close touch with the surgeons of the armies, army corps,
and divisions. The chief surgeon of an army should have a medical representative on each
G-1 and G-4 of the army.
The following table is submitted:
Location.
Operations — G. H. Q.
Chief surgeon.
Personnel (for army areas only).
Army equipment, medical, from advance medical supply depots.
Evacuation of sick and wounded.
Hospital trains.
Ambulance and motor transport.
Operations of same.
Supplies — S. O. S.
Deputy chief surgeon.
Hospitalization.
Supply department.
Statistics — sick and w^ounded.
Personnel (S. O. S.).
Hospital trains, ambulances, and motor transport.
Supply and equipment of same.
Finance and accounting.
Dental service.
Veterinary service.
Professional services.
Ge;ieral sanitation — inspecting, epidemiology, laboratories.
Relations with the general staff.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 69
The chief surgeon's representation on the general staff should be as follows:
G. H. Q.:
G-1. An assistant in connection with supply problems, railway and automatic
overseas tonnage.
G-3. An assistant to coordinate the chief surgeon's office with combat operations in
general, and change of stations of army units.
G-4. A deputy chief surgeon and necessary assistants in connection with the
evacuation of sick and wounded, hospitalization, all construction and pro-
curement of buildings, assignment of units.
G-5. An assistant in connection with Medical Department training.
S. O. S.:
G-4. One or more assistants in connection with hospitalization and evacuation of
sick and wounded.
G-1. One assistant in connection with all tonnage and problems.
Army headquarters :
G-1. An assistant to the chief surgeon of the army.
G-2. An assistant to the chief surgeon of the army.
Corps and division headquarters: No representation of general staff
deemed necessary.
REFERENCES
(1) Report from Col. S. H. Wadhams, M. C, the chief of the medical group, fourth section,
general staff, general headquarters, A. E. F., to the chief of G-4, general staff, general
headquarters, A. E. F., December 31, 1918. Subject: Activities of G-4 "B," 4.
(2) General Orders, No. 31, General Headquarters, A. E. F., February 16, 1918.
(3) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., February
22, 1918. Subject: Designation of medical officers to represent chief surgeon at
general headquarters. On file, A. G. O., World War Division, chief surgeon's
files (321.6).
(4) Memorandum from the representative of the chief surgeon, A. E. F., with general
headquarters, A. E. F., medical section, general staff, to the chief of staff", A. E. F.,
May 2, 1918. Subject: Duties of officers of Medical Department at general head-
quarters, A. E. F., G-4-B. On file, A. G. O., World War Division, chief surgeon's
files (321.6).
(5 Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., March 15,
1918. Subject: Organization. On file, A. G. O., World War Division, chief surgeon's
files (321.6).
(6) Memorandum from acting assistant chief of staff, G-4, to the chief of staff, April 6,
1918. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(7) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., April 30,
1918. Subject: Need for medical section, general staff. On file, A. G. O., World
War Division, chief surgeon's files (321.6).
(8) Wadhams, S. H., Col., M. C, and Tuttle, A. D., Col., M. C. : Some of the early problems
of the Medical Department, The Military Surgeon, Washington, D. C, 1919, xlv.
No. 6, 636.
(9) Memorandum from the medical representative of the chief surgeon, general headquarters,
A. E. F., fourth section, general staff, to the acting chief of staff", G-4, September 20,
1918. Subject: Plan of organization for the medical or "B" division of G-4. On
file, A. G. O., World War Division, chief surgeon's files (321.6).
(10) Report from the commander in chief, A. E. F., to The Adjustant General of the Army
(undated), part 8, Vol. I, "Activities of G-1," 29. On file. General Headquarters,
A. E. F. Records.
(11) General Orders, No. 138, General Headquarters, A. E. F., August 23, 1918.
(12) Letter from the chief surgeon, A. E. F., to the chief of staff, A. E. F., March 24, 1919.
Subject: Relation of chief surgeon's office to S. O. S., G. H. Q., and the armies. On
file, A. G. O., World War Division, chief surgeon's files (321.6).
CHAPTER in
LIAISON OF THE MEDICAL DEPARTMENT, UNITED STATES ARMY,
WITH THE MEDICAL SERVICES OF THE ALLIES
LIAISON WITH THE BRITISH MEDICAL SERVICE
On June 9, 1917, the chief of staff, A. E. F., notified one of our medical
officers, who had been serving as military observer, of his assignment as liaison
officer with the Director General, British Medical Service, in connection with
the administration of American medical units serving wdth the British.' The
necessity for such an assignment is indicated by the chief surgeon, A. E. F.,
who, on June 11, 1917, w^rote the Surgeon General in part as follows, concerning
his relationships with the above-mentioned units and with casual American
personnel assigned to the British forces:^
As already reported to your office, I assumed some weeks ago an unauthorized super-
visory control over American medical personnel arriving in England, for service with British
forces.
My position was such I could neither act nor advise in any authoritative manner and
my relations with the personnel and the British medical officials has been purely advisory.
Many points had arisen which required decisive action or opinion, and I laid the whole
matter before General Pershing with my recommendations and suggestions. These he
approved and a memorandum has been issued as the result * * *
It is General Pershing's understanding that this medical personnel with the British is
not at this time under his control. If this understanding is erroneous, information is re-
quested by cable, for I will sever my connection with this personnel, and the British medical
service on my departure for France, and as chief surgeon, A. E. F., will exercise no super-
vision unless it is explicith- directed by the War Department. * * *
Before headquarters moved to Paris the chief surgeon wrote the liaison
officer with the British as follows:^
Inclosed herewith is a copy of a memorandum prepai'ed this date. Copies have been
supplied to the following officers:
Commanding officer, United States Army, Base Hospitals Nos. 2, 4, 5, 10, 12, 21.
Director general, British medical service.
Surgeon General, United States Army, Washington, D. C.
Liaison officer, Adastral House, Victoria Embankment.
*******
Adjutant general, American Expeditionary Forces.
The Adjutant General, United States Army, Washington, D. C.
Judge advocate, American Expeditionary Forces.
Quartermaster, American Expeditionary Forces.
This memorandum covers in a general way the results of all that has been done in con-
nection with this personnel.
In so far as the British War Office is concerned it is the result of conferences with the
director general and his asststant, General Babtie, and it has the approval of the commanding
general.
There has been no word of instruction of any kind received at this embassy from Wash-
ington regarding this personnel. They have been ordered to report to Lieut. Col. A. E.
Bradley, M. C, for instructions and have all been reported by him to the War Office for duty.
71
72
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Lacking instructions and information, no office has been organized nor established for
administrative purposes. The matter was placed before General Pershing on his arrival
and recommendations made which are embodied in the accompanying memorandum.
It is suggested that you look to the base hospitals for such office enlisted personnel as
may be needed for the administration of the American necessities. No doubt some British
assistance will be forthcoming on your proper representation of the necessity therefor.
Fifty-two medical officers, unattached to organized units, have reported up to date.
Many of these have gone to France and some have been assigned here in England. Others
are awaiting assignments. * * *
The Surgeon General has written me a personal letter that besides the six base hospitals
already here, he proposes to send, in June, 200 medical officers and 200 nurses, and similar
numbers in July and August.
The commanding officer of Base Hospital No. 2 has made inquiries as to promotion of
men of his enlisted force, and steps should be taken promptly to obtain the necessary authority
from the Surgeon General to promote privates, and to conduct examinations for the making
of noncommissioned officers.
Personal reports have been forwarded, but some personnel returns, etc., have been held
until some check could me made by an authorized central office which is established by this
action of the commanding general. These held papers and some little correspondence have
been left for you in the embassy office.
* * *****
After the chief surgeon had received from The Adjutant General, United
States Army, the letter quoted in Chapter II, which prescribed the scope of his
authority,^ he wrote our liaison officer in London on June 25, as follows: ^
Inclosed herewith is a copy of order making the assignment of "Chief surgeon. United
States forces in Europe," which has been received since the preparation of memorandum
and letter of instruction to you dated June 11, 1917.
It will be noted that authority in all matters in Europe pertaining to the Medical
Department is vested in the chief surgeon, A. E. F., and you will be guided accordingly.
The instructions contained in the letter referred to above are therefore modified as
follows:
(a) You will in future, in general, in your relations with this office and the American
medical units and personnel with the British medical service, act as w-ould a surgeon of a
department in the United States.
(6) All reports, requisitions, returns, etc., of whatever nature will be forwarded to this
office. The number of copies in each case will be that fixed by regulations governing under
war conditions.
(c) It is directed that for all commissioned personnel and all unattached enlisted and
civilian personnel, you make, in your office, nominal monthly check lists showdng the address
and duty of each individual. After making these lists you may transmit direct to the
Surgeon General the personal reports received by you instead of forwarding them to this
office, sending only to the chief surgeon the check lists above referred to.
(d) It is desired that all United States Army hospital units make reports each month,
through United States medical channels, of the work being done by them — a numerical
report of all cases treated by the organization in the hospital served by them.
All instructions contained in the memorandum and letter of June 11 conflicting with
these instructions of this date are revoked.
The liaison officer with the British medical service, with office in Adastral
House, kept the records, reports, and pay accounts, and cared for the mail of
all American officers, nurses, and enlisted men of the American Expeditionary
Forces on duty with the British.*' He was later assisted by two commissioned
officers and four clerks. In discharging these duties he kept trace of the assign-
ment of those members of our medical department who were assigned to duty
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 73
with the British, assisted them in obtaining pay and allowances, procuring
leaves of absence or sick leave, and promoted their interests in other matters.^
For example, when any were taken prisoner, he reported that fact to the Ameri-
can Red Cross, which undertook to send them packages of food and to com-
municate with them and their families in the United States.^ He also reported
to the chief surgeon, A. E. F., those officers under his jurisdiction who were
recommended for promotion and assembled the records on which these recom-
mendations were based. This was an important subject in which the personnel
concerned so interested themselves that there was almost constant agitation in
connection with it. For this reason this subject engaged a large proportion of
the efforts of the liaison officer and of those of his office force.^ Another of his
duties was to arrange when necessary for the transfer, to the direct control by
the headquarters, A. E. F., of those members of the Medical Department under
his supervision, who required discipline.'^ He investigated such cases, procured
witnesses, and reported them to the chief surgeon, American Expeditionary
Forces.*^
Through the liaison officer for the Medical Department in London, the
medical officers serving with the base hospitals assigned to the British were in
much closer contact with the chief surgeon's office than were the casual American
medical officers assigned to British units. As mentioned in the chapter on
*' Personnel," there was great difficulty at first in reaching these casual officers,
and because of their ignorance of regulations, general orders, etc., they seldom
reported changes of status. In many cases officers served with the British for
months before they became of record in the chief surgeon's office, A. E. F.
The liaison officer procured the records, statement of cause of disability,
whether in line of duty or not, and other data required for our sick and wounded
report in the case of each individual of the American Expeditionary Forces,
who became incapacitated while assigned to the British, whether in France or
Great Britain.^ A great amount of this work was carried on in cooperation
with the chief surgeon of base section No. 3 (the British Isles), and after March,
1918, most of these data were returned to him;** but prior to January 14, 1918,
the liaison officer discharged the duties of chief surgeon of this base section,
in addition to the others more properly pertaining to his office.^
The liaison officer cooperated in securing buildings and sites for hospitals,
especially before July 1, 1918.^ He investigated and reported upon properties
which were offered to the American Expeditionary Forces for hospitalization
purposes. It is of interest to note that in the course of these activities he found
it necessary to decline Windsor Castle, which was offered for our hospital
purposes by the King of England; without extensive alteration, that historic
structure could not be adapted to our needs." The King, therefore, offered to
build a hospital in the castle grounds, and this offer was accepted.^ The liaison
officer inspected other residences and estates offered us for hospitalization
purposes, and his reports led to the acceptance of a number of these." Sites
for the location of our base hospitals were thus selected throughout England,
and to these American casualties were sent " until in the spring of 1918, when
it became necessary to send a number of them to British hospitals.'
74
ADMINISTRATION, AMKKKAN EXPEDITIONARY FORCES
Another duty of the Haison officer was the selection of those ports where
American casualties from the continent would be received, the creation of
machinery for their reception, and the determination of their destination when
placed on British hospital trains.*' The ports selected included some of those
in the Channel, on the Thames, in Scotland, and in Ireland.*'
The liaison officer supervised the assignment in Great Britain of American
officers of the Medical, Dental, and Sanitary Corps for the study and treatment
of gassed cases, and of cardiac conditions, the study of the methods and standards
used in examinations of fliers of the Royal Air Force, of food and nutrition, and
of general, orthopedic and maxillofacial surgery.^ He investigated the treat-
ment and care during convalescence of injuries caused by mustard gas, and the
findings made in cases that came to autopsy.® He was liaison officer with the
Royal Air Force.® The chief surgeon, A. E. F., frequently asked that certain
specialists who were on duty in our hospitals which were under British con-
trol, be transferred to the service of our troops in France, and the liaison officer
was charged with transactions with the British authorities which would effect
the release of the specialists.® The needs thus created in British hospitals
he then sought to meet by assignment of untrained personnel.® Our six base
hospitals serving with the British were constantly in need of specialists and
replacements, and these needs w'ere handled by the liaison officer.®
The liaison officer not only cooperated in effecting the transfer to the Ameri-
can Expeditionary Forces of those American physicians who were serving in
the British Army and now sought transfer to ours, but he also advised the
director general of the British Army medical service, concerning the many
quacks, alleged physicians, and practitioners of various pathies who went to
England from the United States to enter the British Army.®
In addition to cooperating with the American Red Cross in its efforts to
assist personnel under his jurisdiction who had been captured, the liaison
officer cooperated with the representatives of that body in London.® He
assigned medical officers to hospitals established by that society, and was
designated by the commander in chief as personal adviser and aide to the
director general of the American Red Cross, when that officer conducted an
inspection tour through Great Britain.®
One of the duties of the liaison officer was the procurement in Great Britain
of supplies for our Medical Department, both before and after a purchasing
agent for this department was assigned to service in Great Britain.® In this
duty he not only promoted procurement from civil firms but also obtained
large quantities of supplies from the British Government.® The liaison officer
served as a member of the purchasing board for the Medical Department in
Great Britain, from October, 1917, until the middle of December of that vear.®
The British brought up for his consideration and action many questions
which pertained to the British Expeditionary Force in France, and to the
American Expeditionary Forces as entities.® The liaison officer was the channel
of communication between the chief surgeon, A. E. F., and the chief surgeon,
base section No. 3, on the one hand, and the Royal Army Medical Corps on the
other.® The chief surgeon's office, A. E. F., also transacted business with the
British through the British mission established at Tours, and through the liaison
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 75
officer pertaining to G-1, who represented the American Expeditionary Forces
at headquarters of the British Expeditionary Forces.®
Deaths occurring among American units or detached personnel serving
with the British were reported direct to the headquarters, American Expedi-
tionary Forces.^
After the base section No. 3 was organized and a chief surgeon was assigned
to it, the Haison officer continued to be charged with supervision of the six base
hospitals and casual American medical personnel assigned to the British, but
his activities did not extend to the medical organizations of our Second Corps.*^
That command which consisted of American troops serving under British con-
trol was provided with a corps surgeon who was directly responsible to the
chief surgeon, A. E. F., or in some matters to the latter's deputy at general
headquarters.®
The average personnel of the Medical Department, A. E. F., constantly
on duty with the British Army approximated 800 officers, 600 nurses, and 1,100
enlisted men.® On November 23, 1918, there were serving with the British, 888
officers, 1,311 enlisted men, 676 nurses, and 24 civilian employees.®
American Medical Department organizations which participated in the
North Russian expedition were under British command, but occupied, in
reference to the liaison officer with the British, a position comparable to that
of the base hospitals assigned to the British Expeditionary Force in France.®
The official methods of the Medical Department organizations of the North
Russia expedition were made to conform, therefore, to British requirements
in so far as they w^ere relevant to British control, but other reports and returns
conformed to American requirements.®
LIAISON WITH THE FRENCH MEDICAL SERVICE
The increasing number of American troops which entered the lines, mingled
with the French, brought the two armies into very close relationship, until
March, 1918, when under military exigencies the two services operated as one.^
The chief surgeon's office had to have a clear knowledge of the organization of
the French Army and especially that of its medical department, from the Min-
istry of War to the field sanitary units, for French methods required that
business be transacted only through definitely authorized agents.^ Therefore,
it was necessary that the Medical Department, A. E. F., maintain the closest
contact possible with the French authorities, for their cooperation was essential
in a number of matters including the development of our program for hospital
procurement.^
The French realized more clearly than had the Americans, this necessity
for close cooperation and provided liaison officers for every branch of endeavor.^
Very shortly after the arrival of the first American troops the French Govern-
ment established at the Ministry of War the special Franco-American bureau
with subbureaus, know^n as sections, wherever needed." It thus provided an
agency through which all matters affecting the two services could be studied
and handled. In the subsecretariat of state, French medical service, a sub-
section of this Franco-American service was established." Also, in this sub-
secretariat a special technical division charged with American hospitalization
76
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
was organized. The object of this latter division was to assist in every way
possible the procurement of hospitals, hospital sites, and medical supplies for
the American Expeditionary Forces, and to facilitate the transfer to our medical
service of those existing French hospital installations and buildings which our
service needed.^
Owing to the shortage of medical officers, the chief surgeon, A. E. F., was
unable to comply with the request of the French that he place one of his subordi-
nates as liaison officer in this Franco-American section but he did direct the
chief of the hospitalization division in his office to effect close liaison service
therewith, in addition to his other duties.** At this time when the great prob-
lems of the Medical Department were those pertaining to the hospitalization
and supply and were concerned almost exclusively with the Services of Supply,
this plan worked very satisfactorily.^
On August 25, 1917, in anticipation of the movement of General Head-
quarters of the American Expeditionary Forces to Chaumont, the chief surgeon
designated the purchasing officer for the Medical Department, in Paris, as
Haison officer for the French medical service,'" and on the same date requested
that a French officer be attached for liaison purposes to his own office after this
had been established at Chaumont."
Therefore, after the chief surgeon's office arrived at Chaumont an experi-
enced French medical officer was assigned to liaison service with it, but after
this officer had reported the French commander in chief required that he be
placed under his jurisdiction.'^ This the undersecretary refused to permit;
and as the French commander in chief would allow no French officer to remain
in the zone of the armies who was not entirely under his control, this liaison
officer was relieved.'^ The result was that the chief surgeon, A. E. F., lost a
valuable adviser, and the close and direct relations between his office and the
subsecretary of state, medical department, in Paris, were severed.'^
On September 15, 1917, the chief surgeon and the chief of the hospitalization
division of his office visited the French headquarters at Compeigne, for the
purpose of making arrangements concerning the transaction of business relating
to our Medical Department in the zone of the armies, and on the 17th they
held a conference in Paris to determine the manner in which the Medical
Department should transact business with the secretariat, now that our head-
quarters had moved into the zone of the armies.'^
After headquarters, A. E. F., were established at Chaumont, the French
high command established there a military mission which was organized with
the same bureaus as the French General Staff This organization provided a
medical section under a French medical officer, who was charged with trans-
action of all business of whatever nature affecting the Medical Department in
the zone of the armies.^ The chief of the hospitalization division in the chief
surgeon's office was designated liaison officer between that office and the
French mission.^
As questions pertaining to procurement of hospitals and other facilities were
of immediate concern to the Services of Supply, in whose jurisdiction base
hospitals and supply depots were being located in great numbers, it was expe-
dient that the chief surgeon of that command also be in close touch with the
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 77
French subsecretary of state, medical service.'^ The chief surgeon, A. E. F.,
therefore, notified the chief of the French mission at Chaumont, on October 19,
1917, that he had designated the chief surgeon. Services of Supply, as his
representative for all matters of Medical Department interest outside the zone
of the armies.'^ He also asked that a French liaison officer be attached to the
latter's office, which was then in Paris.'* This was done, and after headquarters
of the Services of Supply moved to Tours in January, 1918, a French liaison
officer was attached to the office of its chief surgeon there.''
On February 9, 1918,'^ in compliance with a request of the subsecretary of
state, medical service,'^ a senior medical officer of the American Expeditionary
Forces was assigned to liaison duties with his office, and other officers to each
of the 11 regions in which Americans were then conducting their most import-
ant activities.'®
The officer selected for this assignment as liaison officer with the subsecre-
tary of state, medical service, was the chief of the hospitalization division of
the chief surgeon's office, who was performing liaison duty with the French
mission at general headquarters.^ The cumulation of such duties upon one
individual was necessitated by the shortage of officers and, in fact, worked out
well, for the great majority of questions which required negotiations with the
French continued to pertain to procurement of hospitals and medical supplies.^
After the chief surgeon's office, A. E. F., moved to Tours, in March, 1918,'^
it transacted some business direct with the French mission established in that
city,'^ but contact was maintained chiefly through the officer referred to above,
who remained with general headquarters at Chaumont as representative of the
chief surgeon.^" Relieved from duty in the hospitalization division, he now in
addition to his other duties, maintained liaison between the Medical Depart-
ment, A. E. F., on the one hand, and, on the other, with the subsecretary of
state, medical service, in Paris, and the French mission at Chaumont.^ Part
of this duty was his supervision of the liaison effected by other medical officers
assigned to that duty, whether for armies, corps, or divisions in the field, or for
regional subsections in the Services of Supply.^
In compliance with a circular letter from the Minister of War, dated
December 30, 1917, Franco-American sections had been instituted in connec-
tion with the large French services.^' These sections were charged with the
study of all Franco-American affairs transmitted to them and the solution of
problems incident thereto.^'
Eventually, sections of the Franco-American service were established at
each headquarters of the military regions (approximately 20) into which France
was divided, and a local medical officer of the A. E. F. was assigned to each, in
addition to his other duties, as liaison officer for the chief surgeon.** All matters
of policy were determined between the Franco-American section in Paris, and
the chief surgeon's office, but, when policies had been declared the execution of
details conforming thereto was made a duty of the regional subsections.^ The
activities of these regional officers are discussed at greater length below.
The matters which the liaison officer for the Medical Department conducted
with the office of the subsecretary of state, medical service, may be classified as
follows (a) Procurement of French hospitals for the American Expeditionary
78
ADMINISTRATION', AMKHICAX KXI'KDITION A K V FORCES
Forces; (b) procureineiit of existing l)uildiiigs, such as hotels and schoolhouses,
for hospital purposes; (c) all questions of standard medical supplies obtained
from the French medical service; (d) the execution of contracts for the purchase
of sanitary formations from the French medical service, such as mobile hospitals
and mobile surgical units, etc. ; (e) formulation of policies regarding the exchange
of the necessary data covering American patients in French hospitals and French
patients in American hospitals; (f) formulation of policies regarding control of
communicable diseases, particularly with a view of protecting the French civil
population; (g) miscellaneous matters.
The above classification practically outlines the scope of duties which
devolved upon the American liaison officer with the French medical service.^'^
The matters which required the greatest amount of work were those connected
with procurement of hospitals of the American Expeditionary Forces, and the
hospital supplies which could be secured better in Europe than in the United
States. From the very beginning of our effort it was necessary that the
American Expeditionary Forces take over from the French certain hospitals
and their equipment, in order to meet the needs of arriving American troops,
and this need continued until our barrack hospitals could be constructed.^^ At
first the procedure for taking over these hospitals was by direct request upon the
office of the subsecretary of state, through the liaison officer attached to his
office. Later this duty was performed through the regional liaison officers for
the Medical Department.^ Each of these officers acted on all routine matters
as an intermediary between the local American authorities and the director
of the French medical service for the region concerned.'' Matters of policy
continued to be determined between the representative of the chief surgeon,
A. E. F., and the office of the subsecretary of state, medical service, in the
Ministry of War, but the details conforming thereto were carried out by the
regional liaison officers.^
As noted above. Franco- American sections were established as need arose
at headquarters of each of the 20 military administrative regions into which
France was divided.^ A medical officer of the American Expeditionary Forces
in each of these regions was accredited to the respective Franco-American
section estabhshed at headquarters of each, and, in his liaison duties, which he
discharged in addition to others, was under the control of the liaison officer for
the Medical Department.^
These officers were given definite rules concerning acquisition of hospital
sites and of buildings suitable for hospital purposes, the taking over of existing
French hospitals, and the coordination of the medical services of the two coun-
tries in many other respects, but the greater part of their duties was concerned
with hospitalization.^^ They were directed to maintain contact and cordial
relations with the regional medical director of the French Army, with whom
they conducted initial negotiations for the transfer of projects and installations;
to exert every effort to avoid friction; and to arrange with the medical director
the local policies which would guide them in future liaison activities.^ In
their instructions these officers were informed that the French had manifested
a desire to cooperate in every way possible and already had given us many
of their best hospitals. They familiarized themselves with all hospitalization
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 79
prospects in their regions in order that in emergencies appropriate request
could be made for their procurement.*^ From time to time they were directed
to inspect and report upon hospital properties made available by the French,
to conduct such investigations, as were prescribed, of certain projects or instal-
lations, and were given instructions concerning further development of the
liaison service.^ Also, they were guided by general orders concerning liaison.
They not only notified the chief surgeon, A. E. F., of their liaison activities but
also the chief surgeon, Services of Supply, until the office of the former absorbed
that of the latter in March, 1918, promptly furnishing the latter any hospitaliza-
tion data he desired and assisting him in the acquisition of buildings. The
liaison officer for the district of Paris was concerned with the proper distribution
of American patients in that jurisdiction, for certain hospitals had been desig-
nated for the reception of American wounded, and close cooperation with the
French was necessary in order that this distribution might be made to best
advantage.
Liaison in matters pertaining to sanitation and epidemiology of both civil
communities and military organizations was maintained, through the medical
officers of the French military mission at general headquarters, A. E. F., and
at headquarters. Services of Supply, and through the Franco-American sections
in each of the regions wherever American troops were stationed or through
which they passed. The French mission at headquarters. Services of Supply,
included a medical officer in direct liaison with the chief surgeon, A. E. F., and
suitable French liaison officers were assigned to duty with the chief surgeons
of sections of the Services of Supply, and with the commanding officers of a
few of the larger hospital centers. '■^^ The chief of the French skin and vene-
real service of each region was directly accredited to the American medical
service as liaison officer in all matters affecting his specialty. The technical
chiefs at the French headquarters of the several regions, were directed to coop-
erate with the local liaison officers of the American Expeditionary Forces in
matters aft'ecting the hygiene, epidemiology, and prophylaxis of American
troops.-*^ They were ordered to effect technical cooperation in the following
matters especially : (1) Study and survey of water supplies; (2) employ-
ment of all bacteriological laboratories by American medical officers in their
efforts to confirm the diagnosis of communicable diseases, detect carriers,
perform water analyses, etc.; (3) regular and constant receipt of information
concerning incidence of infectious diseases among American troops and measures
taken to control their spread; reciprocal notification to the American authori-
ties of all epidemics of any importance among French civil or military popula-
tions with note of preventive measures taken; '^^ (4) notification to the Medical
Department of the American Expeditionary Forces of localities quarantined
and released from quarantine. Study in collaboration with the chief medical
officers of hospital centers and of dermatovenereological subcenters, of all
questions concerning the treatment and prevention of venereal disease and
information of the Medical Department of all regulations, circular letters,
and notices concerning sanitation, epidemiology, and preventive measures.^^
In order to comply with these instructions the following reports were made
by the regional Franco-American sections Report every 10 days of all con-
13901—27 ii
80
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tagioiis diseases among American troops stationed in the region, including all
necessary precautions. Prompt notice to civil authorities of contagious
diseases occurring among American troops.^^ Monthly report by chiefs of
dermatovenereological centers and subcenters, including in a special chapter
all questions concerning venereal diseases occurring among American troops.^*
Monthly report by the assistant chief medical officer of the region or the tech-
nical adviser. This was addressed to the medical officer of the French military
mission at headquarters, Services of Supply, to be transmitted to the office of
the chief surgeon, A. E. F.^®
The Franco-American liaison was of considerable benefit and importance
in certain other technical professional matters; e. g., delivery of sera to Ameri-
can medical officers by French laboratories, sterilization, and analysis of
drinking water in railroad stations.^*
A French ministerial circular letter of October 18, 1919, provided for
collaboration of the American and French medical authorities in reports relative
to the bacteriological and chemical tests of water supplies along the railroad
lines traversed by troop convoys.^^
Just as liaison was established between the American and French Medical
Departments at American headquarters at Chaumont, at Tours, and at head-
quarters of the several French military regions, it was similarly maintained in
the field between the medical service of smaller organizations of American
troops and that of the medical service of the command with which they were
serving. Medical officers of American corps or divisions operating under the
control of one of the allied nations were designated, in addition to their other
duties, as liaison officers for the chief surgeon, A. E. F., between the medical
services of the troops concerned. Thus, on May 21, 1918, an American
medical officer was assigned as liaison officer for the medical service of the 1st
Division with whatever French force to which that division would be assigned,"
and the chief surgeon, American First Corps, on July 13, was made liaison
officer for the American Medical Department with the French Sixth Army
under whose tactical control that corps was then serving. Similarly, when
French divisions later served under American command, French medical offi-
cers of those commands maintained liaison with the chief surgeons of the
American corps and armies to which such divisions were assigned.^ This
liaison effected by our medical service with that of our allies in the field, the
chief surgeon supervised through his deputy at general headquarters.
VETERINARY LIAISON WITH THE FRENCH
On April 11, 1918, the chief surgeon, A. E. F., was directed to designate
two veterinary officers who would form, with two French veterinary officers,
a Franco-American veterinary mission which would be charged with investi-
gating and recommending measures to prevent or combat epidemics among
animals in France. A French veterinary inspector designated by the under-
secretary of state was charged by the latter with keeping this mission informed
of all epidemics that might occur in the vicinity of American troops. The
mission was to visit the organizations in which contagious diseases were reported
and suggest all prophylactic measures indicated by insanitary conditions.^*^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 81
The mission also was at the disposal of the veterinary inspector who was to
seek its advice and assign it to services in connection with any matters per-
taining to the French veterinary general inspectorate.^*' The undersecretary
suggested that the following duties of the French mission would be especially
useful:^" (1) Visiting American remount depots, both to ascertain the con-
dition of animals bought and the state of those places from a sanitary stand-
point. (2) Enforcing glanders prophylaxis by systematic use of malleiniza-
tion, as carried on in the French Army. (3) Furnishing the United States
Army with every information as to how to deal with diseases due to acclima-
tization of young horses, notably strangles and its complications. (4) Carry-
ing on antimange defense on a methodical basis through the use of chemical
products (sulphur and baths) and promptly initiating the construction of all
installations needed. (5) Providing for defense against the various sorts of
lymphangitis, in order to prevent spread of same, both in the United States and
the French Army. (6) Suggesting all measures to be taken in connection
with any other contagious disease that might be reported in the United States
Army. (7) In regard to the animal's food, the composition of rations, the use of
substitute foodstuffs, the making of summer and winter horseshoes, and giving
advice with a view^ to facilitating the proper maintenance of horse strength.
It was understood the mission should report every week on the work it
had done to the high American and French veterinary authorities to which it
was attached and should point out in special reports the improvements that
could be made in the organization and functioning of the veterinary service
in each army.^*'
It was later proposed by the French that the instructions for the mission
be made more definite, that it be made mandatory that this mission be con-
sulted in case of epidemics, and that when ordered to do so, or when it thought
such action necessary, it visit the organizations where contagious diseases were
reported and propose appropriate prophylactic measures.
On September 30, 1918, the chief surgeon, A. E. F., notified the chief of the
Franco-American veterinary mission that the value of the mission, operating
on the above lines, had ceased, but that it could be of great value if its activities
were directed into other channels.^^ He therefore requested that a French
veterinary officer be assigned as liaison officer in the chief surgeon's office,
A. E. F., and that one be assigned as liaison officer with, the assistant chief
veterinarian of the advance, intermediate and each base section, respectively,
and to each army.^^ The services of these officers were to be purely liaison
between the assistant chief veterinarian concerned and the local French veteri-
nary and civil authorities.^^ In conformity with this recommendation one
French veterinary officer was attached for liaison purposes to the chief of the
veterinary service, A. E. F., at Tours and another to the assistant chief of the
veterinary service in the advance section, at Nogent en Bassigny.^^ Others
were also assigned to the First, Second, and Third Armies,^* but the Franco-
American veterinary liaison mission with headquarters in Paris continued to
operate until several months after the beginning of the armistice.^^
The last French liaison officer on duty with the Medical Department,
A. E. F., was relieved on June 30, 1919.^«
82 ADMIXISTHATIOX, AMKRICAX EXPEDITIONAKV FORCES
LIAISON WITH THE ITALIAN MEDICAL SERVICE
Liaison with the ItaUan medical service was maintained through our chief
surgeon base section, No. 85 On November 23, 1918, 57 officers and 1,010
enhsted men of the American Expeditionary Forces were serving under the
control of the Itahan Arniy.^^
PERSONNEL
(July 28, 1917, to July 15, 1919)
LIAISON OFFICERS
WITH THE BRITISH ARMY
Col. Matthew A. De Laney, M. C.
Col. William J. L. Lyster, M. C.
WITH THE FRENCH ARMY
Col. Sanford A. Wadhams, M. C.
WITH THE ITALIAN ARMY'
Col. Elbert E. Persons, M. C.
REFERENCES
(1) Telegram from the chief of staff, A. E. F., to Maj. W. J. L. Lyster, M. C, June 9, 1917.
Subject: Liaison officer. On file. Record Room, S. G. O. (9795).
(2) Letter and memorandum from the chief surgeon, A. E. F., to the Surgeon General,
U. S. Army, June 11, 1917. Subject: American medical personnel serving with
British forces. On file. Record Room, S. G. O. (9795).
(3) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C., June 11, 1917,
Subject: Administration of American medical personnel serving with British service.
On file, Record Room, S. G. O. (9795).
(4) Letter from The Adjutant General of the Army, to Col. A. E. Bradley, M. C, American
Embassy, London, May 28, 1917. Subject: Designation as chief surgeon of the
United States forces in Europe. On file, Record Room, S. G. O. (9795).
(5) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, June 25, 1917.
Subject: Instructions. The administration of American medical personnel with
British in relation to A. E. F. On file, A. G. O., World War Division, chief surgeon's
files (201, Lyster, W. J. L.).
(6) Report from Col. M. A. Delaney, M. C, liaison officer with the Director General,
British Medical Service, to the Surgeon General, U. S. A., Februarj- 18, 1924. Subject:
Liaison activities with the British Medical Service. On file. Historical Division,
S. G. O.
(7) Report from Capt. Arthur Morehouse, San. Corps, to the Surgeon General, U. S. Army,
February 12, 1924. Subject: Summarized history of Army activities in base section
No. 3, England. On file. Historical Division, S. G. O.
(8) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to Mav 1, 1919.
On file, Historical Division, S. G. O.
(9) Wadhams, S. H., Col., M. C, and Tuttle, A. D., Col., M. C: Some of the early prob-
lems of the Medical Department, A. E. F. The Military Surgeon, Washington,
D. C, 1919, xlv. No. 6, 636.
(10) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., August 25,
1917. Subject: Liaison officer, with the French Service de Sante. On file, A G. 0.,
World War Division, chief surgeon's files (211.01).
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 83
(11) Letter from the chief surgeon, A. E. F., to Sous-Secretariat d'Etat da Service de Sante,
Premiere Division Technique, Hdpital Am4ricaine, Minister of War, France, August
25, 1917. Subject: Officer of liaison. On file, A. G. O., World War Division, chief
surgeon's files (211.01).
(12) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., September
2.3, 1917. Subject : War diary for the week of September 23, 1917. On file. Historical
Division, S. G. O.
(13) Letter from the chief surgeon, A. E. F., by direction of the commander in chief, A. E. F.,
to the chief, French mission, headquarters, A. E. F., October 19, 1917. Subject:
Liaison officer for the American Sanitary Service in Paris. On file, A. G. O., World
War Division, chief surgeon's files (211.01).
(14) Letter from the chief surgeon, A. E. F., to the chief, French miUtary mission, October
21, 1917. Subject: Appointment of liaison officer. On file, A. G. O. , World War
Division, chief surgeon's files (211.01).
(15) Letter from the Assistant Secretary of State of the Military Sanitary Service, to Col.
F. A. Winter, chief surgeon, line of communications, A. E. F., Tours, January 25,
1918. Subject: Detail of officer for service with chief surgeon, line of communica-
tions, Tours. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(16) Letter from the chief surgeon , A. E. F., by direction of the commander in chief, A. E. F.,
to the chief French Military mission, February 9, 1918. Subject: Appointment of
officers of the United States Army Medical Corps to act in liaison with French
authorities. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(17) Letter from the Sous-SecrMariat d'Etat du Service de Sante, to the Sous-SecrHariat d'Etat,
Presidence du Conseil, January (no date given). Subject: American officers to be
attached to French American services on sections. On file, A. G. O., World War Divi-
sion, chief surgeon's files (211.01).
(18) War Diary, chief surgeon's office, A. E. F., March 24, 1918. Copy on file, Historical
Division, S. G. O.
(19) Memorandum from the chief surgeon, A. E. F., to the French mission, headquarters,
S. O. S., June 28, 1919. Subject: Veterinary liaison officer. On file, A. G. O. , World
War Division, chief surgeon's files (211.01) .
(20) Letter from the chief surgeon, A. E. F., to Sous-Secretaire d'Etat du Service de Sante,
Section Franco-Americaine, French mission, G. H. Q., A. E. F., March 8, 1919.
Subject: Epidemic diseases in the A. E. F. On file, A. G. O., World War Division
chief surgeon's files (710).
(21) Report on the general survey of communicable diseases, A. E. F., October 7, 1921, by
Col. Haven Emerson, M. C. On file. Historical Division, S. G. O.
(22) Report from the commander in chief, A. E. F., to The Adjutant General of the Army,
March 26, 1919. Activities of G-1, Appendix 8, Report of liaison service (pages not
numbered). On file. General Headquarters, A. E. F. Records.
(23) Letter from the chief surgeon, A. E. F., to Maj. A. E. Schlanser, M. C, February 12,
1918. Subject: Appointment as liaison officer with French Medical Service; and
letter from the chief surgeon, A. E. F., to First Lieut. F. E. May, Interpreter Corps,
N. A., February 25, 1918. Subject: Liaison with French Medical Service. On file,
A. G. O., World War Division, chief surgeon's files (211.01).
(24) Memorandum from the chief surgeon, A. E. F., to Col. James A. Logan, jr., Q. M. C,
February 24, 1918. Subject: Liaison officer. On file, A. G. O., World War Division,
chief surgeon's files (211.01).
(25) Report from Col. Haven Emerson, M. C, to the chief surgeon, A. E. F., May 31, 1919.
Subject: Report of Division of Sanitation and Inspection, Medical Department,
A. E. F., on file. Historical Division, S. G. O.
(26) Reports and records of communicable diseases, October 7, 1921, by Col. Haven Emerson,
M. C. On file, Historical Division, S. G. O.
(27) Letter from commander in chief, A. E. F., to Lieut. Col. Paul C. Hutton, M. C, May 21,
1918. Subject: Liaison. On file, A. G. O., World War Division, chief surgeon's
files (211.01).
84
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(28) Letter from tlie chief of the French military mission with the A. E. F. to the com
mander in chief, A. E. F., Medical Department, July 13, 1918. Subject: Liaison
officer. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(29) Telegram from Col. James A. Logan, jr., Q. M. C, to the commanding general, A. E. F.,
April 11, 1918. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(30) Letter from the Undersecretary of State with Prime Minister to the commander in
chief, A. E. F., May 11, 1918. Subject: Liaison Franco- American veterinary
mission. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(31) Letter from the chief of the directorate of the rear to the chief of G-4, general head-
quarters, September (no date), 1918. Subject: Franco-American veterinary mission.
On file, A. G. O., World War Division, chief surgeon's files (211.01).
(32) Letter from the chief surgeon, A. E. F., to chief of Franco- American veterinary liaison
mission, Paris, September 30, 1918. Subject: Franco-American Uaison mission.
On file, A. G. O., World War Division, chief surgeon's files (211.01).
(33) Letter from chief of French mission at headquarters, S. O. S., to the commanding general,
S. O. S., October 8, 1918. Subject: French veterinarians appointed to the A. E. F.
On file, A. G. O., World War Division, chief surgeon's files (211.01).
(34) Letter from the chief surgeon, A. E. F., to the Franco-American veterinary liaison mis-
sion, Paris, January 24, 1919. Subject: Assignment of French veterinarians to
Second American Army; and letter from the chief veterinarian, A. E. F., March
15, 1919. Subject: Liaison officers, first and third Armies. On file, A. G. 0.,
World War Division, chief surgeon's files (211.01).
(35) Letter from the chief of the Franco-American veterinary liaison mission to the chief
surgeon, A. E. F., January 14, 1919. Subject: American liaison officer. On file,
A. G. O., World War Division, chief surgeon's files (211.01).
(36) Memorandum from the chief surgeon, A. E. F., to the assistant chief of staff, G— 1, S. O. S.,
July 1, 1919. Subject: French liaison officer relieved from duty. On file, A. G. 0.,
World War Division, chief surgeon's files (211.01).
(37) Report of the activities of the Ambulance Service with the Italian Army (not dated),
by Col. E. E. Persons, M. C. On file, Historical Division, S. G. O.
CHAPTER IV
THE ADMINISTRATION DIVISION"
When the chief surgeon's office, A. E. F., was organized on July 28, 1917,
one of its divisions was that of records and correspondence. This division was
charged not only with central control of all communications entering and leav-
ing the office but also with certain elements of internal administration of the
office. The last mentioned duty later determined the name of this division.
The methods adopted for the care, control, and disposition of records,
and for office administration, were not the result of preliminary plans, for to a
large degree they were adaptations to necessities. It was soon determined
that a definite system of recording correspondence capable of expansion had to
be estabhshed, therefore, the War Department filing system was instituted
with such modifications as appeared necessary for its adaptation to the needs of
the Medical Department in time of war. This system adopted at this time was
never changed in principle. The procurement of equipment and supplies for
the current work and expansion of the chief surgeon's office became one of the
duties of this division, thus taking over services which had been performed
by several officers prior to its organization. One of the earhest duties of the
office staff had been to obtain office supplies and equipment. The three small
rooms at No. 17 Rue Constantine in which the office of the chief surgeon
first was located in June, 1917, were furnished by the French Government with a
few tables, desks, and chairs, which with several typewriters brought from the
United States, constituted the initial equipment of the chief surgeons' office.
The procurement of the additional furniture and equipment required when the
chief surgeon's office moved, in July, into the six rooms allotted it in the Hotel
St. Anne, was, in part, one of the earliest activities of the administration
division.
An exceptionally aggravating difficulty, which existed at first arose from
the fact that at that time no American post office service was provided, and
mail intended for personnel of the Medical Department was addressed in the
care of the chief surgeon. All of this mail found its way to the administration
division, where its importance and value were fully appreciated, but where
there was not force adequate to handle it. When the first officials of the
American post office arrived, some 10,000 letters had accumulated.
Another duty of the administration division was the improvisation of
such blank forms as were necessary, and provisions for the printing of these
and other documents. Often the division was embarrassed by the demands
for paper, and many expedients were utilized to conserve the supply. Old
envelopes were used for scratch paper, letterheads were cut in half for short
letters and memoranda. Small pieces were used whenever possible and both
sides of each sheet were used in mimeographing, multigraphing, printing,
etc., but despite all the efforts at economy the shortage in paper was always
serious.
» Entire chapter based on "Report on the administrative section of the chief surgeon's oflSce, A. E. F., undated,"
by Capt. R. A. Dickson, M. A. C. On file, Historical Division, S. G. O.
85
86
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Very early in the history of the American Expeditionary Forces the need
for clerical help in the chief surgeon's office hecaine very urgent. Soldier
clerks were drawn from the six base hospitals then serving with the British
and a few others were enlisted from among American citizens resident in France.
Difficulty in obtaining suitable clerical help continued after the chief surgeon's
office moved with headquarters to Chaumont, early in September of 1917.
However, while the chief surgeon's office was located at Chaumont the need
for clerks was gradually relieved, for during this time base hospitals began to
arrive in France; and as they could not promptly be located, their personnel
was available for transfer. Accordingly some of the stenographers and typists
from these units were assigned to the chief surgeon's office.
As the work continued to expand other personnel, commissioned, enlisted,
and civilian, were assigned to this office until their number eventually approxi-
mated 500 persons. The officer in charge of the administration division super-
vised the two officers who were in command of the two detachments into which
were grouped enlisted personnel assigned to the chief surgeon's office. One of
these officers also was in general charge of the civilian employees on duty in
the office.
In his procurement and care of office furniture and equipment the officer
at the head of this division was assisted by a property officer who was immedi-
ately accountable for all Government property in the chief surgeon's office.
Other officers under his jurisdiction were those engaged in the service of the
record room and library, and the officers who served by roster throughout the
night in the chief surgeon's office. Another of the duties discharged by the
chief of this division was the procurement of additional office space. Work
was increasing in a geometrical ratio and until after the armistice was signed
progressively greater expansions in accommodations were necessary.
It had been anticipated that the nine rooms assigned to the chief surgeon's
office in one of the French barracks at Chaumont would be ample for prospec-
tive needs, but they were soon outgrown and the problem of additional accom-
modations became very serious. This was solved as an incident to the transfer
of the chief surgeon's office to Tours, on March 21, 1918.
The extent to which personnel, records, office equipment, and supplies had
increased at Chaumont was evidenced by the fact that when the chief surgeon's
office moved to Tours an entire train was necessary for their transportation, in
contrast to one car which had been ample for the movement of the chief sur-
geon's office from Paris to Chaumont.
At Tours the chief surgeon's office occupied rooms in building No. 3 of the
French Barracks No. 66, but by September 1, 1918, it had so expanded that
the finance and accounts and the statistical divisions were moved to other
buildings.
No record was kept in detail of the vast amount of correspondence, reports ^
and returns which passed through the chief surgeon's office. It was decided
that the time necessary to count and tabulate the number of pieces of mail
could be used more advantageously otherwise. All these documents passed
through the record office. Incoming mail was opened in one office, taken to
the desk of the officer in charge of records and correspondence, and thence
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 87
distributed by him and his assistants to the different divisions of the chief
surgeon's office. Similarly, mail from the different divisions of the office, after
being signed by the respective chief, was concentrated here, examined, and sent
to the mailing room. By this means all the information passing in or out of
the office was so concentrated that the officer in charge of this division was
able to answer many inquiries coming over the phone or otherwise, without
reference to other divisions. This method also enabled him to follow up
many papers that might otherwise have been misplaced.
All telegrams were numbered beginning with No. 1 on the 1st of each month
so that any reply could refer to the number on this telegram and the sender
could be located without delay.
PERSONNEL °
(July 28, 1917, to July 15, 1919)
Lieut. Col. Robert A. Dickson, San. Corps, chief.
Maj. Arthur Morehouse, San. Corps.
Maj. Arthur W. Proctor, San. Corps.
Capt. William J. Fen ton, San. Corps.
Capt. Henry W. Kelly, San. Corps.
Capt. Frederick W. Mueller, jr., San. Corps.
Capt. Frank Steiner, San. Corps.
First Lieut. Orin F. Hallam, San. Corps.
First Lieut. Harry C. Hanford, San. Corps.
» In this list have been included the names of those who at one time or another were assigned to the division during
the period, July 28, 1917, to July 15, 1919.
There are two primary groups — the heads of the division or the section and the assistants. In each group names have
been arranged alphabetically, by grades, irrespective of chronological sequence of service.
CHAPTER V
THE PERSONNEL DIVISION
ACTIVITIES
After the office of tlie chief surgeon was organized on July 28, 1917, its
personnel division was charged with all matters having to do with personnel of
the several branches of the Medical Department, A. E. F.^ As in the Surgeon
General's office," this included all administrative control of their promotion
and assignment to station, and, in some instances, appointment.^ A dental
section of the personnel division was organized toward the end of August, 1917,
under the officer who was also dental surgeon for headquarters.^ The chief
of the Army Nurse Corps did not become a part of the personnel division in
the office of the chief surgeon, A. E. F., until that office moved to Tours in
March, 1918, when it absorbed the office of the chief surgeon. Services of
Supply, in which the chief of the Army Nurse Corps, A. E. F., theretofore had
been serving.^ The chief nurse then became the head of the Army Nurse
Corps section in the personnel division of the chief surgeon's office, A. E. F.^
Before August 29, 1918, officers and men pertaining to the veterinary service
were assigned to the remount service in the Quartermaster Department, and
until that date this personnel operated under that department.* Subsequent
thereto the members of the veterinary service were under the control of the
veterinary division which was then established in the chief surgeon's office.*
After the chief surgeon's office was fully organized the personnel belonging to
the dental, veterinary, and nursing services were, generally speaking, under
the administrative control of the chiefs of such services, and the head of the
personnel division exercised only an indirect supervision over their subordinates,
but requests for changes of assignment and other technical matters came to his
office as a phase of routine and in conformity with his general control.^
Though the personnel division of the chief surgeon's office eventually
exercised general administrative control, as outlined above, over all members of
the Medical Department in the American Expeditionary Forces, in certain
fields such responsibility was, in some degree at least, in subordinate offices.*
Thus before March 21, 1918, the personnel serving in the Services of Supply
was under the administrative control of the chief surgeon of that jurisdiction,
until his office was absorbed by that of the chief surgeon, A. E. F.* After the
chief surgeon's office, A. E. F., had moved to Tours its personnel division
maintained contact with the medical service in the zone of the armies through
the chief surgeon's representative at general headquarters.* In the several
armies Medical Department assignments were controlled by the respective army
surgeons. Authority was granted eventually to the director of professional
services to procure travel orders for consultants direct from the general head-
quarters,^ and the director of the division of laboratories and infectious diseases
» Consult Chap. Ill, Vol. I, of this history.
89
90
ad:ministrati()X, amkkk ax expeditionary forces
was authorized to request travel orders for his subordinates without reference
to the chief surgeon's office." With members of the Medical Department, who
were serving with one or another of our allies, the personnel division mamtamed
contact through the respective liaison officers accredited to the medical services
of those countries.8 Members of the sections of the United States Army
Ambulance Service, which were loaned to the French and Italian Govern-
ments, had a relationship with the chief surgeon's office in a few matters,
especially those pertaining to technical reports; but when some of these sections
were reloaned by those Governments to the United States, their members came
more directly under the control of the personnel division as elements of the
Medical Department, A. E. F., except in a very few matters; e. g., fragmenta-
tion of iinits.^ Authority for assignment of personnel within their jurisdiction,
and for promotion of enlisted men to certain grades, was granted the chief
surgeons of armies, corps, and divisions, to surgeons of territorial areas, and
the commanding officers of such Medical Department formations as hospital
centers.'"
A part of the Medical Department of the United States Navy, serving in the
American Expeditionary Forces, was under the control of the chief surgeon,
A. E. F., in conformity with the regulation which prescribed that when marines
were serving with the Army they would come under the jurisdiction of the
latter." Not only the medical officers and enlisted men on duty with the
marines, but also the personnel of Naval Base Hospital No. 1, assigned to their
service, therefore, came under the chief surgeon, A. E F." This personnel of
the Medical Department of the Navy increased from 5 officers and 34 enlisted
men in June, 1917, to 68 officers and 493 enlisted men in September, 1918, after
which month its strength gradually fell.^^ The highest number of its officers on
this duty was reached in January, 1919, when these totaled 12}^ This naval per-
sonnel included that on duty at Naval Base Hospital No. 1.^* located at Brest,
that serving with the marine bridge which formed a part of the 2d Division,'^
and four surgical teams. Naval Base Hospital No. 5, Brest, offered 200
beds to the Army but this was a purely naval institution in all other respects."
After the office of the chief surgeon, A. E. F., moved on March 21, 1918, to
Tours, orders affecting Medical Department personnel under the jurisdiction
of that command, were issued by headquarters, Services of Supply.^ Orders
affecting personnel in the zone of the armies, or on duty with the United States
Army Ambulance Service, were issued by general headquarters on request
of the personnel division of the chief surgeon's office or occasionally by tele-
phone on request of that division through the representative of the chief
surgeon with the general staff.^ More frequently in emergencies orders from
this source were obtained by telegraphic request upon the adjutant general,
A. E. F., at Chaumont.^
Headquarters of the special services — i. e., the professional services of the
Medical Department — were established in September, 1917, at Neufchateau.^
Here the professional services were directly under control of the chief surgeon's
office, until the reorganization of the American Expeditionary Forces in March,
1918, after which date the group was under concurrent jurisdiction of the
hospitalization division of that office at Tours and of the representative of the
ORGANIZATIOX AND ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 91
chief surgeon with the general staif, A. E. F., at Chaumont.* The consultants
supervised the professional work of the officers serving in their respective
specialties, and acted as agents of the personnel division, in so far as they
recommended assignments of the officers who were under their professional
supervision. Such recommendations were approved in practically all instances,
except that in some cases officers were held in certain positions for disciplinar}'
reasons.*
Orders issued on the recommendations of the senior consultants were at
first issued through the personnel division of the chief surgeon's office, but
later, because of the large increase in work involved, and in order to expedite
service, they were issued through the director of professional services stationed
at Chaumont who was authorized to procure them direct from general head-
quarters, A. E. F.* This led to complications at times because of the possi-
bility of general headquarters and headquarters. Services of Supply, issuing
conflicting orders concerning the same officer, but this system was otherwise
so generally advantageous that it was continued.*
Until the two offices were consolidated the personnel division in the office
of the chief surgeon, A. E. F., and in that of the chief surgeon, line of com-
munications, maintained very close contact.^ The personnel division of the
chief surgeon's office, line of communications, exercised control over all medical
personnel within its jurisdiction until January, 1918, when this authority was
decentralized, the surgeons of the several territorial sections of the American
Expeditionary Forces then assuming supervision of all medical personnel
within their respective borders, except that serving at base hospitals.^
Replacements were handled entirely through the Services of Supply.* A
medical casual depot at Blois was planned and practically organized when it
was taken over as a casual officers' depot.* It continued, however, to receive
and distribute Medical Department casuals until July, 1918, when this service
was transferred to the 1st Depot Division at St. Aignan.* This transfer was
made with a view of establishing a short course of training in field work at the
1st Depot Division, but it was never possible to carry out this plan because of
the constant shortage of Medical Department enlisted personnel which neces-
sitated the prompt use of all available men, the longest stay in the depot being
not more than two weeks.* The transfer was a disadvantage, since it occasioned
some delay in getting officers and men to points where they were needed at
once. This delay was due chiefly to lack of transportation.*
One of the greatest difficulties encountered by the personnel division of the
chief surgeon's office was that of keeping record of the stations of officers, nurses,
and men.* This difficulty was due to delays or losses of documents in the
mail, carelessness in rendering reports, and similar causes.* Perhaps the great-
est factor occasioning this difficulty was the fact that under general orders,
A. E. F., daily change reports were rendered direct to the central records
office, and many officers thought that these records were forwarded to the
chief surgeon.* It w^as not until after the armistice had been signed, w^hen
service became somewhat more settled, that it was possible to correct and
complete records, and even at the best there was always uncertainty concerning
the actual location of many officers, nurses, and enlisted men.* During the
92
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
suinmer of 1918 orders were issued that all personnel records were to l)e kept
hy the central records office and that no staff department should retain any
of them.-* This order was the result of the belief that centralization of records
was the only efficient method, and it undoubtedly would have prevented
duplication of them; but it was thought at that time by the chief surgeon's
office that such action would have utterly disrupted the medical service/
In point of fact the order was never carried into effect, and records of Medical
Department personnel were retained in the personnel division of the chief
surgeon's office until the end of the war.*
It was much more difficult to obtain accurate records of the casual officers
assigned to the British Expeditionary Force in France who arrived in the
period June to September, 1917, than the records of those on duty with Base
Hospitals Nos. 2, 4, 5, 10, 12, and 21 which had been attached to the British
in May and June of that year.'' Officers connected with these hospitals
were in much closer contact w ith the American Army than those casual officers
assigned to purely British units."* There was great difficulty at first in reaching
these latter officers, and because of their ignorance of regulations, general
orders, etc., they very seldom reported change of status.* In many cases
officers served with the British for months before the chief surgeon's office
had record of them, and in general it w^as difficult to obtain from them personal
reports.*
It was also very difficult to obtain recommendations for promotions for
officers serving with the British, and many of those concerned came to feel
that the Medical Department was not sufficiently interested in the matter.*
It would have been advantageous had there been a Medical Department
representative attached to the British headquarters in France for the purpose
of keeping in touch with these casual medical officers and of informing them of
the various orders which might affect their status.* The chief surgeon of the
American Second Corps was in liaison with headquarters, British Expeditionary
Force in France, but only in so far as corps interests were concerned.*
STRENGTH OF MEDICAL DEPARTMENT PERSONNEL
Personnel of the Medical Department increased from 7 officers and about
twice that number of clerks (including 2 enlisted men) in June, 1917,'^ to
a maximum of 174,083 on January 11, 1918,^^ but this great expansion was
effected only after repeated urgent requisitions.^^ A most important function
of the personnel division was to provide personnel to keep activities of the
Medical Department up to standard despite a constantly increasing shortage
of Medical Department personnel,* especially of officers and nurses.'^"
The acute needs of the Medical Department for personnel were consid-
erably relieved by the cessation of hostilities, and by the splitting up of two
depot and four combat divisions.^*' On November 16, 1918, a memorandum
was submitted to the effect that no more Medical Department units from
the United States were desired, but that there was need for the following
personnel of that department as casuals: 200 medical officers; 125 officers,
Dental Corps; 41 officers, Veterinary Corps; 1,500 nurses; 2,000 enlisted men,
" For details concerning shortage of Medical Department personnel consult Chap. I, Vol. VIII, of this history.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 93
Medical Department; and approximately 2,722 enlisted men of the Veterinary
Corps. The total personnel of the Medical Department in Europe on that
date was 15,407 officers, 8,593 nurses, and 126,281 enlisted men of whom
944 officers, 656 nurses, and 1,314 men were serving with the British. Arrival
of additional personnel and the decrease in the number of admissions led
to a slight surplus in Medical Department personnel for the whole A. E. F.,
but it was soon absorbed through the return of officers and men to the United
States."
By November 30, 1918, Medical Department personnel totaled 163,841
officers, nurses, and enlisted men; i. e. 8.6 per cent of the American Expedi-
tionaTy Forces.
The following tabulation of Medical Department personnel shows the
bimonthly totals from June 1 to November 30, 1918.* In some cases these
totals are only approximate, as reports of arrivals of personnel were often
delayed in the mails.*
OfiBcers
Nurses
Enlisted
men
June 1, 1918 -
5, 198
9,601
14, 483
17, 487
2,539
4,735
7, 522
8,951
30, 674
67, 140
104, 557
137, 403
Aug. 3, 1918
Oct. 5, 1918._ _. ---
Nov. 30, 1918_
Medical Department personnel pertaining to the Navy also served in the
American Expeditionary Forces supplementing that of the Army. In Novem-
ber, 1918, this personnel numbered 62 officers and 416 enlisted men. The
highest number of officers, nurses, and enlisted men reported severally in the
American Expeditionary Forces at any time was as follows:* Officers, 18,146;
nurses, 10,081; enlisted men, 145,815.
Totals were not reached by the foregoing classes of personnel simultane-
ously. The highest grand total of Medical Department personnel collectively
was reported as follows under date of January 11, 1919.'^
Officers 17, 767
Nurses 9, 994
Enlisted men 145, 815
Civilian employees 507
Total 174,083
These totals should actually show as of the first week in December as there
were no Medical Department arrivals subsequent to that date, but because
of delay in receiving reports the full strength was not recorded finally until
the week ending January 11, 1919.^^
94
ADMIMSTKATIOX. AMERICAN EXPEDITIONARY FORCES
The grades held by this personnel and the branches of the service to
which the members therein pertained were as follows:
Table 1. — Medical Department personnel, American Expeditionar)/ Forces, January 11, 1919'^
WITH UNITED STATES
ARMY
Officers:
M. C...
S. C...
D. C...
V. C...
A. A. S.
Soldiers
Nurses
Civilians. . .
Total.
WITH BRITISH
Officers:
M. C.
S. C
D. C.
Soldiers...
Nurses
Civilians.
Total.
WITH FRENCH
Officers:
M. C_
S. C
D. C.
A. A. S
Soldiers
Total.
WITH ITALIANS
Officers:
M. C.
S. C
D. C
A. A. S
Soldiers..
Total
Grand total.
Weekly net loss,.
Weekly net gain.
Briga-
dier
gen-
erals
Colo-
nels
Lieu-
ten-
ant
colo-
nels
102
302
1
Majors
1,409
14
42
52
Cap-
tains
4,315
144
321
107
1
203
3
5
First
lieu-
ten-
ants
Sec-
ond
lieu-
ten-
ants
6,672
442
1,430
330
27
Total
officers
12,803
1,183
1,805
885
28
624
6
4
16,704
5
2
111
Total
enlisted
men
139, 788
1,313
Total
nurses
9,455
9, 455
539
539
3,704
3,704
1,010
,994
63
Total
civil-
ians
492
Grand
total
12,803
1,183
1,805
885
28
139, 788
9,455
-492
166,439
859
14
11
1,313
539
15
2,751
5
2
111
3,704
3,803
18
1
1
33
1,010
483
» Includes seven contract surgeons.
The work of the personnel division increased during December, 1918, because
of the large number of applications for immediate return to the United States
for discharge.* It w as estimated that 6,000 of these applications were received,
70 per cent of them from officers who had arrived overseas after September 1,
1918.* On December 2, in Circular No. 52, the chief surgeon issued instructions
to personnel concerning their return to the United States. Many casual officers
were released shortly after the beginning of the armistice, mainly for the pur-
pose of returning to the United States for discharge because of their affiliation
with colleges.* On account of the number of these releases it became necessary
to hold many other officers also desiring immediate return.*
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 95
General Orders, No. 4, G. H. Q., A. E. F., January 4, 1919, directed that
individuals would not be discharged in Europe without specific authority — in
each case from headquarters, A. E. F. If applications for discharge in Europe
were approved, individuals seeking such discharge were to be sent to the dis-
charge camp, St. Aignan. Other instructions concerning return to the United
States or discharge in Europe were published during the same month by General
Orders, No. 17, G. H. Q., A. E. F., January 25, 1919, and General Orders,
No. 20, G. H. Q., A. E. F., January 30, 1919, and by other later orders issued
by headquarters of the American Expeditionary Forces, or of the Services of
Supply. Instructions on the subject were also published in Embarkation
orders issued as a separate file, by headquarters, Services of Supply.
Release of a large number of base hospitals for return to the United States
within a few weeks after the beginning of the armistice, necessitated removing
certain of the junior officers from each of these units, in order to supply demands
for personnel from the army of occupation and from the various base sections,
and also to replace some officers of long service in the American Expeditionary
Forces w^ho had urgent reasons for return to the United States.^
By the middle of January, the weekly net loss of officers had reached 400,
and after that date it ran from 100 to 600 each week.* On March 1, it was
reported that the drain on the Medical Department personnel, because of
attendance at various universities, had again created a somewhat difficult situa-
tion.* A large number of applications for return to the United States were now
being disapproved except in unusual cases.* The movement of personnel
belonging to base hospitals was increasing, but it was necessary to retain at
least 50 per cent of the officers of those units which had been in France less than
one year, and assign them to other organizations.* By March, personnel was
returning to the United States at the rate of 300 officers, 300 nurses, and 2,000
enlisted men per week.^^
The entire United States Army Ambulance Service on duty with the
Italian forces was returned to the United States about April 1, 1919.*
On April 26, 1919, when about one-half of the American Expeditionary
Forces had been returned to the United States, the Medical Department per-
sonnel remaining in France was : *
Officers 12, 544
Nurses 6, 238
Enlisted men 21, 351
Civilians 347
By May 3 1 , the figures were as follows : * •
Officers 9, 7 6
Nurses 4, 837
Enlisted men 95, 957
Civilians 243
13901—27 7
96 ADMINISTRATION, AMEKK AN EXPEDITIUNAHV FORCES
On May 31, only one medical officer remained on duty with the British
Expeditionary Forces.^ By July 12 the personnel status of the Medical De-
partment was as follows:'^
Table 2. — Medical Department personnel, American Expeditionary Forces, July 12, 1919
Briga-
generals
Colo-
nels
Lieu-
tenant
colo-
nels
Mrtjors
Cap-
tains
First
lieu-
tenants
Sec-
ond-
lieu-
tenants
Total
officers
Total
enlisted
Total
nurses
Total
civil-
ians
Grand
total
WITH UNITED STATES
ARMY
Officers;
M. C
3
62
134
3
10
2
2
571
38
30
12
2
1,913
188
176
38
1
1,318
187
201
89
10
4,001
635
422
213
15
4, 001
635
422
213
15
27,846
2,239
157
S. C ----
219
D. C.
5
V. C
72
A. A. S
t
27, 846
2,239
-157
Total
5, 286
27, 846
2, 239
157
35,528
LOSSES SINCE LAST
REPORT
Officers:
M. C
3
10
92
4
10
2
145
7
37
4
1
95
11
48
2
2
345
37
96
16
3
345
37
96
16
3
24, 583
473
19
S. C
15
D. C
1
2
V. C..._
6
A. A. S-..
24, 583
473
1
19
Weekly net loss -
497
24, 583
473
19
25, 572
° Includes two contract surgeons.
The personnel status on August 31, when the American Expeditionary
Forces was succeeded by the American forces in France and the American forces
in Germany was as follows:
Table 3. — Consolidated daily field report of Medical Department personnel, S. 0. S.,
August 31, 1919
Officers
Enlisted men
Nurses
Med-
ical
Corps
San-
itary
Corps
Den-
tal
Corps
Vet-
eri-
nary
Corps
Mas-
ter
hos-
pital
ser-
geant
Hos-
pital
ser-
geant
Ser-
geant
first
class
Ser-
geants
Cor-
porals
Cooks
Wag-
oners
Pri-
vates
first
class
Pri-
vates
Total
en-
listed
Base Section No. 1--.
Base Section No. 2
Base Section No. 5
Advance section
Intermediate section-
District of Paris
36
25
127
25
13
19
16
7
2
5
14
1
2
2
2
7
6
4
16
5
6
4
2
2
6
5
1
1
1
5
1
2
6
2
3
3
4
8
3
7
6
1
10
25
21
63
5
9
9
10
10
35
30
146
19
9
15
14
6
24
23
63
5
5
11
4
16
11
102
3
5
4
9
15
2
81
1
1
89
93
648
49
29
39
45
4
81
74
482
66
38
39
11
289
258
1,598
1.54
98
123
104
37
9
20
98
18
15
30
12
1
Arrondisementof
Tours -
1
Office of chief surgeon-
Total
268
35
43
15
20
37
150
274
142
150
101
996
791
2,661
203
OKGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 97
PROMOTIONS
Though the promotion section of the chief surgeon's office was never under
the direct control of the personnel division, it is discussed at this point because
of its close association therewith.* This very important duty was under the
immediate control of the executive assistant to the chief surgeon, who formu-
lated the general plan for promotion, as prescribed in Circular No. 3, chief sur-
geon's office, and who gave this subject his immediate attention.^ He was
assisted in this service by a commissioned officer who was engaged in no other
duty.^
Early in the existence of the American Expeditionary Forces promotions
were made by the War Department upon the recommendation of the chief
surgeon and the Surgeon General, but this system was later abandoned and
all promotions in the Medical Department had to be approved by the com-
mander in chief.*
The need for making promotions in the Medical Corps of the American
Expeditionary Forces was especially urgent because most Medical Reserve
Corps officers were commissioned in the lowest grade (first lieutenants), origi-
nally the only grade provided under the law.* Among these were capable men
who had been in the practice of medicine 15 or 20 years. It was the intention
of the Surgeon General that these officers be given prompt promotion as soon
as their fitness for positions of increased responsibility was demonstrated; but
the machinery for promotion presented unexpected difficulties in the American
Expeditionary Forces, and for this reason the proportion of lieutenants at the
cessation of hostilities was about 60 per cent, instead of the 14 per cent pro-
vided by law.*
It is certain that many of the medical officers, serving with the British
especially, did not receive the promotions to which the law and the character
of their services entitled them.* They failed to get merited promotions, because,
in addition to the obstacles, delays, and accidents which characterized the
history of promotions of Reserve Corps officers serving under the immediate
jurisdiction of the American Expeditionary Forces, there were the added delays
incident to mail communications with the British Expeditionary Force, and the;
great difficulty of getting from the nine hundred or more officers on duty with
the British, the reports of "Character of service and qualifications" upon which
was based the roster which determined their promotions up to and including
the rank of major.*
Very few promotions were made during the first 10 months of the American
Expeditionary Forces.* Those proposed by the chief surgeon were disapproved,
as a rule, on the ground that a definite and methodical scheme of promotion
which would do justice to all, as nearly as possible, should be presented before
the commander in chief would be willing to make promotions except in very
special cases.* A scheme was finally worked out and presented to the command-
ing general, Services of Supply, on May 17, 1918, by whom it was forwarded
on May 19 with the following indorsement:
Heretofore I have generally disapproved recommendations for promotions in the Medical
Corps because they have come as isolated cases and presented no facts by which a reasonable
judgment could be formed as to the relative merits of the particular case, in comparison with
98
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the entire body of medical officers.* As this paper presents a i)lan wliich appears to me to
be comprehensive, legal, and reasonable, I approve of it and reconinicnd that it be adopted
as the basis for promotions of officers in this corps serving witli the American Expeditionary
Forces in Europe.*
The plan in question is given in Circular No. 36, chief surgeon's office, June
11, 1918, which is reproduced in the appendix of this volume. It was formally
approved by the commander in chief June 27, 1918.^ The first list of officers
recommended for promotion under it was forwarded on June 15, and five other
lists in July.* Later it was learned that these lists were not forwarded from
general headquarters until about August 10.* After that date lists sent in were
forwarded much more promptly.* As was true in other branches of the service,
promotions of lieutenants were not cabled to Washington but were sent by
courier, and even in the case of those recommended for promotion to higher
grades, the inevitable delays in the War Department made the process of get-
ting them through very slow.*
On September 4 the chief surgeon in common with other administrative
chiefs, was informed by the adjutant general, A. E. F., that no more promotion
lists were to be forwarded to Washington, as a new War Department general
order on the subject of promotions (General Orders, No. 78, War Department,
August 22, 1918) was en route from the United States.* It was hoped that this
order, which authorized the commander in chief, A. E. F., to make promotions up
to and including the grade of colonel (subject to confirmation by the War De-
partment), would greatly simplify and expedite promotions in the American
Expeditionary Forces, but this expectation was not realized, the opinion having
been advanced that in order to determine the question whether vacancies existed,
an approved table of organization was necessary.* On September 20 the chief
surgeon, A. E. F., wrote to the adjutant general, A. E. F., that as the law provided
that there should be a certain proportion of medical officers in each grade,
the number of these vacancies could readily be determined by applying the
proportions to the total number of medical officers in the American Expedi-
tionary Forces.* He added that an agreement had been made with the Surgeon
General, by which the commander in chief, A. E. F., could make promotions
up to the authorized proportion in each grade for the medical officers in the
American Expeditionary Forces.* These proportions, as established in Bulletin
59, general headquarters, A. E. F., August 16, 1918, were as follows for the
Medical and Dental Corps and presumably for the Veterinary Corps:* Colonel,
3.16; lieutenant col., 5.42; major, 23.70; captain, 53.90; first lieutenant, 13.82.*
The strength of the Sanitary Corps was 1 per 1,000 of the total strength of
the military forces, the number in each grade being proportional to the number
authorized by law for the corresponding grades of the Medical Corps.* No
grade above that of major was authorized by this order.* To this the adjutant
general, A. E. F., replied as follows on September 24:*
It will be necessary to have the War Department approve the aggreement between
the Surgeon General and the chief surgeon before the commander in chief will be authorized
to promote by temporary appointment, subject to confirmation by the War Department,
except where there is a vacancy in a table of organization authorized by the W^ar Department.
The question of the applicability of General Orders, No. 78, to the Medical
Department of the American Expeditionary Force was then taken up and
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 99
was referred to the War Department by the commander in chief in a cable
dated October 11.* To this the Chief of Stafl" replied on October 19, stating
that this order did not apply to the Medical Department, but it was learned
later that the negative in this cable reply was an error in coding.* When
the matter was again presented by the commander in chief, on October 28,
for reconsideration, he was informed by cable of November 5 that his request
for authority to promote medical officers was approved.* The chief surgeon
was informed on November 7 of this decision, but four days later the armistice
was signed and all temporary promotions were stopped.* The best use possible
was made of this short period by securing 680 promotions, but there remained
about 6,500 vacancies for men who were entitled to promotion by law and
by the character of their service.*
On December 9, 1918, the following estimate of Medical Corps officers
on duty in the American Expeditionary Forces, the legal allow^ances and
vacancies on a basis of 1,500,000 men was formulated by the representative
of the chief surgeon with the general staff.^^
ALLOWANCE
Legal
percentage
Basis,
1,500,000
On duty,
American
Expedi-
tionary
Forces
116
333
1,543
4,608
7, 432
Vacancies
Colonel -
3. 16
5. 42
23. 70
53. 90
13. 82
332
569
2, 489
5, 660
1,450
116
236
946
1,052
1 5, 982
Lieutenant colonel ---
Major -
Captain _
First lieutenant -
100. 00
10, 500
14, 032
> E.xcess.
On January 15, 1919, a list of recommendations w^as forwarded for pro-
motions, including 85 lieutenant colonels to the grade of colonel, 282 majors to
the grade of lieutenant colonel, 932 captains to the grade of major, and 2,457
lieutenants to the grade of captain.* These were approved and published in
orders on February 17, 1919.* This list did not by any means exhaust
the possibihties, as there yet remained the following vacancies:* 241 in the
grade of colonel, 293 in the grade of lieutenant colonel, 1,151 in the grade of
major, and 1,323 in the grade of captain. The regular officers recommended
on this list were not promoted until about May 1, 1919.* Another list of 1,171
names received favorable action on May 2, 1919, but several hundred deserving
officers whose active service dated from 1917 remained unpromoted when the
chief surgeon was notified that no further recommendations should be for-
warded.* In most of these instances the recommendations had not been
forwarded at an earlier date because the medical officers whose duty it was to
forward the reports of character of service and qualifications had failed to give
the necessary data which were called for by the scheme of promotion, such as
age, length of active service, date of last promotion.*
The following table shows the larger fists of recommendations for promo-
tion made by the chief surgeon, and favorably acted upon by the War Depart-
ment or general headquarters, A. E. F.:*
100
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Recommended
1918
May 1".
June 15.
June 21 .
July 6..
July 15.
July 18.
July 19.
July 29.
Aug. 5--
Aug. 12.
Aug. 21.
Sept. 4..
Oct. 10.
Oct. 27..
Nov.
1919
Jan. 15..
Apr. 19.
To-P- Tomajor
120
36
74
82
129
49
.58
261
2,290
764
33
15
63
54
52
24
27
136
807
321
To lieu-
tenant
colonel
225
83
3,911
1,613
To colo-
nel
Total
Where promoted
112
21
1
103
24
11
2
161
51
137
136
181
136
141
403
3, 391
1, 171
6,182
War Department.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
General headquarters
Do.
Do.
Do.
Do.
Many of the officers recommended for promotion in the list of January 15,
1919, did not receive it because of delay in announcing the promotions and the
fact that before this was accomplished these officers had sailed for the United
St ates.*
Similarly, of those officers whose promotions were announced on February
17, 1919, 419 officers did not notify the personnel division of the chief surgeon's
office or general headquarters of their acceptance of commission, the majority
of them having sailed for the United States within a very few days of the date
they would have received their promotions.*
Delays in promotion were attributed by the chief surgeon to the follow-
ing circumstances: Delays in the personnel section, general headquarters,
A. E. F.; delay due to transmission to Washington, and in securing prompt
action there; delay of two months due to discussion concerning applicability
of General Orders, No. 78, War Department, 1918, to the Medical Corps;
discontinuance of promotion for some months after the armistice began.
THE SANITARY CORPS
Under laws enacted prior to the World War none except a person holding
a doctorate degree in medicine or denistry could be commissioned in the Medi-
cal Department; however, after we entered the war, and in order to meet the
need for sanitary engineers, chemists, administrators, etc., a new branch of
the Medical Department, entitled the Sanitary Corps, was organized under
the authority granted by the act of May 18, 1917.^^ The officer personnel of
this new corps was not to exceed one-tenth of 1 per cent of the total Army
strength; the number of enlisted men was to be determined by the Secretary
of War.^^ The number of officers in the several grades was to be proportionate
to that of corresponding grades of the Medical Corps, but, as originally pre-
scribed, no grades were provided for in the Sanitary Corps above the grade of
major.
STRENGTH
The Sanitary Corps in the Americn Expeditionary Forces comprised
officers, already commissioned, who were sent to France, and others commis-
sioned overseas. 2^ In order that vacancies in this corps would not all be filled
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 101
by men sent from the United States, on May 25, 1918, General Pershing noti-
fied the Surgeon General that he desired to hold vacancies in the Sanitary
Corps, in units already overseas, for men to be promoted from such units,
and that he did not wish to have additional Sanitary Corps officers sent to
France to fill the positions." Eventually, this arrangement brought up the
question as to how many persons could be commissioned in the Sanitary Corps
in France, so on October 30, 1918, General Pershing sent another cablegram
to the War Department, in which it was asked how the strength of the Sani-
tary Corps was to be determined and what proportion would be allowed in
each grade. On November 8, War Department answered to the effect that
under General Orders, No. 80, War Department, 1917, the allowances of the
Sanitary Corps were colonels, 1; lieutenant colonels, 5; majors. 111; captains,
1)36; first lieutenants, 975; second lieutenants, 802.^^
The strength of this corps increased gradually until 1,185 of its officers
were serving in the American Expeditionary Forces on January 4, 1919.^'
This number amounted to 7.03 per cent of all officers of the Medical Depart-
ment, A. E. F}'
PROJECT FO*R TRANSFERRING CERTAIN AMERICAN RED CROSS
PERSONNEL TO SANITARY CORPS
On October 3, 1918, the commander in chief notified the Secretary of
War that the American Red Cross representative and the chief surgeon, A.
E. F., desired that such parts of the American Red Cross personnel as were
serving the armies in Europe be incorporated in the Sanitary Corps.^° The
commander in chief approved this policy in order that coordination might be
perfected, and requested that the Sanitary Corps of the xA.rmy be enlarged
sufficiently to permit such absorption, that he be authorized to enlist American
Red Cross personnel and to make appointments of American Red Cross officers
in appropriate grades of the Sanitary Corps.^" This authorization he asked
for was to include 1 colonel, 2 lieutenant colonels, and others in grades propor-
tional to those provided for in existing orders. The number of officers to be
commissioned under the authority thus requested would not exceed 750 and
the number of enlisted men would not exceed 1,500.^° It was not intended
that this absorption of American Red Cross personnel would change materi-
ally the duties in which that organization was engaged.^^
On October 11, the commander in chief further cabled that it was not
intended that American Red Cross officers should be appointed in the Sanitary
Corps unless they were mentally, morally, and physically qualified. He
added that commissioning officers from the American Red Cross should not
give members of other societies grounds for urging like action for their own
members, for the reason that the American Red Cross personnel serving the
armies were performing the same duties as was the Medical Department of the
Army.^^ He expected that American Red Cross officers appointed in the
Sanitary Corps would remain, in general, in their then duties but would be
subject to general assignment.^^
This project for the transfer of American Red Cross personnel to the
Sanitary Corps never materialized.^^
102
ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
DUTIES
The majority of the officers of the Sanitary Corps in the American Expedi-
tionary Forces were assigned to hospitals where they discharged such duties
as adjutant, mess officer, and property officer. On the whole, however, the
duties discharged by officers of the Sanitary Corps were quite diversified,
comprising, in addition to those referred to above, duties as accountants,
architects, interpreters, opticians, those connected with certain phases of gas
defense, and in connection with rodent destruction.^^
PROMOTIONS
In this corps, as in other branches of the Medical Department, promotions
were not commensurate with vacancies. On April 19, 1919, to cite but one
illustration, the chief surgeon recommended that promotions be made in the
Sanitary Corps to fill the vancancies then existing.^^ Those in the grade of
lieutenant colonel then numbered 59; major, 126; captain, 162; while excess
proportions of officers in the grade of first and second lieutenants, respec-
tivelv, were 22 and 327.^^
CONTRACT SURGEONS
The few contract surgeons in the service of the Medical Department
overseas, like medical officers, were directly under the jurisdiction of the chief
of the personnel division, and not of any separate section of his office.* The
general circumstances in which they were employed are discussed in the first
volume of this history. The authority enjoyed by the Surgeon General to
employ contract surgeons subject to the approval of the Secretary of War ^*
was also delegated to the chief surgeon, A. E. F.^^ Among their number were
women who were engaged as anesthetists, laboratory technicians, and in certain
other duties as required. The total number of men and women serving as
contract surgeons in the American Expeditionary Forces was 13, of which
number there were 2 men and 11 women.^^
PERSONNEL"
(July 28, 1917, to July 15, 1919)
Maj. Gen. M. W. Ireland, M. C, chief.
Col. E. M. Welles, M. C, chief.
Col. W. H. Thearle, M. C.
Lieut. Col. J. S. Coulter, M. C.
Lieut. Col. J. W. Meehan, M. C.
Maj. W. Denison, M. C.
Maj. Clarence S. Ketcham, M. C.
Maj. E. H. Rogers, San. Corps.
Capt. J. H. Mael, San. Corps.
Capt. P. J. Skelly, San. Corps.
First Lieut. A. S. Callaway, San. Corps.
First Lieut. D. E. Mannix, San. Corps.
" In this list have been included the names of those who at one time or another were assigned to the division
dm-ing the period July 28, 1917, to July 15, 1919.
There are two primary groups — the heads of the division or the section and the assistants. In each group names
have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 103
REFERENCES
(1) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 28,
1917. Subject: Weekly war diary. On file. Historical Division, S. G. O.
(2) War diary, chief surgeon's office, A. E. F., September 5, 1917.
(3) War diary, chief surgeon's office, A. E. F., March 24, 1918.
(4) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file.
Historical Division, S. G. O.
(5) Report from Maj. Edward M. Welles, jr., M. C., chief of personnel division, A. E. F.,
to the Surgeon General, U. S. Army, April 10, 1924. Subject: Personnel activities.
On file, Historical Division, S. G. O.
(6) Report from Col. W. L. Keller, M. C., director of professional services, A. E. F., to the
chief surgeon, A. E. F., December 31, 1918. Subject: Brief outline of the organiza-
tion and activities of the professional services between April, 1918, and December 31,
1918. On file, Historical Division, S. G. O.
(7) Report from Col. J. F. Siler, M. C, director of laboratories and infectious diseases, to
the chief surgeon, A. E. F. (not dated). Subject: Activities of the division of lab-
oratories and infectious diseases, from August, 1917, to July, 1919. On file, Historical
Division, S. G. O.
(8) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lystcr, M. C, June 11, 1917.
Subject: Administration of American medical personnel serving with British Service.
On file. Record Room, S. G. O. (9795).
(9) Official report from the chief of the U. S. Army Ambulance Service with the French
Army, April 15, 1919, by Col. Percy M. Jones, M. C. On file, Historical Division,
s. g". O.
(10) Circulars, chief surgeon's office, A. E. F. No. 36, June 11, 1918; No. 38, July 11, 1918;
No. 45, August 13, 1918; No. 50, October 4, 1918; No. 54, November 9, 1918.
(11) Report of the Medical Department activities of Base Section No. 5, including Naval
Base Hospital No. 5, compiled under the direction of, and submitted by, the base
surgeon, to the chief surgeon, A. E. F. (undated). On file. Historical Division,
S. G. O.
(12) Weekly numerical reports of personnel of the Medical Department, A. E. F. On file,
Historical Division, S. G. O.
(13) Report of strength of the A. E. F., by months, as shown by the consolidated returns
for the American Expeditionary Forces. On file, Returns Section, Miscellaneous
Division, A. G. O., January 12, 1924.
(14) Report of Medical Department activities at Naval Base Hospital No. 1 (undated), by
the commanding officer. On file. Historical Division, S. G. O.
(15) Report of the Medical Department activities of the 2d Division (undated) by the divi-
sion surgeon. On file, Historical Division, S. G. O.
(16) Report on movement of surgical teams (undated) by the director of professional services,
A. E. F. On file, Historical Division, S. G. O.
(17) Wadhams, Sanford H., Col. M. C, and Tuttle, Arnold D., Col., M. C: Some of the
Early Activities of the Medical Department, A. E. F. The Militartj Surgeon,
Washington, 1919, xlv. No. 6, 636.
(18) War Diary, chief surgeon's office, A. E. F., January 11, 1919.
(19) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April 17,
1919. Subject: Medical Department activities, A. E. F., to November 11, 1918.
On file. Historical Division, S. G. O.
(20) War Diary, chief surgeon's office, November 20, 1918.
(21) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., March
20, 1918. Subject: Activities of chief surgeon's office. On file. Historical Division,
S. G. O.
(22) Embarkation Instructions, Headquarters, Services of Supply No. 1, November 20, 1918,
to and including No. 30, August 7, 1919. On file, A. G. O., World War Division,
321.1 (Embarkation Service).
104
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(23) Memorandum from Lieut. Col. E. M. Welles, jr., to Col. S. H. Wadluims, M. C,
deputy of chief surgeon with General Staff, December 9, 191S. Subject: Table
showing allowance of officers of all grades for A. E. F. on a basis of 1,500,()()() men.
On file, A. G. O., World War Division, chief surgeon's files (320.21).
(24) Letter from the chief surgeon, A. E. F., to Maj. James A. Shannon, Inf., chief of person-
nel. General Headquarters, August 4, 1918. Subject: Promotions. On file. Histori-
cal Division, S. G. O.
(25) General Orders No. 80, W. D., Washington, D. C, June 30, 1917.
(26) Statement based on a study of general correspondence concerning the Sanitary Corps.
On file. World War Division, A. G. O., chief surgeon's files (211.234).
(27) Cable No. 1178-S, par. 5, from General Pershing to Chief of Staff and Surgeon General
of the Army, May 25, 1918.
(28) Cable No. 377-S, par. 1, from the chief surgeon, A. E. F., to The Adjutant General,
U. S. Army, for the Surgeon General, October 30, 1918.
(29) Cable No. 252-R, par. 2, from the Surgeon General to the chief surgeon, A. E. F.,
November 8, 1918.
(30) Cable No. 1738-S, par. 1, subpar. D, from General Pershing to The Adjutant General
of the Army, October 3, 1918.
(31) Cable No. 1780-S, par. 1, subpar. C, from General Pershing to The Adjutant General
of the Army, October 11, 1918.
(32) Cable No. 2095-R, par. 1, from The Adjutant General of the Army to General Pershing,
October 23, 1918.
(33) Letter from the chief surgeon, A. E. F., to the commander in chief, April 19, 1919.
Subject: Promotions of officers in the Sanitary Corps, Medical Department. On
file, A. G. O., World War Division, chief surgeon's files (211.234).
(34) U. S. Compiled Statutes 1916 (act of February 2, 1901, C. 192, sec. 18), 31 Stat. 752.
(35) Memorandum from legal reference section to Capt. E. J. Berry, S. C, January 10,
1919. Subject: Contract surgeons. On file, A. G. O., World War Division, chief
surgeon's files (211.26).
(36) Contracts between the chief surgeon, A. E. F., and Dr. Paul Gallagher, October 9, 1918,
and Dr. H. B. Marville, August 1, 1918. On file, A. G. O., World War Division,
chief surgeon's files, the first contract under 201 (Gallagher), and the second con-
tract under 211.25 (Contract Surgeons).
(37) Letter from Dr. Esther C. Leonard, contract surgeon, to commanding officer, hospital
center at Vichy, December 5, 1918. Subject: Quarters; contract between the
commanding officer, hospital center at Vichy, and Dr. Anna Tjomsland, December
4, 1918. Both on file, A. G. O., World War Division, chief surgeon's files, 211.26.
Statement of service furnished to The Adjutant General, LT. S. Army, V^y the Surgeon
General, June 30, 1922. Subject: 9 contract surgeons (female) V. S. Army, who
served overseas. On file, Personnel Division, S. G. O.
CHAPTER VI
THE DENTAL SECTION
The dental subdivision of the chief surgeon's office, though part of the
personnel division/ was in a large degree separate therefrom.- Because of
its relationship with the personnel division, its activities are considered here,
though these were of a much wider character than control of dental personnel
alone. It exercised both general and technical control over all matters affect-
ing the dental service throughout the American Expeditionary Forces; e. g.,
dental laboratories, procurement and distribution of dental supplies, dental
organization, professional dental service, and liaison with the maxillofacial
services.^
In view of the fact that the dental service was not classed among the pro-
fessional services and, therefore, can not logically be discussed with them in
another part of this volume or in others, it appears expedient to consider here
not only the activities of the dental section of the chief surgeon's office, but of
the administrative activities of that service as a whole.
On June 12, 1917, General Pershing cabled through the American ambas-
sador, London, to the Secretary of War, requesting that the senior dental
officer of the Army be sent to France with the second convoy of troops, there
to establish a depot and organize work, and that dental officers be sent with
all troops in proper proportion.^ Confidential orders were issued by the War
Department, June 25, 1917, in compliance with the above request.* During
a conference with the Surgeon General of the Army, prior to embarking, the
dental officer in question made request for authority to organize and take with
him a dental corps unit, to be composed, with himself, of six specially qualified
dental surgeons.^ This request was granted, the necessary telegraphic orders
were issued, and the members of this unit assembled in New York City, July
10-15.^ Regulation field equipment and supplies, with which the five officers,
other than the chief of this group were supplied, were augmented through
purchase of complete laboratory equipment and supplies, and special oral
surgical instruments and appliances.^ Transportation was secured with the
second convoy, due to sail on or about July 28.-'
During the latter part of June the Surgeon General had also requested
orders directing 20 members of the newly organized Dental Service Corps to
proceed to New York for transportation with the second convoy of troops. -
Several members of this corps, attached to Base Hospitals Nos. 8 and 9 and
to the First Regiment of Engineers, were at this time also assembled at the port
of embarkation, and a total of approximately^ 30 dental officers were provided
transportation with the second convoy.^ Unfortunately, all the equipment and
supplies of the First Army Dental Corps Unit was submerged in the sinking
of the vessel on which its members were embarked, and though a large por-
tion of the equipment and supplies was rescued several weeks later, it proved
worthless and a total loss.^ The unit was reequipped by the local medical
supply depot and finally sailed early in August, 1917.^
105
106
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Upon arrival in France, all the dental officers destined lor organizations
of the 1st Division proceeded to the division training area to join their com-
mands; those attached to base hospitals accompanied these organizations to
their station, and all personnel of the First Dental Corps Unit proceeded in
accordance with their orders to headquarters, A. E. F., then in Paris, where,
on August 22, 1917, the head of this group reported to headquarters. ^ He was
then directed to report to the chief surgeon for duty as assistant in matters
pertaining to the dental branch/
Plans for the organization of the Medical Department, A. E. F., already
under way, contemplated the utilization of dental personnel in several newly
created administrative positions. At a conference in the chief surgeon's office,
it was decided that the First Dental Corps Unit should be broken up and its
personnel assigned to stations where technical administration and supervision
would be required.^ Its members were then individually assigned to the
office of the chief surgeon; headquarters, Field Artillery brigade, Le Valdahon;
headquarters, 1st Division, Gondrecourt; Medical Supply Depot, Cosne; head-
quarters, field hospital company, 1st Division, Gondrecourt training area; and
to the dental clinic at headquarters, A. E. F.^
Throughout the war, the dental section continued to function as a part of
the personnel division in the chief surgeon's office, moving with it to Chaumont
on September 1, 1917, and later to Tours in March, 1918.^
When headquarters, A. E. F., were moved to Chaumont, a headquarters
dental clinic was established there. ^ Here two complete field outfits and a
laboratory were installed under direction of the senior dental surgeon, and
began operating within 48 hours after the establishment of headquarters. This
establishment continued its activities until the last day those headquarters
remained at Chaumont.^
During September and October, 1917, plans were formulated and their
application inaugurated for an organization which would direct and control
the dental service of the great number of troops expected.^ Consideration was
given to providing administrative positions whose occupants w^ould supervise
the professional and official service of dental officers on duty with major com-
mands; to the assignment of specially selected dental officers to supply depots
and service schools, and to provision of professional consultants of chief clini-
cians at important hospitals and of oro-dental specialists qualified for service
at maxillofacial hospitals.^ The organization of the office of the senior dental
surgeon was completed and plans were made for the instruction of all dental
officers holding administrative positions.^ Instruction was given to a large
degree by means of correspondence between the chief of the dental section
and his subordinates. This was supplemented by his frequent inspections at
the several divisions and hospitals within the training areas. Instruction of
di vision dental surgeons began with the establishment of a school for them in
the 1st Division on September 15.^
On October 12, 1917, a cablegram was received from the Surgeon General's
office, announcing that the Army Dental Corps reorganization bill had been
signed by the President on October 6, 1917.^ Office orders were then issued
assigning the senior dental surgeon to duty as chief dental surgeon, under general
ORGAXIZATIOX AND ADMIXISTEATIOX OF CHIEF SURGEON'S OFFICE 107
direction of the chief surgeon, A. E. F., and on October 27 his duties became
wholly those of an administrator and director of the de-ntal service, A. E. F.^
Though technically belonging to the personnel division of the chief surgeon's
office, he was provided a separate office and clerks. During October and Novem-
ber, further consideration was given to the preparation of adequate plans for the
organization of the Dental Corps on the comprehensive lines necessary to meet
the need of an army of 1,000,000 men.^
Shortly after the arrival of the chief surgeon's office at Tours, in March,
1918, the office personnel of the dental section was increased by 2 sergeants,
Medical Department, for the record room and 1 additional enlisted stenographic
clerk.^ Thereafter from time to time the division expanded to meet the
requirements of increased service until, in addition to the commissioned per-
sonnel, it had a maximum of 4 stenographers and 9 record clerks.^
Until June, 1918, the only officer serving in the dental section was the chief
dental surgeon; another officer charged with procurement and distribution of
dental supplies was then assigned, and in September, 1918, this personnel was
reenforced by a third officer.^
ORGANIZATION OF THE DENTAL SERVICE
Though the organization which the Dental Corps finally developed was
begun early in the history of the American Expeditionary Forces, its completion
in a satisfactory manner was not practicable until after the bill reorganizing
the corps became a law on October 6, 1917.- By this organization, each
division was allowed 30 dental officers, under direction of a senior, the
division dental surgeon.^ The latter was under the general direction of the
division surgeon and was charged with the responsibility of coordinating,
supervising, directing, and inspecting the dental service of the division.^ The
senior dental officer with regiments which required more than one dental surgeon
was designated regimental dental surgeon and charged with the responsibility of
conducting the service of his specialty. When army corps were organized it
became necessary to appoint corps dental surgeons, who were under general
directions of the corps surgeon. These administrative officers were charged with
the coordination and direction of all the dental service of their respective army
corps, which included the inspection, supervision, and instruction of the several
division dental surgeons, and supervision and control of all dental officers
assigned to duty with corps troops.^ After the organization of field armies,
experienced dental officers were assigned to duty as army dental surgeons, under
general direction of the army surgeons and were charged with the responsibility
of supervising and coordinating the dental service in the respective commands in
which they served, including the dental service of divisions, corps, army troops,
evacuation, and mobile hospitals. Their administrative activities pertained
chiefly to the service of dental surgeons of corps and divisions. Those officers
rendered reports to them through medical department channels and their own
reports and returns were made in turn, through medical department channels to
the chief surgeon, A. E. F.^ In the Services of Supply a supervising dental
surgeon in charge of the service of his specialty in each section (including the
district of Paris) was vested with the responsibility of coordinating and con-
108
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
ducting the service' under general direction of the surgeon. He also submitted
reports and returns, through medical channels, to the chief surgeon. Hos-
pitals centers, depot divisions, replacement depots and later, embarkation
areas were provided with local dental supervisors, usually selected from among
the senior dental officers of those commands.- Their duties, in addition to
those of a professional character, were the centralization and coordination of the
professional service and supply of the dental department in their respective
jurisdictions under general direction of the senior medical officer through whom
their reports and returns were rendered to the chief surgeon.^ In all of these
organizations large dental infirmaries were established in favorable locations
where a number of dental surgeons were assigned under centralized control.^
Each hospital in the American Expeditionary Forces was staffed and equipped
for dental service.^ Base and evacuating hospitals usually had two dental
officers equipped with complete base outfits and laboratories; all other hos-
pitals had at least one dental officer equipped with operating outfit only.^
In the early fall of 1917, the French turned over the artillery training
area at Mailly to the American forces for the development of Coast Artillery
organizations.^ As the dental officers who accompanied the first American
organizations moving into this area were all recently appointed from civil life,
it was necessary to send an experienced officer to organize and coordinate their
services. This he accomplished partly through the establishment of a small
school of instruction.^
The general plans for the organization of the dental service, A. E. F.,
were made and tentatively approved early in its history. The approval,
however, had the provision that none of them would be put into effect until
called for in the general scheme for the organization of higher commands.^
Such organization, however, was immediately initiated for the units of the
expedition then present and the 1st Division being well advanced in its combat
training, was the first to receive the benefits accruing from this development.^
Among other provisions, orders were issued announcing a division dental
surgeon and providing for dental inspection, technical supervision, a head-
quarters dental clinic, and schools.^ When in the early fall of 1917, the 2d
Division moved into its training area with headquarters at Bourmont, dental
officers were assigned to its several imits.^ No division dental surgeon had
been sent over with it, but one was designated from the American Expedi-
tionary Forces in the latter part of November. Under his direction the dental
service of this division was organized, a division school established and the other
activities were thoroughly coordinated. Like action was taken for the 26th
and 42d Divisions.^
An important development within each combat division area was the
establishment of a headquarters dental clinic.^ Each of these clinics was
served by competent operators and was fully equipped, including complete
laboratories; each was technically in charge of the division dental surgeon
who was responsible for its efficient management. Later, w^hen divisions
entered upon the last phase of combat training, instructions were issued for
organization within each division of a portable dental laboratory.^ This unit
was placed in charge of a selected dental officer conversant with dental labora-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 109
tory practice, who was assisted by a specially qualified dental mechanic. This
laboratory, which assumed the necessary prosthetic service for the division
and obviated need of transferring patients to points outside its command,
usually was located at the division field hospital, which was farthest from the
line. After our divisions assumed combat activities, this unit assisted in first
aid at the front. ^
When the line of communications was organized in August, 1917, with
headquarters in Paris, all dental surgeons except those attached to divisions,
detached combat organizations, or to base hospitals, came under control of
the line of communications and were assigned by its headquarters to duty
with detached commands in its several sections.^ A headquarters dental
clinic was organized in the headquarters of the line of communications, its
first equipment consisting of the old type portable dental outfit, with which
all dental officers arriving from America were supplied. This equipment
was augmented by complete base dental outfits for two operators and one
complete laboratory.^
After removal of headquarters, line of communications, to Tours, in
June, 1918, this clinic, remaining in Paris, became known as the attending
dental surgeon's office, district of Paris. ^ It was increased in size by the
assignment of additional dental officers with full base equipment to meet the
growing requirements of its service, and continued to function until with-
drawal of the American Forces in France from the district of Paris toward
the end of 1919.^
When the advance section w^as organized in the latter part of February,
1918, a supervising dental surgeon was assigned to it, and the office of the
chief dental surgeon thereby relieved to an appreciable extent.^ This super-
vising dental surgeon was charged with the supervision and coordination of
all elements of the dental service throughout his jurisdiction. The majority of
troops then in the area were widely scattered; e. g., engineer organizations
making preparation at a number of camps for the early arrival of large numbers
of American troops, and signal corps battalions installing telegraph and tele-
phone lines. ^ Many other detached organizations were later located through-
out this section.^ The dental officers attached to these several commands
were all under the technical direction and instruction of the supervising dental
surgeon, advance section.^
Approximately 35 dental officers were serving within the advance section
at the time of its organization. This number w^as more than doubled there-
after until November, 1918. But their number remained short of that required
and it became necessary to assign several of them to an itinerant service
in order that they might visit some of the smaller units. ^
The intermediate section. Services of Supply, with headquarters at Nevers,
was in operation for some time without organized dental service, but increase
of the various activities throughout its area and the arrival of dental officers,
newly appointed from civil life and unacquainted w^th military procedure,
necessitated the appointment in April, 1918, of a section dental surgeon.^
The duties of this officer w^ere similar in every respect to those outlined above
for the supervising dental surgeon, advance section.^
110
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The wide dispersion of troops in the intermediate section also presented
many difficulties in the furnishing dental service; furthermore, some organi-
zations were much expanded after arrival in France; e. g., an engineer regiment
which landed with approximately 2,000 men had expanded before the end
of activities to a strength of 20,000.^ Since the legal allowance of dental
officers for the American Expeditionary Forces was based on the proportion
of one dental officer to every 1,000 men, and as units were organized when
they sailed, it was not practicable to supply dental officers in a corresponding
degree to those units which were expanded overseas.^
The organization of the dental service for base sections began with the
appointment of a supervising dental surgeon for base sections Nos. 1, 2, and 5
in April, 1918.^ Owing to the shortage of experienced dental officers of field
grade, it was necessary to utilize one officer to organize the dental service
for the three sections. While it was appreciated that it would be difficult
for one officer to exercise dental supervision of three important base sections,
this arrangement was maintained for several months.^ In December, 1918,
a supervising dental surgeon was appointed for base section No. 1 (St. Nazaire)
and in the same month another for base section No. 2 (Bordeaux) This
position in base section No. 5 was at first filled by a temporary assignment
but later a permanent detail was made. The supervising dental surgeon
of a base section discharged duties similar to those mentioned above in con-
nection with the advance section, but he also exercised technical supervision
over the receipt and storage of dental supplies arriving at the port and organ-
ized and developed dental clinics at section headquarters and at the disem-
barkation camps where troops were held temporarily.^
No supervising dental surgeon was designated for base section No. 3,
for the surgeon of that section considered such an assignment unnecessary.^
Base section No. 4 having comparatively few American organizations
or activities, was therefore never provided with a supervising dental surgeon.
The dental service of the permanent command and of detached organizations
there was supplied by dental officers assigned to organizations temporarily
within the section.^ A supervising dental surgeon for base section No. 6
was not appointed until December, 1918.^
The dental service in the large areas occupied by depot divisions had to
be expanded in order that adequate clinics might be established in the several
billeting towns and camps. In the First and Second Depot Division areas this
was effected by the division dental surgeons, each of whom also organized and
equipped a central dental clinic and dental laboratory.^ The establishment
provided at St. Aignan (First Depot Division) proved a model for this type of
clinic, being the first organized for group dentistry. Later, in order to meet
local requirements, a course of instruction was carried on in the first depot
division area in order to develop dental assistants from selected young men
serving in medical detachments of the division concerned.^
At the five replacement depots, located, respectively, near Amiens (with
the American Second Corps), to the northwest of Paris, adjacent to St. Dizier,
adjacent to Toul, and near the town of Meaux, the dental service was similar
in every respect to that of the First Depot Division.^ It comprised the organi-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 111
zation of large dental clinics where the mouths and teeth of soldiers passing
through the depot might be placed in first-class condition without appreciable
loss of time. These clinics gave full opportunity for group dentistry and proved
of the greatest value as time-saving expedients.^
PERSONNEL
The total number of officers who served in the Dental Corps, A. E. F., was
1,876.^ The highest officer strength of that corps was 1,805, which it attained
on January 11, 1919.^ Of these officers 79 belonged to the Dental Corps,
United States Army, 12 to the Dental Corps, United States Navy, about 225
to the National Guard, and the others to the Dental Reserve Corps. ^
The total personnel, including enlisted men of the Medical Department
assigned to its service, approximated 4,000, of whom more than 2,000 (includ-
ing the officers above mentioned) were graduate dentists.** The enlisted men,
Medical Department, assigned for duty to the Dental Corps served either as
dental assistants or as dental mechanics. Many of them were undergraduates
in dentistry.*
The full quota of commissioned dental personnel authorized at the rate of
1 to 1,000 men was never attained in the American Expeditionary Forces, and
there was a shortage of over 300 dental officers at the time the armistice was
signed.* A dental officer was sent with approximately every thousand men of
large organizations embarking from the United States, but this ratio was not
extended to small organizations and to casuals, so that a shortage accrued for
the American Expeditionary Forces as a whole.* This shortage was most
apparent in organizations that greatly expanded overseas, as noted above.
Furthermore, it was found necessary to give three dental officers to each combat
division in excess of the pro rata allowance, because of the fact that certain units;
e. g., field signal battalions, machine-gun battalions, with less than 1,000 men
each, operated as separate organizations.* But after the armistice began a
general plan for equalization was carried out whereby each command was
assured of dental service. The full quota eventually was reached by reassign-
ment of about two-thirds of the dental personnel from each division sent
home, for only a skeletonized dental force was authorized to return with the
division which it had served.* That contingent remained with the division for
the purpose of rendering professional services during the voyage. This practice
of retaining part of the divisional personnel was discontinued in April, 1919.*
Though the great majority of dental officers came from the United States,
either with troops or as casuals, several American dentists, among other patri-
otic citizens already in Europe, offered their services shortly after American
headquarters were established in France.^ It was announced that the policy
of the Medical Department would be to accept the services of all physicians
and dentists, subject to a professional examination which would determine
that they were professionally qualified.^ Five approved civilian candidates
were eventually commissioned in the Dental Corps after examinations and a
considerable number of enlisted men were also examined for temporary com-
missions in the Dental Corps. ^ A total of 123 passed their examinations in
13901—27 8
112
ADMTXISTRATIOX, AIMERICAN EXPEDITIONARY FORCES
France, but onk 40 of these were enabled to serve as officers on account of a
War Department decision not to commission after the armistice began candi-
dates who passed the examination.^ Recommendations were made to the
adjutant general, A. E. F., that the 83 successful candidates who had not been
commissioned at the time of the signing of the armistice be appointed and
commissioned in the grade of first lieutenant. Dental Reserve Corps (inactive
status), and that their commissions be given them as a reward of merit on the
date of their final discharge from the Army.^ This recommendation was
approved and was largely carried out. In many instances, however, the
commissions were not forthcoming until several months after discharge.^ The
regular Dental Corps was increased by nine officers through appointments
made in the American Expeditionary Forces from the Dental Reserve Corps.^
While the majority of dental officers of the American Expeditionary
Forces served in France, a large number arriving with organizations in Eng-
land were detained there temporarily or permanently for duty at our several
hospitals, aviation camps, and instruction centers.^ Several dental officers
were detailed for duty w^ith organizations serving in Italy and northern Russia,
and in March, 1919, 20 dental officers, with enlisted assistants and full portable
outfits, were sent to the United States military mission, Berlin, Germany, for
special duty in the Russian military prison camps. ^
During the fall of 1917 it was announced that the six American base
hospitals then loaned to the British would eventually come under control of
the American Expeditionary Forces, but this was never actually accomplished.^
Nevertheless, a number of medical and dental officers belonging to these units
were detached and assigned to service in the American Expeditionary Forces.
Thirteen dental officers were obtained in this manner.^
SCHOOLS
Division schools for the instruction of recently joined and inexperienced
dental reserve officers were established in the early fall of 1917.^ It was
recognized that these officers, however well qualified professionally, were
unacquainted with methods of conducting a military dental practice, with
customs of the service, the system of obtaining supplies, military correspond-
ence, and the formulation of reports and returns.^ The instruction, there-
fore, considered the methods of conducting a military dental practice, duties
of an officer, customs of the service, procurement of supplies and equipment,
preparation of reports and records. The division dental schools were in charge
of the division dental surgeons and under general direction of the division
surgeon concerned.^ Sessions were held two afternoons a w^eek. The advan-
tages of this instruction were soon apparent in the dental service of the 1st
Division, in which the first school of this character was established, and which
became the model for the dental section of the Army sanitary school. Similar
schools were conducted in all the other early divisions in France.^
The plan for division instruction w^as changed in November, 1917, by the
organization of the dental section of the Army sanitary school at Langres.^
With a full realization that a large number of specially qualified officers,
both medical and dental, would be needed for face and jaw surgery, immediately
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 113
upon entry of the American Army into combat activities, preparations were
made to establish a post-graduate course of instructions in oral, plastic and
prosthetic surgery.^ This was conducted at the American Red Cross Military
Hospital No. 1, Neuilly, which was selected for this purpose because of its
central location and the excellence of the facilities which had long been estab-
lished there. ^ A competent faculty of well-qualified and experienced instruc-
tors was assembled at this hospital, under the direction of a colonel of the
Medical Corps. ^ The several subjects of the curriculum were as follows:
Special anatomy, bacteriology and infections, face and jaw fractures, plastic
surgery, oral surgery, prosthetic surgery (fracture appliances), postoperative
care. Roentgenology and photography, anesthesia, and Medical Department
administration in war.^
A schedule for lectures and clinical instruction was prepared and it was
planned that the school would open in January, 1918, but this was deferred
until March. ^ Owing to the enemy offensive, which started March 21 and the
necessity for using in large degree as evacuation hospitals all hospitals in the
Paris district, this important course was indefinitely postponed.^ It was finally
abandoned on account of the continuous battle activities immediately north of
Paris and because of the arrival in March, 1918, of 40 medical and dental
officers, specially trained in maxillofacial surgery. The availability of these
officers, obviated any need for the school. They were organized with teams
and distributed as described below.^
A school for the instruction of enlisted men as dental assistants was early
organized at headquarters, First Depot Division, St. Aignan.^ Through dili-
gent investigations conducted in the several units of the 41st Division, now
designated First Depot Division, and of the several casual groups arriving from
the United States as replacement troups, several hundred young soldiers were
found and brought to this school for instruction as dental assistants. A large
percentage were undergraduates in dentistry who in consequence readily took
up this special work. They were given an intensive course of instruction and
upon its completion were awarded certificates of proficiency. A list of each
class was sent to the chief surgeon, A. E. F. who made assignments from it
throughout the dental service.^
In order to meet the demands for competent laboratory assistants —
dental mechanics — a school was organized at the central dental laboratory head-
quarters. First Depot Division, in extension of the course for dental assistants.^
The men sent here were given intensive instructions in primary laboratory
work for a period of one month. Upon its completion they were classified
and those rated as most proficient were sent to a second school for dental
mechanics, which was established in the dental laboratory at American Red Cross
Military Hospital No. 1, Neuilly.- Here they were given advance instruction
in dental and oral surgical prosthesis, which comprehended the construction
of swaged and cast-metal splints and all other fractured jaw appliances required
in maxillofacial surgery. Upon completion of a six-week course of instruction,
the graduates were given certificates and assigned to duty at the various base
hospitals where this special type of surgery was being conducted.^
114
ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
After the armistice began a school for instruction of dental assistants in
oral hygiene and prophylaxis was organized at headquarters, Base ISection No.
2, Bordeaux. It admitted students selected from among 400 enlisted men and
gave them instruction on a number of subjects pertaining to the practice of
dentistry. On graduation these men were assigned to service at the larger
clinics.^
In February, 1919, the American University was established at Beaune.^
Its dental department began work on March 12, 1919, being the first depart-
ment to open.^
During the autumn of 1918 a special course of clinical instruction was
conducted in dental and maxillofacial prosthesis by the senior consultant in
prosthetic dentistry. This officer visited each hospital center and important
base hospital and then gave instruction to officers and dental mechanics in the
highly specialized technique of maxillofacial prosthesis. -
SUPPLIES AND EQUIPMENT
Originally the types of dental equipment for the American Expeditionary
Forces w^ere those prescribed by the Surgeon General, viz, portable dental out-
fits for dental officers attached to field organizations, and the base dental equip-
ment (as far as practicable) for all base hospitals.*
The plans promulgated by the headquarters, A. E. F., in the summer of
1917, for the shipment of all Army supplies provided for a reserve of approxi-
mately four months, but requisitions issued by the Medical Department for
the shipment of supplies for the 1st Division included approximately a five
months reserve.* Its subsequent instructions in regard to the 2d, 26th, 42d, and
41st Divisions contemplated but a four months reserve and thereafter until the
inauguration of the automatic supply table, excess supplies were issued on the
basis of three months reserve. The plan contemplated the storage of 15 days
supply at the advance depots, 30 days supply at the intermediate depots, and
45 days supply at base sections. While this plan was never completely followed,
it proved of value as it assured storage in France of a reserve supply. The
plan was materially changed after the adoption of the automatic supply system
which became effective in March, 1918.^
The Medical Department automatic supply table %vas prepared after due
consideration and elaborate study based on plans outlined by the general staff
in the summer of 1917. Six months experience and observation were utilized in
its formulation and preparation. The dental department participated in its
preparation in so far as its own supplies w^ere concerned.^
The dental tables of the automatic supply were formulated to meet actual
requirements of portable dental outfits for the 30 dental officers authorized for
each combat division, for the outfits of the various detached commands in the
Services of Supply, and for normal replacement of these assignments.^ The cal-
culations for base dental outfits were made upon the requirements of hospitals
which pertained to divisions and of those that were to be stationed in the Services
of Supply plus the normal replacement for equipment of this character.^ The |
arrival of certain kinds of dental equipment and supplies was delayed by the
priority shipment of other articles — rations, clothing, ammunition, etc. — bv con-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 115
gestion at the ports of embarkation and debarkation, by lack of adequate facili-
ties at the base ports for systematic storage and by lack of facilities for prompt
movement by rail to place of destination.^ Because of this delay it was neces-
sary to make some emergency purchases of dental equipment and supply in
France, through the medical member of the general purchasing board in Paris. ^
With a view of facilitating these special purchases, a dental officer was assigned
temporarily to duty with that board. Until the automatic supply became
effective and continuous the purchase of certain articles of dental equipment
was conducted on so great a scale as seriously to embarrass the French market.^
The French authorities soon observed this situation and placed an embargo on
the further purchase of dental supplies by the American Army, but upon our
protest to this inhibition the embargo was raised for a few weeks and further
purchases were authorized to the value of 1,000 francs per month. ^ The
demands for laboratory equipment were so great and the supply so limited in
France that it was necessary to investigate the possibilities of purchasing this
type of equipment in England.^ The supply officer for the Medical Department
who was ordered to London for this purpose succeeded in purchasing laboratory
equipment and supplies in amounts considered sufficient to last until material
of this type was received from the United States, through operation of the auto-
matic supply table. ^ The British War Office, on observing the depletion of
this type of special material, also placed an embargo on further purchases of it
by the American Army. None of this much-needed laboratory equipment which
had been purchased by the medical supply officer in England ever reached France,
for the British vessel on which it was shipped was sunk by enemy submarines.^
The original plans for shipment of dental equipment contemplated that each
dental officer embarking with his organization for overseas duty take with him
a complete portable outfit, whose several chests were filled with six months' sup-
ply.^ Theoretically this arrangement was eminently satisfactory, and proved
to be so in the early months of the war before the overseas transportation became
congested. Later, dental equipment was placed aboard ship with all the other
elements of the cargo which were unloaded en masse at the base ports in France.
Here the dental equipments were lost in the overcrowded warehouses or at the
large supply dumps adjacent thereto.^
In the effort to remedy this situation, a cablegram was sent to the Surgeon
General recommending that previous instructions on this matter be so modified
as to direct each dental officer to carry his portable outfit as baggage, for which
he would be personally responsible both on shipboard and after arrival in
France.^ This plan was carried out more or less satisfactorily and was insisted
upon as the only possible method that would insure the dental officer having his
equipment in his possession on arrival.^ But in maintaining this plan the dental
service ran counter to that general instruction to port commanders which directed
that equipment be unloaded from ships and placed in a pool, to be subsequently
claimed if possible, and if not, replaced through emergency requisition on
supply depots.-'
In accordance with previously arranged plans of organization, competent
dental officers were assigned to duty at the impotrant supply depots, the first
officers thus assigned reporting at the depot at Cosnes on September 1, 1917.^
116
ADMIXI8TRATIOX, AMERICAN FA'PEDITIONARY FORCES
His duties woro later extended to ineliide purchase of dental equipment and
supplies through the medical member, general purchasing board. On March 1,
1918, a dental officer was assigned to the advanced medical supply depot,
Is-sur-Tille.^ On account of the great amount of dental supplies received at
medical supply depot No. 1, base section No. 1, in the earlier months of 1918,
a dental officer was placed there on duty as assistant to the medical supply
officer, where he remained until June, 1919.^ In 1918 one or two more dental
officers were detailed to serve with the other large supply depots. These officers
remained for short periods on temporary duty.^ In the late autumn of 1918 a
dental officer was sent to the Gievres depot for temporary duty to develop
certain articles of field equipment.^ No dental officers were permanently
assigned to supply duty at the base ports other than at St. Nazaire (base section
No. 1), but the supervising dental surgeons in the base sections were available
to render counsel concerning dental equipment.^
Actual field experience in combat divisions early demonstrated the fact that
the old pre-war portable dental outfits were not practicable for active field service.
The bulk and weight of the several containers seriously handicapped their trans-
portation with mobile units. After careful study the following conclusions were
reached concerning the field dental equipment:^ The full portable outfits were
to be retained for use at camp hospitals and at such other detached organizations
of the Services of Supply as could readily furnish transportation for them.
Modified portable outfits packed in three chests were provided for combat
divisions.^ These consisted of the essential equipment of medicines and of a
small stock of supplies Which were considered sufficient for the practice of field
dentistry.^
An even more reduced outfit, termed "campaign equipment," was provided
for the use of dental officers with divisions in battle areas. ^ This consisted of a
•dental engine chest and its normal contents, plus the contents of the emergency
dental kit. This kit was designated personal dental equipment and was to be
carried by each officer at all times while in the combat area. It comprised a few
essential instruments and medicines in cloth rolls and a very small amount of
supplies, all contained in Hospital Corps pouches carried over the shoulder by the
dental officers and their assistants.^ Thus officers were enabled to render first-
aid dentistry at all times for the relief of pain and for minor oral surgical or dental
operations. This modification of dental equipment helped solve many of the
transportation problems for the dental service in combat divisions, and while it
increased the weight carried by dental officers, it proved advantageous by
making it possible for anyone requiring emergency dental service to obtain it at
any time from the dental officer of his command.^
In combat divisions, the transportation of dental equipment and supphes
was always a problem and when not carried individually, a source of irritation
to division commanders, transportation officers, and division surgeons.^ This
was largely due to the fact that no provisions had ever been made in the Tables
of Organization for dental personnel, commissioned and enlisted, or for dental
equipment. Omission in these tables of the Dental Corps and of provision
for transport of its supplies resulted in the loss of much equipment and the
consequent temporary lack of dental service in several of the divisions.^ The
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 117
1st Division on its movement into a combat area in May, 1918, to mid it
expedient to abandon all its dental equipment on account of the lack of trans-
portation, for this material had not been considered by its transportation
oflicer in making his allowances for the rapid movement of equipment and
supplies.^ This loss was immediately investigated and efforts were made for
finding and salvaging the abandoned equipment. Though not found at the
time it was subsequently redeemed through the salvage service.^ In the
interim, through efforts made at intermediate medical supply depot No. 3, the
dental service of the division was reequipped with modified portable outfits.
As a result of the information obtained by the chief dental surgeon, who was
sent to investigate the matter, the dental service, both personnel and equip-
ment, was for the first time provided for in division tables of organization.^
Instructions on the subject were published in General Orders, No. 99, G. H. Q.,
A. E. F., June 19, 1918, which provided for a divisional dental service com-
prising 31 officers and 32 enlisted men, with 10 portable dental outfits, 20
modified portable outfits and 1 portable laboratory. The total weight of this
equipment was 12,000 pounds and its bulk 574 cubic feet.^
A portable dental laboratory was also adopted to meet the prosthetic
requirements of a division.^ All essential equipment for this was packed in
one dental supply chest, which weighed approximately 200 pounds.
When the several army corps were organized provision was made for
supply parks at or near the headquarters of each, except for the Second Army
Corps, which was operating under the British.^ In accordance with the Abbe-
ville agreement replacement supplies were to be furnished by the British Army
for the troops composing divisions of that corps. Therefore, the American Expe-
ditionary Forces were not directly concerned in its replacement supplies until
the late fall of 1918, when the corps reverted to American control.^ The initial
dental equipment and supply for the troops in that corps would have been
amply sufficient to carry them through their campaign under British control,
had it not been that all their equipment was reduced to a minimum and excess
supphes abandoned immediately prior to their entry into the combat zone.
Each division was directed to organize supply dumps in its area for replace-
ment purposes.^ The corps parks and division dumps were fed from the
advanced medical supply depot, Is-sur-Tille, as were also the army supply
depots at the time of the organization of the First Armj^, August 12, 1918.^
Great difficulty was experienced in procuring the necessary special equip-
ment for maxillofacial surgery and for the prosthetic and reconstruction pro-
cedures required in the practice of that specialty.^ Adequate consideration
and study had been given this subject prior to the departure from the United
States of specialists in this line, and provision had been made whereby special
ciiests containing maxifiofacial unit equipment would be shipped immediately
on their departure.^ These plans failed and the much needed special equip-
ment for this service was not received until after the signing of the armistice.
It was found subsequently in the midst of a quantity of supplies at the port of
Marseille.- Loss of this equipment necessitated the purchase of all articles
of this type that could be found in France and the manufacture of such parts
of it as were not found in that market.- The British and French afforded the
118
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
benefit of their experience in the treatment of face and jaw wounds and this
greatly appreciated assistance helped materially in procuring much of this
special equipment through purchase and manufacture.^ Though this ocjuip-
ment was not available on many occasions when it was needed by the dental
officers at evacuation hospitals, mobile hospitals and at some few base hospi-
tals, the deficiency was well met by individual ingenuity and by improvisation.^
Generally speaking, the system of dental supply through operation of the
automatic table was satisfactory, this being especially true in regard to field
equipment.^ Theoretically, the automatic table met the situation in an admir-
able manner, and had ocean, rail, and storage facilities permitted its movement
according to the priority schedule, no shortage or delayed replacement or
replenishment would have occurred.^ As it actually worked out, the lack of
laboratory equipment and supplies was embarrassing on several occasions and
there was a long period extending over several months when the shipment of
greatly needed base outfits, including electrical equipment, was withheld.^
Consequently projects for installation of this type of equipment in all base
hospitals and major clinics were delayed. A large consignment of this class of
equipment and supplies arrived in November, 1918, and was thus available
for the several hospitals and the many large clinics then being established in
base sections, embarkation camps and army areas. ^ In these places efforts were
being made to render complete dental service for the troops who had been
temporarily deprived of it, through the exigencies of an active campaign.^
The following special appliances were developed in the American Expedi-
tionary Forces to meet the requirements of its dental service •}
AMEX DENTURE
A denture cast in aluminum of one piece, wherein the base plate and the
teeth themselves were reproduced in this light, inexpensive metal. This proc-
ess of plate construction lent itself admirably to the military service, inas-
much as more than 98 per cent of the dentures required were for partial loss
of teeth. For full dentures, well-matched porcelain incisors and cuspids were
attached thereto solely for esthetic purposes. These appliances materially
reduced the expense of dentures, the supply stock, and necessary equipment.^
AMEX CASQUE
A surgical appliance for face and jaw reconstruction; the further develop-
ment of a similar article used in the surgical services of the British and French
Armies. It consisted of an adjustable steel band, fitting around the circumfer-
ence of the head, with adjustable cranial bands and an adjustable perpendic-
ular rod and horizontal face bow. Its use in facial and jaw reconstruction
permitted of absolute fixation for either soft parts or osseous fragments, and
it was of great value in this class of highly specialized surgery.^
EMERGENCY KITS
These consisted of two Hospital Corps pouches to be slung from the shoul-
der, one for the dental officer and one for his enlisted assistant.^ They con-
tained the essential instruments and medicines, secured in cloth rolls, and sup-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 119
plies for administering first-aid dentistry and for the simpler operations of field
dentistry. They were prescribed articles of personal equipment for dental
officers and were ordered carried whenever combat organizations entered the
combat area. Through them it became possible for the troops to receive
emergency dental treatment for the relief of pain without leaving their com-
mands.^
FOLDING TRENCH CHAIR
This article of equipment was developed for the purpose of supplying a
seat, with stabilized head rest, in order that dental services might be rendered
conveniently in trenches, dugouts, and advanced dressing stations.^ It was
made of aluminum, reinforced by steel rods and was capable of being folded
and carried in a musette bag with the two pouches of the emergency kit. It
weighed, complete 4^ pounds.^
DENTAL AMBULANCES
The difficulties of supplying dental care to troops at outlying stations
emphasized the great need for dental ambulances, which when fully equipped
as ''mobile dental clinics" would be capable of traveling under their own power
from station to station.^ Plans were made to have such mobile dental clinics;
further, it was planned that they would remain at each station a sufficient
number of days to permit of the emergency dental treatment of the command.
Eleven such vehicles voluntarily contributed in America, and only requiring
transportation overseas, unfortunately remained at a home port of embarka-
tion for many months through lack of shipping facilities. Several communi-
cations urging their transportation were made by cable and letter to the United
States, but these were fruitless.^
Two dental ambulances were, however, presented in France to the dental
service, A. E. F.^ One, donated conjointly by two American dentists, had come
originally from American Red Cross hospital at Neuilly. It was thoroughly
overhauled, equipped, and put in charge of a dental officer November 1, 1917,
being designated dental ambulance No. 1, A. E. F.^ Assigned to the motor
transport division, Mailly, then located back of the line to the southeast of
Soissons, this vehicle continued to operate during the entire period of activi-
ties, its station assignment being with one or another of the several units of
the motor transport corps in the vicinity of Mailly. The second ambulance
was presented to the dental service by the American Red Cross, through its
medical director in Paris. ^ This ambulance was delivered at headquarters,
Chaumont, about March 1, 1918, and was immediately placed in charge of a
dental officer and designated dental ambulance No. 2.^ Its station assign-
ment was with the Air Service of the advance section, with headquarters near
Colombe la Belle, and its first location at the second bombardment airdrome.^
Throughout the entire subsequent period of activities this vehicle rendered
service to the several small detached stations adjacent to the headquarters,
Air Service.^
INSPECTION
It was early realized that the best service could be obtained only through
providing direct supervision and inspection of dental work by qualified dental
inspectors.^ Instructions therefore were issued requiring that each dental sur-
120
ADMIXISTRATIOX, AMERICAN EXPf:i)ITU)NAH V FORCES
gcoii in an administrative position make regular and systematic inspections of the
dental officers attached to the command.- These inspections were to consider
personnel, both commissioned and enlisted, discipline and efficiency, character of
service, etc. Reports of inspections were forwarded through medical channels
to the office of the chief surgeon, A. E. F, In addition to these inspections, it
was found necessary at first for the chief dental surgeon to make frequent visits
to the headquarters of each division in the American training area. There he
inspected the office records, and the methods of the division dental surgeon, as
well as the headquarters dental clinic.^ At the same time he gave instructions
to remedy defects or to effect a development of the service. As these inspections
by the chief dental surgeon were later extended to include base hospitals, he
visited during the first six months of the American Expeditionary Forces, base
hospitals Nos. 15, 18, 21, 23, 31, 32, 36, and American Red Cross Hospital No. 1,
Neuilly. His personal inspections in training areas were made regularly until
March, 1918, when the chief surgeon's office was moved from general head-
quarters, Chaumont, to the headquarters of the Services of Supply at Tours. ^
SERVICE RENDERED
The character of the dental service in the American Expeditionary Forces
differed considerably in different zones and from time to time, depending on
resources and campaign activities.^ When the combat divisions were in training
areas it as possible to conduct a high-class tooth-conservation service, with a
view^ of rendering all men dentally fit for the period of the campaign.^ There-
fore, consistent efforts were made then to survey and record oral and dental
conditions for the entire personnel of organizations. These records were care-
fully studied so as to give priority for cases requiring oral prophylaxis as a health
measure; i. e., for extraction of broken-down teeth and roots, evacuation of
abscesses, and removal of rough calcareous deposits.^ This was followed later
by such filling operations for tooth conservation and masticatory restoration as
were deemed practicable.^ Later, when divisions entered combat areas, and
when dental outfits were reduced to combat equipment it was impossible to
give more than emergency treatment for the relief of pain, and dental service
was necessarily of a simpler character.^ On the march, and during actual
engagements, as already mentioned, dental officers and enlisted assistants
carried emergency kits, for the sole purpose of rendering immediate treatment,
which mainly consisted of extraction, minor surgical operations, medicinal
applications and sometimes plastic fillings, so that the soldier might return to the
front line without loss of time.^
During the armistice, when the troops had returned to rest and billeting
areas for the winter, the character of dental service again changed. More
careful consideration w^as now given to tooth conservation, through permanent
fillings, tooth restorations, and the construction of crow^ns, bridges, and den-
tures.^ Every effort was made to put the teeth of the men in first-class
condition, prior to their return to the United States and release from service.^
The number treated for the month of March, 1919, as compared with the
number treated in September, 1918, showed an approximate gain of 300 per
cent in dental activities and accomplishments.^ The former was a period of
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 121
rest, the latter one of active field operations. The consolidated report for
February, 1919, shows that during that month 119,792 persons were treated
and 183,031 dental operations performed.^
The service rendered at base hospitals was of high order at practically all
times. Their superior equipment materially enhanced the performance of high-
grade professional work, but during the stress of battle the dental service
rendered at these units and at evacuation hospitals consisted mainly in the
emergency treatment of wounded with special consideration of face and jaw
cases.
The practice of dentistry was carried on very thoroughly wherever modern
dental equipment, consisting of base dental outfits with electrical apparatus,
high-low base chairs, white-enamel steel cabinets and complete laboratories, was
installed.^ Such facilities were provided at the large dental clinics organized
in the base sections. Services of Supply, in embarkation areas, at hospital
centers and at several important headquarters.^
The various base section dental clinics and those at replacement depot, St.
Aignan, embarkation area, Le Mans, American University, Beaune, and at the
central dental infirmary, district of Paris, were organized for the purpose of
centralizing, standardizing, and directing dental service, for coordinating the
problems of equipment and supply, and for obtaining the greatest efficiency
through technical direction and by friendly competition.^ From 10 to 30
operators were occupied in these large clinics; they became show places of
great interest to visitors.^
Comparatively few dentures were required by the (approximately) 2,000,000
men in the American Expeditionary Forces, and those constructed were mostly
partial dentures for the replacement of a few lost teeth. The full dentures
required were less than 2 per cent of all dentures constructed.^
A consolidated report covering dental service rendered in the American
Expeditionary Forces from July, 1917, to May, 1919, inclusive, shows that a
total number of 1,396,957 persons were treated; 2,626,368 sittings were given;
497,948 treatments (medicinal) were administered; 2,013,580 operations per-
formed (which included 1,605,424 fillings and 384,427 extractions); and the
following prosthetic operations performed: 60,387 crown and bridge construc-
tions, including repairs and resets, and 13,140 denture construction and repairs. ^
In the early months of the American Expeditionary Forces, consideration
was given to the selection of certain base hospitals and providing those so
selected wath special personnel and appliances for handling the maxillofacial
cases of the American Army.^ The following hospitals were tentatively chosen
for this work: Base Hospital No. 18, Bazoilles; Base Hospital No. 15, Chau-
inont; Base Hospital No. 21, Dijon; Base Hospital No. 26, Angers; Base
Hospital No. 6, Bordeaux, and Base Hospital No. 8, Savenay.^ These units
were held in reserve for the accumulation of cases that would require evacua-
tion to the United States. ^ These plans were changed in May, 1918, upon
the arrival of the above-mentioned group of 40 specialists in general and dental
surgery for duty in the maxillofacial surgical service. These officers came over
under direction of a medical officer who was a well known specialist in this
line of surgery and who was soon designated chief consultant of maxillofacial
surgery, A. E. F.^
122
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The dental personnel of this group soon came under the adnunistrative
control of the dental division of the chief surgeon's office.^ The chief surgeon
decided to make temporary assignment of a medical and dental officer to each
of the several important centers in England, Belgium, and France, where this
work was being done, in order that they might observe and study the latest
method of procedure.^ They could be spared at this time because American
troops had not yet largely entered into active combat, nor had the special
equipment which these officers required, been received from the United States.^
Upon the return of these officers from their tours of observation, they were
organized by the chief surgeon into maxillofacial teams, each composed of one
surgeon and one dental surgeon, and were assigned to the important hospitals
or to hospital centers.^ The original plan of designating certain hospitals for
maxillofacial surgery w^as therefore abandoned, the new arrangement providing
that each important hospital center and every evacuation hospital would carry
on this work.^ Base Hospital No. 115, Vichy, was designated the "head hos-
pital," and an adequate group of surgical and dental specialists was sent there
to organize and develop it.^
Between 2,000 and 2,500 cases of face and jaw injuries occurred among
the American wounded.^ Of this number, about two-thirds treated in the
hospitals in France were cured, and were returned to duty there. ^ About
700 cases of severe type, requiring reconstruction operations, were evacuated
to the United States.^ The cases selected for such evacuation were of five
classes: First, compound, comminuted fractures of the jaw in process of con-
solidation and having splinted fixation; second, compound, comminuted
fractures, with delayed union due to sequestra, presence of infected teeth or
foreign bodies and requiring long-continued drainage — splinted with fixation;
third, united fractures with loss of bony substance, requiring bone graft or
prosthetic replacement — splinted with fixation; fourth, cases with healed scars
involving either of the conditions mentioned above and requiring a series of
plastic operations; fifth, cases of any of the above types, with extensive loss of
soft tissue partially healed and distorted, for corrective plastic operations.
The first convoy of these wounded embarked in October, 1918.^
The technique employed in the hospitals of the American Expeditionary
Forces for the treatment of the injuries classed in the foregoing categories was
based to a large degree upon that developed through the experience gained by
the French, British, Belgian, and Italian services, for in these armies, through
opportunities covering a period of four years, several men had become masters
in maxillofacial surgery.^
The selective methods of making bone grafts, in cases in which appreciable
loss of bony substance occurred, were of three types. ^ First, free graft from
a rib, the tibia, or the crest of the ilium; second, osteoperiosteal grafts from
the tibia; third, pedicled graft from the mandible itself, shifted into position.^
Some form of splint was used in all these cases to assure fixation of fragments
in normal relation.^ The policy ultimately adopted for this class of cases con-
templated that the simpler ones would all be cared for in the hospitals in the
American Expeditionary Forces and that the severer cases, after the first stages
of the work, would be evacuated to a hospital at a base port, where they w^ould
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 123
receive the properly adjusted "open bite" splints to prepare them for the
ocean voyage.^ In this connection, it should be remarked that none of the
"closed bite" splints could be used in these cases, for it was feared that because
of seasickness they would endanger the life of the patients through subjecting
them to strangulation by vomitus.-
Many types of splints were made for these cases and many names were
given to the several types. ^ With a view of standardizing them, the follow-
ing terms were finally adopted: Interdental splints were splints made for
one jaw, either upper or lower. Intermaxillary splints were those made for
both upper and lower jaw and connected by some mechanical method for
fixation.- This latter type was made for both the "open-bite" method and
the "closed-bite" method, to meet requirements, and, as many of the cases
required at different times both the open- and closed-bite splint, a combination
splint was devised which could be used in either circumstance.^ This splint
was provided with lock pins through the bicuspid region, which held the upper
and lower parts firmly together as a closed bite, but when the pins were with-
drawn and the jaws opened, the insertion of metal stilts to retain the open
bite was feasible. These stilts were firmly held in position by the reinsertion
of the lock pins.^
PERSONNEL "
(July 28, 1917, to July 15, 1919)
Col. Robert T. Oliver, D. C, chief.
Lieut. Col. William S. Rice, D. C.
Maj. Richard K. Thompson, D. C.
First Lieut. John D. Brown, D. C.
REFERENCES
(1) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 28,
1917. Subject: Weekly war diary. On file, Historical Division, S. G. O.
(2) Report from Col. Robert T. Oliver, D. C, chief of the dental service, A. E. F., to the
Surgeon General, U. S. A., April 13, 1921. Subject: The dental service. On file.
Historical Division, S. G. O.
(3) Letter from The Adjutant General to the Surgeon General, June 19, 1917. Subject:
Extract from cablegram (cipher cable) received at War Dept., from Page to Sec-
retary of State, London, June 12, 1917. On file, Record Room, S. G. O. (138036).
(4) Confidential Orders, No. 2, par. 2, War Department, Washington, D. C, June 25, 1917.
On file, Personnel Record, Personnel Division, S. G. O.
(5) Par. 8, Special Orders, No. 76, general headquarters, A. E. F., August 23, 1917.
(6) Report from Brig. Gen. Jefferson R. Kean, M. C, to the chief surgeon, A. E. F.,
April 24, 1919. Subject: Data to be used bj- military board of allied supply. Copy
on file. Historical Division, S. G. O.
(7) Par. 77, Special Orders, No. 37, headquarters, intermediate Section, Nevers, A. E. F.,
April, 1918. On file, A. G. O., World War Division, Intermediate Section (Special
Orders) .
(8) Report from the chief surgeon, A. E. F., to the Surgeon General, L^. S. A., May 1, 1919.
Subject: Activities of the chief surgeon's office to May 1, 1919. On file. Historical
Division, S. G. O.
" In this list have been included the names of those who at one time or another were assigned to the division during
the period July 28, 1917, to July 15, 1919.
There are two primary groups — the heads of the division or the section and the assistants. In each group names
have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
CHAPTER YII
THE NURSING SECTION; RECONSTRUCTION AIDES
THE ARMY NURSE CORPS
The few hundred nurses who formed a part of the six base hospital units
assigned to service with the British Expeditionary Forces, and the other nurses
who arrived in France during the early period of the American Expeditionary
Forces, were for five months under the general jurisdiction of the office of the
chief surgeon, A. E. F., after that office was established in June, 1917, ^ and
of its personnel division after that division was created in July.^ On October 2,
1917, General Pershing cabled to the War Department a request that a com-
petent member of the Army Nurse Corps be sent to Paris to serve as superin-
tendent of nurses of the American Expeditionary Forces.^
The chief nurse of Walter Reed Hospital was selected for this assignment
and, with an assistant, reported for duty on November 14, 1917, at head-
quarters, line of communications (then in Paris), and on the day following
was assigned as chief nurse, line of communications.^ At the time in question,
most of the nurses of the American Expeditionary Forces were on duty at base
hospitals in France, and these (other than the six above mentioned) were
under the administrative control of the chief surgeon, line of communications.*
When headquarters, line of communications, moved to Tours in January,
1918, the office of the chief nurse accompanied it as a part of the personnel
division, office of the chief surgeon, line of communications.* No member of
the Army Nurse Corps served in the office of the chief surgeon, A. E. F., until
that office moved to Tours and there absorbed the office of the chief surgeon,
line of communications, in March, 1918.* The office of the chief nurse then
became a section of the personnel division, chief surgeon's office.*
On October 8, 1918, the Surgeon General notified the chief surgeon that
authority had been received from the Secretary of War for the appointment
of a director and two assistant directors of the nursing service in France, and
for a director and two assistants for our nursing service in base section No. 3
(England).' No such appointments were made in base section No. 3, however,
for the chief surgeon of that section decided that so many administrators for
the nursing service there were unnecessary and, therefore, continued in that
section the office of chief nurse which had been established there June 17,
1918.' The chief nurse of the American Red Cross in France, who formerly
had been chief nurse of Base Hospital No. 21, was appointed director of the
nursing service, A. E. F., and on November 15, 1918, reported to the chief
surgeon, A. E. F., at Tours,' thus replacing the chief nurse, A. E. F., who left,
on December 2, to become assistant to the superintendent of the Army Nurse
Corps in the Surgeon General's office.' The chief nurse of base section No. 3
and a nurse who had been assistant to the chief nurse were appointed assist-
ant directors of the nursing service, A. E. F., November 18 and December 14,
125
126
ADMIXISTRATIOX, AMERICAN' FA'PEDITIOXAKV FORCES
respectively.' The staff of the director of the nursing service, was fiirtlier
augmented by assigning to it, on January 13, 1919, a nurse from Base Hospital
No. 7, who formerly had been matron of General Hospital No. 22, British
Expeditionary Forces, and, on February 3, 1919, the chief nurse of Base Hospi-
tal No. 27, the duties of the last-mentioned member of this staff including both
service at the central office and inspection of the nursing service in hospitals.^
Most of the nurses who served in the American Expeditionary Forces
arrived as members of base hospital units, but others came in replacement
units, and were not attached to any hospital until assigned in France.' Others
sailed as casuals (one group of these, which arrived in the summer of 1918,
including 500 nurses) and a few as members of small organizations such
as mobile operating units, psychiatric units, etc.; one group consisted of
anesthetists.'
On August 11, 1917, the chief surgeon, when submitting to the chief of
staff, A. E. F., an estimate of the medical personnel that would be necessary
for an army of 1,000,000 men, calculated that the number of nurses required
for such a force would be 22,430; however, at no time did the quota of nurses
approximate this estimate.*
In the first six months after the United States entered the war a few more
than 1,100 nurses arrived, of whom about half served in the six base hospitals
assigned to the British.' From November, 1917, until March 31, 1918, less
than 900 others arrived, and there was a consequent shortage on that date of
400, even under the reduced priority schedule prescribed by the general staff,
A. E. F.' At this time there were only 2,088 nurses in France, of whom approx-
imately 700 were under British control.'
The consequent shortage of nurses in the American Expeditionary Forces
was due primarily to the great need for combatants and to lack of transport
facilities.* At times there were as many as 1,400 nurses in the mobilization
station in New York, awaiting transportation, several groups being thus de-
tained as long as three months.^ By the middle of April, when the shortage
of Medical Department personnel had become so acute that a breakdown in
its service was threatened, the shortage of nurses was estimated at 1,121.' On
May 3 a cable was sent asking that 555 be sent immediately. '
On June 30, 1918, nurses serving in Europe, or designated for foreign
service, were distributed as follows:^ British forces, 755; French forces, 14;
American forces, 3,323; awaiting transportation or en route to mobilization
station, 1,258; total, 5,350. This number included nurses sent to the American
Red Cross Military Hospitals Nos. 1,2, and 3.^
Because of the increase of our combat activities in the ensuing weeks,
Medical Department personnel was engaged to such an extent that on July 27,
1918, the chief surgeon reported that the resources of the Medical Department
were practically exhausted in so far as personnel was concerned, and on August
10 a cable was sent from general headquarters, requesting absolute priority for
medical organizations, including 2,312 nurses.' During that month, 1,000
nurses arrived in France.'
Under date of September 21, the personnel division reported that the
shortage of nurses continued to be acute ; all hospital units were short of nurses
and demands were being made by camp hospitals for large numbers of them
ORGANIZATION' AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 127
because of the epidemic of influenza.*^ It was impossible, of course, to furnish
all the nurses requisitioned by various organizations.^
When the armistice was signed there was a total of 8,587 nurses on duty
overseas, the number short of actual needs being approximately 6,925;^ the
number of patients in hospital under treatment on November 12 totaled 193,-
026, distributed in 153 base hospitals, 66 camp hospitals, and 12 convalescent
camps. ^ The number of nurses on duty in the hospital centers, where the
largest number of patients were grouped at this time, was as follows:' At
Mesves hospital center where patients in 10 base hospitals and in the con-
valescent camp numbered 20,186 on November 16, the center's peak day,
there were 394 nurses.' At Mars hospital center, on November 16, in six
hospitals and in the convalescent camps, 14,302 patients were cared for by
493 nurses.' At Allerey, on the 17th, in 6 hospitals and in the convalescent
camp, there were 17,140 patients, cared for by 360 nurses, and at Toul on the
28th of November, in 7 hospitals there were 10,963 patients, cared for by 320
nurses.' The maximum number of nurses at certain centers at one time was:
Mesves, 650 on January 4, 1919; Mars, 642 on December 4, 1918; Toul, 438 on
February 1, 1919.'
Between November 11, 1918, and January 25, 1919, when the greatest num-
ber of nurses was on duty in the American Expeditionary Forces, nearly 1,500
nurses arrived — more than the total number received in 1917.* The greatest
number of nurses reached in the American Expeditionary Forces was recorded
in the week ending January 11, 1919, when their number totaled 10,081, includ-
ing approximately 700 on duty with the British.* This total should show as
of the first week in December, for there were no arrivals subsequent to that
date.^ At this time the strength of the American Expeditionary Forces was
approximately 1,750,000 men.^ With the exception of casual nurses who were
separated for various reasons, the first group which left France was that with
Base Hospital No. 2, which sailed early in January, 1919.' From that time
the return of nurses was gradual, averaging from January through April, 1919,
about 200 nurses a week.' During the last week of April over 800 nurses sailed.'
No chief nurse was appointed for any of the sections of the Services of Supply
except base section No. 3.*
One of the important developments of the nursing service in France was
the appointment of a chief nurse at some of the hospital centers.' This plan,
which was not prescribed in orders from higher authority, developed at the
several centers independently, in an informal manner in November, 1918, and
was a natural result of the grouping at each center of several hospitals under
a general command.' It developed to different degrees in the several centers
and was apparently of value in every place where it was tried, except that in
one or two instances the center chief nurse was unable to secure cooperation.^
The plan w^as adopted at the following centers:' Allerey, Bazoilles, Beau
Desert, Mars, Mesves, Nantes, Savenay, Toul, Vichy.
Center chief nurses acted as assistants to the director of nursing service.
At Mesves her duties were prescribed as follows: '
1. To assist the commanding officer of the center in such matters pertaining to the
Juirses of the center as he may see fit to assign to her.
13901—27 9
128
ADMINISTRATION, AMERICAN EXPEDITIOXAHY FORCES
2. To assist in the distribution and readjustment of nurses witliin tlic center, aceordniK
to the pressure of work in the various hospitals.
3. To keep informed by frequent visits of the conditions in the hospitals of the center,
as they affect the nursing personnel such as quarters, the mess, means of recreation, care of
sick nurses, etc.
4. To bring to the attention of the director of nursing service, after consultation with
the commanding officer of the center, any matters which seem to need special adjustment.
5. To act as chairman of a committee of chief nurses of the center. This committee
will make suggestions for regulations governing the conduct, and social relations of nurses,
which shall be, as far as possible, uniform for the entire center. These suggestions should
be presented to the commanding officers for their approval and indorsement. The object
of this committee will be to promote the welfare of the nurses within the center, and to
maintain a high standard of service and conduct within the Army Nurse Corps.
6. To act as hostess of the center. In that capacity she will meet each new chief nurse
arriving at the center and see that the latter has all information that will assist her in the
performance of her duties. She will also, in cooperation with the commanding oflScers and
chief nurses of the center, endeavor to promote a wholesome social life among the nurses.
Similarly, as prescribed by regulations, a chief nurse was designated for
each hospital where a group of nurses was on duty, whether mobile, evacua-
tion or base, and whether it was part of a center or operatmg independently.'
Experience showed that the nursing units definitely organized by a head
nurse in civil hospitals and colleges, among women who were accustomed to
work together were more quickly efficient than were those composed of casuals
gathered from many sources.' The latter, with no previous division of assign-
ments according to the particular qualifications of each member were inevitably
handicapped at first by a lack of mutual acquaintanceship.'
RECONSTRUCTION AIDES
The employment of reconstruction aides was an innovation during the World
War, and it was not until during the armistice that any great use of them
was made overseas.
A memorandum published December 31, 1917, by the Surgeon General,
covering the organization under the division of military orthopedic surgery, and
giving the duties, status, etc., of the "woman's auxiliary medical aides," was given
application in the American Expeditionary Forces. These aides were engaged
in physiotherapy work."' Their designation was changed to "reconstruction
aides," and some of the provisions for their employment were modified by the
Surgeon General on January 22, 1918."
On May 3, 1918, the Surgeon General authorized the chief medical officer
of each army or separate auxiliary force '^ to appoint head aides, not to exceed
two to each hospital, from among the reconstruction aides serving overseas.
On May 21, 1918, the chief surgeon, A. E. F., initiated a cabled requisition
for 30 reconstruction aides for service in overseas orthopedic hospitals.'^ This
request received a favorable reply, '^ but several months elapsed before they began
arrive in numbers. This led the senior consultants to try and secure them
through the American Red Cross. On July 13, the director of professional serv-
ices was notified that the senior consultants of special services should look far
enough ahead to prevent the employment of aides from the Red Cross, thus neces-
sitating that organization cabling to the United States for replacements.'*
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 129
Kequirements for reconstruction aides who were engaged in occupational therapy
work, were outlined in a circular published by the Surgeon General, August 8,
1918. '*^
Early in August a request was cabled that 20 reconstruction aides be sent
over with each base hospital, half of them to be trained in physiotherapy^ and
half in occupational therapy. These aides were to be carried as civilian em-
ployees and not included in the reports and returns of nurses. Toward the end
of that month the senior consultant in orthopedic surgery was notified that the
Surgeon General was organizing reconstruction aides in groups of 20 members
each and that these groups would be sent as fast as possible to the American Ex-
peditionary Forces, as enumerated units, for further reassignment there. A
reconstruction aide unit arrived at Havre, October 19.^" Certain aides had arrived
before that date but from that time forward their numbers increased consider-
ably. Upon arrival they were assigned to hospitals and hospital centers.
The supervisor of reconstruction aides was at first located at Savenay^^ but
in January, 1919, joined the chief surgeon's office at Tours. ^ All occupational
therapy aides for overseas service were versed in simple bedside handicrafts.
The reconstruction aides were under the direct supervision of the director,
nursing service, their function being to carry out instructions in the rehabili-
tation of wounded in methods of physical and occupational therapy." When
practicable they were quartered at the hospitals and were entitled to rations, to
the laundering of uniforms, to transportation; also they were entitled to $4 per
day when traveling. They w^ere authorized to purchase Quartermaster Depart-
ment supplies on written approval of the commanding officer, but were not
entitled to heat and light. The reconstruction aides had the same pay as
nurses, and increase of pay was applied to them as well.^*
On December 29, 1918, there were 200 reconstruction aides serving in the
American Expeditionary Forces, distributed among 20 base hospitals. By
March 15, 1919, this number had been reduced to 93, of whom 71 were engaged
in physical therapy and 22 in occupational therapy.^® These aides were then
attached to 10 hospitals distributed among 6 hospital centers. On May 1,
1919, there were 109 aides in the Services of Supply (55 occupational, 54 physi-
otherapy) distributed among 14 hospitals. Thirty other reconstruction aides
were at that time on duty with the Third Army in Germany."
On June 18, 1919, the chief surgeon. Third Army, was notified that recon-
struction aides were not now considered civilian employees and that they were
to be returned to the United States before June 30.^^
.See Circular No. 56, chief surgeon's office, Nov. 19, 1918, quoted in the appendix.
130
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL"
(July 28, 1917, to July 15, 1919)
ARMY NURSE CORPS
Bessie S. Bell, chief nurse, A. N. C.
Julia C. Stimson, director, nursing service.
Nina E. Shelton, assistant director, nursing service.
Blanche S. Roulon, chief nurse.
Arma E. Coffee, assistant chief nurse.
Marion G. Parsons, nurse.
SUPERVISOR, RECONSTRUCTION AIDES
Marguerite Sanderson.
REFERENCES
(1) Report from Julia C. Stiinsou, Res. A. N. C, director of nursing service, A. E. F., to
the Surgeon General, U. S. A., May 31, 1919. Subject: Nursing activities, A. E. F.,
on the Western Front, from May 8, 1917, to May 31, 1919. On file. Historical Divi-
sion, S. G. O.
(2) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 28,
1917. Subject: Weekly war diary. On file. Historical Division, S. G. O.
(3) Cable No. 197, par. 3, from Gen. John J. Pershing, to The Adjutant General, October
2, 1917.
(4) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file.
Historical Division, S. G. O.
(.5) Annual Report of the Surgeon General, U. S. Army, 1918, 429.
(6) Weekly war diary, chief surgeon's office, A. E. F., September 21, 1918.
(7) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April 17,
1919. Subject: The Medical Department, A. E. F., to November 11, 1918. On
file, Historical Division, S. G. O.
(8) Final report of Gen. John J. Pershing, September 1, 1919, 77.
(9) Report of "Strength of the A. E. F. by months as shown by the consolidated returns
for the A. E. F.," January 12, 1924. On file, A. G. O., Returns Section, Miscellane-
ous Division.
(10) "Circular of information concerning the woman's auxiliary medical aides," the Sur-
geon General's Office, December 31, 1917. On file. Historical Division, S. G. 0.
(11) "Circular of information concerning the employment of reconstruction aides, Medical
Department, U. S. Army," the Surgeon General's Office, January 22, 1918. On
file. Historical Division, S. G. O.
(12) Memorandum from the Surgeon General of the Army to the Supply Division, S. G. 0.,
May 3, 1918. Subject: Approval of letter of appointment for reconstruction aides.
On file, Historical Division, S. G. O.
(13) Cable No. 1153-S, subpar. A, from General Pershing to The Adjutant General of the
Army, May 21, 1918.
(14) Cable No. 1434-R, par. 4, from The Adjutant General of the Army, June 3, 1918, to
General Pershing. On file, A. G. O., World War Division, chief surgeon's files,
(231.238).
" In this list have been included the names of those who at one time or another were assigned to the division during
the period July 28, 191", to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names
have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 131
(15) Third indorsement from the chief surgeon, A. E. F., to director of professional services,
A. E. F., July 13, 1918; on letter from the senior consultant, orthopedic surgery,
A. E. F., to the chief surgeon, A. E. F., July 11, 1918. Subject: Reconstruction
aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).
(16) Circular, "Reconstruction aides in occupational therapy," Office of the Surgeon Gen-
eral, August 8, 1918. On file, Historical Division, S. G. O.
(17) Cable No. 1546-S, par. 9, from General Pershing to The Adjutant General of the
Army, August 2, 1918.
(18) First indorsement from the chief surgeon, A. E. F., to the commanding officer of Base
Hospital No. 9, August 6, 1918; on letter from the commanding officer, Base Hospi-
tal No. 9, A. E. F., to the chief surgeon, A. E. F., August 2, 1918. Subject: Recon-
struction aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).
(19) Letter from the chief surgeon, A. E. F., to senior consultant in orthopedics, August 28,
1918. Subject: Reconstruction aides. On file, A. G. O., World War Division,
chief surgeon's files (231.238).
(20) Telegram from senior consultant in orthopedic surgery, A. E. F., to the chief surgeon,
A. E. F., October 15, 1918. On file, A. G. O., World War Division, chief surgeon's
files (231.238).
(21) Memorandum from the commanding general, A. E. F., to the chief surgeon, A. E. F.,
November 4, 1918. Subject: Contract and oath of office taken by reconstruction
aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).
(22) Cable No. 267-R, par. 3, from The Adjutant General of the Army, to General Persh-
ing, November 14, 1918. On file, A. G. O., World War Division, chief surgeon's
files (231.238).
(23) Second indorsement, from the chief surgeon's office to the commanding officer. Base
Hospital No. 94, U. S. A. P. O., 713-A, France, January 30, 1919; on letter from the
personnel officer, Base Hospital No. 94, to the chief surgeon, A. E. F., January 30,
1919. Subject: Pay of reconstruction aides. On file, A. G. O., World War Divi-
sion, chief surgeon's files (231.238).
(24) Telegram from the chief surgeon, A. E. F., to the chief surgeon of the advance section,
A. E. F., December 21, 1918. On file, A. G. O., World War Division, chief sur-
geon's files (248).
(25) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to
the chief surgeon, A. E. F., December 29, 1918. On file, Historical Division, S. G. O.
(26) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to
the chief surgeon, A. E. F., March 15, 1919. On file. Historical Division, S. G. O.
(27) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to
the chief surgeon, A. E. F., May 1, 1919. On file. Historical Division, S. G. O.
(28) Telegram from the chief surgeon, A. E. F., to the chief surgeon of the Third Army,
June 18, 1919. On file, A. G. O., World War Division, chief surgeon's files (230.366).
CHAPTER VIII
THE DIVISION OF SANITATION AND INSPECTION"
ORGANIZATION
The division of sanitation, chief surgeon's office, A. E. F., eventually became,
in very large degree, an office of preventive medicine wherein all activities
relating to that subject were centralized.' However, this centralization was
not complete until December 26, 1918, when there w^as transferred to the sanita-
tion division the subsection of venereal diseases, which in the division of urology
had theretofore pertained, with the other professional services, to the division
of hospitalization. -
Ch aut UI.— Scheme for organization of division of sanitation and inspection, chief surgeon's office, A. E. F.
When the chief surgeon's office, A. E. F., was organized, July 28, 1917, the
prescribed activities of the division of sanitation were as follows:^ In charge
of sanitation of camps and quarters, laundries, disinfection and delousing,
health of command, report of sick and wounded, statistics and sanitary reports.
Subsequently these activities were somewhat modified, several of them being
transferred from the Medical Department to other departments of the Ameri-
can Expeditionary Forces. Thus, General Orders, No. 31, G. H. Q., A. E. F.,
January 21, 1918, directed the provision and operation of laundries be vested
in the Quartermaster Corps, and that portable shower baths, taken by organiza-
tions into the zone of the advance, be installed when necessary by the engineers.
General Orders, No. 60, G. H. Q., A. E. F., April 20, 1918, provided that the
personnel of portable disinfestors be furnished by the engineers, and that of
portable laundries and bathing units by the Quartermaster Corps. Concur-
rently with this transfer of some of its responsibilities, the sanitation division
assumed others which had not pertained to it originally.^ By General Orders,
No. 29, G. H. Q., A. E. F., February 14, 1918, general sanitary inspectors were
provided for, and though these officers reported on a wide range of subjects,
in addition to sanitation, they were essentially a part of the division of sanitation.
» Consult also Sec. H, Vol. VI, of this history, wherein a fuller consideration is given the activities of this division.
133
134
ADMINISTRATION, AMERICAN EXPEDITK )N A H V FORCES
On March 6, 1918, the chief surgeon prescribed that the division of sanita-
tion be organized into the following sections:^ (1) Sick and wounded records;
(2) laboratories and infectious diseases; (3) inspection; (4) epidemiology.
Though the last-mentioned section was estabhshed while the chief surgeon's
office was yet at Chaumont — that is, during the early part of March — this out-
lined organization was not effected immediately.^ On March 31, the division
of sanitation was redesignated the division of sanitation, sanitary inspection,
and sanitary statistics, with duties more clearly defined and established than
they had been during the formative stage of its activities.* On May 5, 1918,
the laboratory service was separated from the other professional services* with
which it formerly had been operating under the division of hospitalization, to
become a part of the division of sanitation, though formal orders concerning
this transfer, and the reorganization of the section of laboratories and infectious
diseases as a part of the division of sanitation, were not published until July 20,
1918.^
The organization outlined above was retained until December 26, 1918,
when, as previously stated, the division of urology was transferred to the division
of sanitation from that of the professional services.^
ADMINISTRATIVE FUNCTIONS
In view of the organization described above, the administrative functions
which were included within the jurisdiction of the division of sanitation and
inspection may be classified as follows: ^
(0) The receipt, record, and analysis of reports of disease and injury.
(6) The receipt and review of monthly and special sanitary reports.
(c) The selection, supply, and direction of laboratory services for the prevention, diag-
nosis, and treatment of disease, for the protection of water and food supplies, and for research
by experimental laboratory methods in all matters pertaining to personal hygiene, physiology,
the science of nutrition, pathology, and bacteriology, as they bore upon the problems of the
armies.
(d) Inspection of areas and premises occupied by the troops together with such exami-
nation of men, singly, or in groups, as was required in tracing the origin, distribution, and
spread of causes of nonefFectiveness, whether due to communicable disease or to other cause.
(e) Correlation of the reports of disease with the reports of sanitary conditions, troop
movements, weather conditions, military operations, or other essential factors, to the end
that epidemics might be brought to an end promptly and their recurrence prevented.
(/) Collection of data for statistical purposes to serve as a basis for the direction of
sanitary policies during the present emergency, and for the service of students and adminis-
trators in the future.
(g) The selection, training, and appointment of qualified officers and enlisted men to
serve the functions above described.
(h) Collection and publication of information dealing with preventive medicine.
(1) Maintenance of liaison with other divisions of the Medical Department.
0") Maintenance of liaison with the medical services, both civilian and military, of our
Allies, and with conditions of disease among our enemies, which might affect the health of our
troops.
OFFICE CONTROL
Cummunications betw^een the division of sanitation and inspection and
other divisions of the Medical Department passed through the office of the chief
of the division. All but routine reports were submitted direct to the chief of
the division.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 135
By central control of correspondence and of reports concerning personnel
and supplies, at the offices of the chief of the division, and of the director of
laboratories, provision was made and responsibility placed, for all actions
taken. ^
MEETINGS AND LIAISON
Meetings of the heads of the subdivisions at the office of the sanitation
division, at Tours, or at the central Medical Department laboratory, at Dijon,
provided frequent opportunity for the discussions of new problems and agree-
ment upon policies affecting the division of sanitation. ^ Through the deputy
of the chief surgeon, at General Headquarters, the chief of the division of
sanitation was kept constantly informed of the changing problems of the general
staff.^ Through the surgeons of armies, or of the administrative sections of
the Services of Supply, he was kept in touch with the needs of combat troops
and of organizations in the Services of Supply, from the moment of their arrival
at the ports of debarkation, to arrival at their station in the Services of Supply,
or at the front. ^ Officers, — e. g., sanitary inspectors and laboratory experts —
charged with duties pertaining to the sanitary services, were assigned to the
larger organizations of combat troops, to sections of the Services of Supply, to
hospital centers, training areas, and other large commands.'' When the size
of an organization did not justify the assignment of an officer to such service
exclusively, one was charged with sanitary services of the command in addition
to his other duties.^ Officers charged with sanitary duties thus served all com-
mands from the largest to the smallest, and through these agencies, by successive
echelons of responsibility, the sanitation division exercised appropriate super-
vision in its specialty over all elements of the American Expeditionary Forces.^
Close contact existed between the divisions of sanitation and hospitaliza-
tion, particularly in matters pertaining to infectious diseases.' These included
the venereal diseases, after the subsection charged with that specialty was
transferred to the division of sanitation as described above. The laboratory
division was in especially close liaison with the professional services.''
The location of the headquarters of the division of laboratories and infec-
tious diseases at Dijon, while the office of the chief surgeon was located at
Chaumont, and then at Tours, caused at times, especially after the chief
surgeon's office moved to Tours, delay and inconvenience to the office of sick
and wounded and that of epidemiology, but difficulties in communication
were reduced to a minimum by the almost daily telephonic and telegraphic
communication, exchange of reports, and the frequent conferences held by the
heads of the subdivision.^
The sanitation division also maintained close contact, in matters pertain-
ing to bathing and disinfestation, with the Quartermaster Department,^ and
through its laboratory division with the laboratories of the Chemical Warfare
Service.*
The division also maintained contact with the French civil and miUtary
services, in matters pertaining to sanitation and epidemiology, through the
medical officers of the French military missions at general headquarters and
at headquarters, Services of Supply, and through the French medical officers
in each of the French regions in which American troops were stationed, or
through which they passed.^
136
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL "
(July 28, 1917, to July 15, 1919)
Brig. Gen. Walter D. McCaw, M. C, chief.
Col. Percy M. Ashburn, M. C, chief.
Col. Daniel W. Harmon, M. C, chief.
Col. Henry A. Shaw, M. C, chief.
Col. Haven Emerson, M. C.
Col. Henry C. Fisher, M. C.
Col. Daniel W. Harmon, M. C.
Col. Paul C. Hutton, M. C.
Col. Howard H. Johnson, M. C.
Col. James C. Magee, M. C.
Col. Robert U. Patterson, M. C.
Col. George Walker, M. C.
Col. Linsley R. Williams, M. C.
Maj. George Blackburne, M. C.
Maj. Robert H. Delafield, San. Corps.
Maj. John S. C. Fielden, jr., M. C.
Maj. Bascom Johnson, San. Corps.
Maj. Frank A. Ross, San. Corps.
Capt. George J. Anderson, San. Corps.
Capt. T. L. Harrington, M. C.
First Lieut. Howard H. Antles, San. Corps.
First Lieut. Arthur B. Crean, San. Corps.
First Lieut. Arthur E. Nelson, San. Corps.
First Lieut. Dennison Walcott, San. Corps.
REFERENCES
(1) Report from Lieut. Col. J. F. Siler, M. C, director of laboratories and infectious dis-
eases, A. E. F., to the chief surgeon, A. E. F. (undated). Subject: Activities of
the division of laboratories and infectious diseases, from August, 1917, to July, 1919.
On file, Historical Division, S. G. O.
(2) Report of the division of sanitation and inspection, Medical Department, A. E. F.,
May 31, 1919, by Col. Haven Emerson, M. C. On file. Historical Division, S. G. 0.
(3) Report from the chief surgeon, A. E. F., to the commanding general. Headquarters,
A. E. F., April 17, 1919. Subject: The Medical Department, A. E. F., to November
11, 1918. On file. Historical Division, S. G. O.
(4) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., April 1,
1918. Subject: War diarv for week ending March 31, 1918. On file. Historical
Division, S. G. O.
(5) Circular No. 25, chief surgeon's office, A. E. F., Mav 5, 1918. On file, Historical Divi-
sion, S. G. O.
(6) Circular No. 40, chief surgeon's office, A. E. F., Julv 20, 1918. On file. Historical Divi-
sion, S. G. O.
(7) Report on " Sanitary reports, monthly and special," October 7, 1921, by Col. Haven
Emerson, M. C. On file, Historical Division, S. G. O.
(8) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file, Historical Division, S. G. O.
(9) Letter from the chief surgeon, A. E. F., to Sous-Secretaire d'Etat du Service de Sante,
section Franco-Americaine French mission, G. H. Q., A. E. F., March 8, 1919. Sub-
ject: Epidemic diseases in the A. E. F. On file, A. G. O., World War Division, chief
surgeon's files, 710.
" In this list have been included the names of those who at one time or another were assigned to the division during
the period July 28, 1917, to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names have
been arranged alphabetically, by grades, irrespective of chronological sequence of service.
CHAPTER IX
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
GENERAL ORGANIZATION
When the United States entered the war, practically no information was
available to us relative to the laboratory organization and activities of the
nations engaged. Therefore, it was not possible for the Medical Department
to formulate at that time any definite plan of organization based on their
experience ; however, as a preliminary measure to the provision of a laboratory
service for the American Expeditionary Forces, the officers in charge of the
laboratory division, Surgeon General's office, assembled the personnel for an
initial laboratory and dispatched it to France.' This unit which sailed on July
26, 1917, and arrived in France on August 5, consisted of five officers and six
enlisted men under command of a major of the Medical Corps. Designated
as Army Laboratory No. 1, it was assigned to station at Neuf chateau about 35
miles north of Chaumont.' As the officer in charge of the laboratory division,
Surgeon General's office, had believed that general laboratory supplies would be
available in France, this unit brought with it only a few special items and pro-
cured from the Pasteur Institute in Paris an emergency equipment consisting
of one French Army model field laboratory packed in chests.' This equipment
provided very limited material for clinical pathology and general bacteriology,
and only with the greatest difficulty was a very incomplete equipment for
neurologic and pathologic work procured.' A small requisiCion had been placed
with the supply division of the wSurgeon General's office before this unit left
the United States, but much of this never reached the laboratory in France.'
A requisition was placed for the limited number of items of laboratory equipment
on the Medical Department supply table, and provision was made for the sup-
ply of a standard cantonment laboratory to corps laboratories, and the Army
standard field laboratory equipment (plus a poison detection chest) to mobile
laboratory units, as they were ordered overseas.' Army Laboratory No. 1 was
obliged to occupy a building altogether unsuitable for its purposes, where nec-
essary alterations were made under almost insurmountable difficulties. Neither
gas nor electricity was available with sufficient constancy to permit their use.'
The commanding officer of this unit, who was also the adviser of the chief
surgeon, A. E. F., in all matters pertaining to laboratory service,' formulated a
tentative plan for the laboratory organizations of the American Expeditionary
Forces, which was submitted to the Surgeon General in the following letter:^
1. This letter * * * is intended to furnish your office with an approximate idea
of the officers, men, and supplies needed in France for the laboratory work of an army on the
l)asis of five corps of six divisions each — a total of approximately 1,000,000 men.
PERSONNEL
(a) It is planned to establish one army laboratory with a personnel of 8 officers and 16
men, which will be the central laboratory, fully equipped for all kinds of routine special work,
including research. The laboratory detachment and supplies brought over by Major Nichols
will serve as the nucleus for this laboratory.
137
138
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(b) This office has recommended the establishment of five corps laboratories with a
personnel of 4 officers and 8 men each. These laboratories will be stationary and will need
to have an equipment less complete than that of the central army laboratory, V)ut sufficient
for all routine w'ork. They may be specialized under direction of the army laboratory, if the
routine work of the corps permits.
(c) A field laboratory with two officers and four men each will be provided and attached
to each division. The field laboratory will be mobile and its principal work will be the bac-
teriological and chemical examination of water, the taking of cultures and specimens for
examination in the corps or army laboratory, the examination of smears, etc. The field
laboratories will depend upon and look to the corps and army laboratories for supplies and
supervision of technique, etc.
(d) Summary of personnel —
Number
Officers
Men
Army laboratory (8 officers, 16 men)
1
8
20
16
Corps laboratories (4 officers, 8 men)
5
40
Field laboratories (2 officers, 4 men)
30
60
120
Total
88
176
(e) Chemist. — It is planned to include in the work of the organization given above,
all chemical work which is of great importance in this war and which in the English and
French services is done by separate organizations. It is believed that all laboratory work
can be combined to advantage in our service. For this work officers and men, chemists
of the Sanitary Corps, can be used as follows:
Number Officers
Army laboratory. _
Corps laboratories -
Field laboratories..
SUPPLIES
(a) The supplies for the army laboratory have already been partly arranged for by
a requisition prepared by Major Nichols and submitted before his departure from the United
States. Further requisitions will be made on Washington for this laboratory later.
(b) At present, as our own laboratory supplies will not be avaiable for issue for some
time, work will be started near the established training camp with a laboratory outfit which
has been obtained by purchase from the Pasteur Institute. Emergency items, as they may
be needed, will be obtained here by purchase from the Pasteur Institute or elsewhere.
(c) It is desired that the equipment of the corps laboratories shall be the same as that
already adopted for the cantonment laboratories in the United States. It is believed that
the simplest method of requisition is to ask for five of these outfits.
(d) The standard field laboratory equipment can be used for the field laboratories
with the addition of a chest for the detection of mineral poisons. It might be possible
to obtain these here, but it is preferable to have them sent from the United States. It
is planned to purchase here two motor laboratories, similar to those used in the English
service, * * * f^j. trial; but it is believed that our field laboratory can be used with-
out a special car by transporting it on a light truck or ambulance.
(e) Laboratory supplies to replace those expended will be asked for by the medical
supply officer from time to time according to strength as authorized by the supply table.
2. To recapitulate: For the whole laboratory organization there w'ill be required
about 50 medical officers and 130 men capable of doing routine laboratory work, and 35
officers and 45 men of the Sanitary Corps capable of doing chemical work. These should
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 139
be sent to PVancc so that the required personnel for each division field laboratory will accom-
pany each division. The army laboratory, Major Nichols in charge, will do the work
of the corps laboratories until the latter can be established. There is immediate need for
two chemists to start their part of the central army laboratory organization.
(a) Advance notice of all arrivals should be sent, to facilitate the assignment of labora-
tory personnel.
3. In regard to supplies, there will be needed 30 more field laboratories each with a
small, suitable chemical chest for qualitative analysis for mineral poisons, to be provided
in the United States.
(a) The question of the transportation of field laboratories will be made the subject
of a later communication.
(6) There will be required five corps laboratory equipments similar to those now used
in the cantonments established in the United States.
(c) Additional equipment which will be required for the army laboratory will be
covered by requisitions from France from time to time.
4. Resume:
(a) Required at once: 2 chemists, Sanitary Corps.
(6) Reqviired with each new division which may come to France: 2 officers (1 a chemist),
4 men (1 a chemist), 1 field laboratory equipment, to which there must be added 1 chest,
chemical (for the detection of mineral poisons, etc.).
(c) Required before November 15, 1917: 1 cantonment laboratory (4 others to follow
before January 15, 1918).
(d) The personnel for corps laboratories should be sent from time to time as indicated
by the divisions which are dispatched.
5. For the purpose of supply it is requested that this letter be taken as a requisition.
This letter indicates, among other things, that the chief surgeon's office
desired three special types of laboratories not previously authorized in War
Department Tables of Organization. A representative of one of these types, an
army laboratory, was already provided, so far as nomenclature was concerned,
in army laboratory No. 1, but in addition to its other services this unit operated
as the headquarters laboratory for the entire American Expeditionary Forces
until the central medical department laboratory was established at Dijon,
January 1, 1918.^ Thereafter in addition to serving the troops in the combat
zone, it also served the advance section.^ A second type of unit desired was the
corps laboratory, to be organized and dispatched to France in the proportion
of one for each corps.' The plans accepted at this time provided that each of
these units should be of a stationary character, and well equipped for the ser-
vice of corps troops, but events proved that their employment as contemplated
was not practicable.' Therefore, on arrival, the corps laboratories were diverted
from their original purpose and operated as base laboratories in the different
sections of the Services of Supply. The third type of special laboratory desired
was the field or divisional laboratory unit, one of which was to be provided for
each division. These units were to be supplied with the standard field labora-
tory equipment already authorized by the Medical Department. As the situ-
ation later developed, these divisional units were retained in the final plan of
organization, but their equipment was changed.'
In addition to the special types of laboratories mentioned above, Tables of
Organization already provided for a laboratory as a part of each base hospital
and specified its personnel and equipment.^ Though none of the corps or divi-
sional laboratories reached France before November 1, 1917, several base hos-
pital laboratories (Nos. 6, 101, 15, 18, 17, 8, 9, and 27) arrived and began
140
AD.MINISTKATION, AMERICAN EXPEDITIONARY FORCES
operating.^ These base hospital laboratories had fairly complete equipments
and supplies at this time, but much of it was useless, since neither sufficient
gas nor usable electric current was then obtainable.^
Before November 1, 1917, the personnel of the laboratory service in France
consisted, in addition to the staff of army laboratory No. 1, of two commissioned
officers and a varying number of enlisted technicians with the laboratory of
each base hospital then in France.^
A considerable amount of routine clinical pathology was performed during
this early period and an autopsy service of practical value conducted. The
bacteriologic work done at this time consisted mainly of a study of the organ-
isms concerned in the prevalent infections of the respiratory tract.^ The service
for conducting Wassermann reactions was begun in September, 1917. The
difficulties to be overcome were many. Little equipment was available, all
reagents had to be prepared and standardized, only with the greatest difficulty
could guinea pigs be secured, only a low-speed hand centrifuge was available,
and it was necessary to use some very primitive equipment.^ At that time it
was planned that the Wassermann work for the entire American Expeditionary
Forces would be done at army laboratory No. 1, but this proved impractical
because of delays in transmitting specimens and reports.^
In the latter part of October, 1917, a division charged with the supervision
of the laboratory service of the American Expeditionary Forces was created
as a part of the office of the chief surgeon, and Circular No. 2, chief surgeon's
office, dated November 9, 1917 (quoted in the appendix), which announced
the creation of professional divisions in that office, included among others the
division of laboratories. Later in the same month a section of infectious dis-
eases was added to this division.^
The chief surgeon on November 11, 1917, instructed the director of labora-
tories, A. E. F., to submit plans to organize a division of laboratories and infec-
tious diseases.^ Some information was then available concerning the organi-
zation of the laboratory services in the British and French Armies, but it seemed
advisable to plan for a somewhat more comprehensive organization with greater
centralization and more definite administrative control and coordination than
existed in those forces.^ The general projects of organization and phases of
development for the American Expeditionary Forces as worked out by the
general staff were reviewed, the plans of the hospitalization division of the office
of the chief surgeon, including geographic location of hospitals present and pro-
spective (i. e., those leased, under construction, or projected) were studied, and
as much relevant information as possible was obtained, concerning the proposed
lines of railway communication.^ By means of this information, and the
employment as a basis of the preliminary plans for the laboratory service
already adopted, a highly developed project for the organization of this divi-
sion was formulated.^ On December 29, 1917, a general outline of the pro-
posed organization was submitted to the chief surgeon, and on January 11,
1918, a detailed outline with the statement that plans were already being formu-
lated to effect a number of the features it prescribed.^ This latter project,
which was approved by the chief surgeon, was as follows : ^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 141
Activities — Division of Laboratories and Infectious Diseases
section of laboratories
1. Representative of chief surgeon in all matters relating to laboratory service.
2. General supervision of all laboratories and the assignment of special personnel.
3. Direct supervision of purchase and distribution of laboratory equipment and supplies.
4. Publication of circulars relating to standardization of technical methods, collection of
specimens and other matters of technical interest to the laboratorj^ service.
5. Collection and distribution of literature relating to practicable and definite advances
in laboratory methods.
6. General supervision of research.
7. Supervision and action on manuscripts of laboratorj- personnel to be presented to
chief surgeon for i)ubIication.
8. Cooperation and coordination with the directors of all the professional divisions, in
order that medical and surgical problems arising during the war may be most effectively
handled from the laboratory point of view.
SECTION OF INFECTIOUS DISEASES
1. Representative (advisory) of chief surgeon in matters relating to the prevention and
control of transmissible diseases.
2. Collection and distribution of hterature pertaining to practical advances in methods
of prevention and control.
3. Preparation of circulars relating to prevention and control.
4. Detail of specially trained units with personnel and mobile material, on request from
the division of sanitation, for the investigation of epidemics or threatened epidemics.
5. Experimental investigations of suggested prophylactic methods for the prevention of
infectious diseases and recommendations relative to their general adoption.
6. Collection of statistics and epidemiological data on infectious diseases.
A. CENTRAL ORGANIZATION
1. Central offices.
Personnel:
Director of division of laboratories and infectious diseases —
(a) Assistant director (section of laboratories) .
(b) Assistant director (section of infectious diseases) .
(c) Adjutant; 2 secretaries, 2 clerks, chauffeur and orderly.
2. Central medical department laboratory, A. E. F.
Divisions:
(a) Bacteriology.
(6) Serology.
(c) Pathological anatomy.
(d) Chemistry (sanitary — medical).
(e) Medical biology.
if) Supplies (diagnostic and therapeutic sera, vaccines, culture media, stains,
standard solutions, portable laboratory units, etc.).
Activites:
(a) Standardization of technical methods.
(6) Manufacture and distribution of culture media, stains, agglutinating
sera, amboceptor, antigen, etc.
(c) Distribution of diagnostic and therapeutic sera, vaccines, etc., to base,
camp hospital, army, evacuation hospital, and divisional laboratory
units and to troops.
(d) Supply of complete transportable and other mobile laboratories for
units in the field and for special investigations. (Meningitis, diph-
theria, pneumonia, enteric fevers, etc.)
(e) Supply of laboratory animals.
if) Special highly technical chemical and other laboratory work as required.
142
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Central medical department laboratorv, A. E. F. — ^Contimiod.
Divisions — Continued.
Activities — Continued.
(g) Standardization of technique and records of post-mortem examinations
and supervision of collection of museum specimens to be forwarded to
the Army Medical museum.
(h) Special work on insects (lice, etc.).
(i) Special research work.
(j) Instruction of laboratory personnel in technical methods (wound bac-
teriology, etc.).
(fc) Supply of special personnel and material for the investigation of epi-
demics.
Personnel :
Commissioned —
Commanding officer.
Adjutant.
Quartermaster.
Chief, division of bacteriology.
Assistant, division of bacteriology.
Chief, division of serology.
Assistant, division of serology.
Chief, division of pathological anatomy.
Chief, division of chemistry.
Chief, division of medical biology.
Enlisted and civilians (43) —
2 secretaries.
3 clerks.
10 technicians.
1 electrician.
1 plumber.
1 cabinetmaker.
1 general carpenter.
1 packer.
6 chauffeurs.
1 mechanic, having general knowledge of autos.
1 motor-cycle driver.
5 general utility men.
10 civilian laborers.
Note. — Both commissioned and enlisted personnel will be attached temporarily to
this laboratory from time to time, for purpose of instruction. Special mobile units for special
investigations and reinforcements will be held in reserve at this laboratory.
The central laboratory will supply culture media, stains, therapeutic sera, standard
solutions, and other expendable laboratory items to laboratory units in the intermediate and
advance section, line of communications, and the zone of the advance. It will equip, distri-
bute, and replenish the transportable laboratory units for camp hospital laboratories. It
will stock and replenish all transportable laboratories (in chests) for special investigations
(meningitis, pneumonia, diphtheria, typhoid, dysentery, etc.), and all motorized corps and
special mobile laboratories functioning in the intermediate and advance sections, line of
communications, and the zone of the advance. In the investigation and control of epidemics
and threatened epidemics, it is of the utmost importance that the existence of suspected
disease be recognized promptly, in order that measures for its control and prevention may
be instituted without delay. Experience has demonstrated already that railway transporta-
tion fails absolutely to meet the necessary requirements. All parts of the area served by the
central Medical Department laboratory can be reached by motor transportation in from two
to eight hours and an adequate motor transportation will be urgently required. The following
transportation will be necessary:
1 13^-ton truck.
2 light Ford trucks.
2 Ford ambulances.
1 passenger car closed (Dodge).
1 passenger car (Ford).
2 motor cycles with side cars.
6 motorized bacteriological laboratories (re-
serve) .
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 143
B. GENERAL ORGANIZATION"
(Division of Laboratories)
1. Base laboratories:
(These laboratories will be of two general types: Those functioning directly under
the headquarters of the different sections of the Services of Supply and those func-
tioning as base laboratories for single base hospitals or for groups of base hospitals.)
(1) Base laboratories, Services of Supply — -
Divisions —
(a) Bacteriolog}' .
(6) Serology.
(c) Pathological anatomy.
(d) Chemistry (sanitary and medical).
(e) Supplies (diagnostic and therapeutic sera, vaccines, culture
media, stains, standard solutions, etc.).
Activities —
(a) Manufacture of culture media.
(6) Distribution of culture media, stains, diagno.stic and therapeu-
tic sera, etc., to camp hospital laboratories and base labora-
tories, base hospitals, in their section.
(c) Stocking and replenishing special transportable and motorized
mobile units functioning in their section.
(d) Supply of laboratory animals,
(c) Special research.
(/) Investigation of epidemics and threatened epidemics in their
section by means of special personnel and material attached.
(Transportable units in chests for investigation meningitis,
diphtheria, pneumonia, dysentery, etc., and motorized bac-
teriological laboratory for special investigation.)
(g) Serological and special bacteriological work for camp hospitals,
base hospitals, and for troops.
Personnel — •
Commanding officer.
2 commissioned assistants permanently attached.
2 commissioned assistants to be available for special duty in
investigating epidemics.
The necessary enlisted and civilian personnel.
Transportation —
1 passenger car and 1 motor cycle with side car.
1 motorized bacteriological laboratory.
(2) Base laboratories, base hospitals —
(These laboratories will be organized for single base hospitals (1,000
beds) and base hospital groups (5,000 to 10,000 beds). They will be
well equipped as to personnel and material and capable of doing any
workjOrdinarih' carried on in a good laboratory.)
Activities —
(a) Bacteriological, serological and gross and histopathological
work for base hospitals or for groups of base hospitals.
(6) When necessary, they will be charged with the serological
and specialized bacteriological work for camp hospitals in their
vicinity.
(c) Supply of therapeutic sera, vaccines, etc.
Note. — The routine pathological work (blood counts, urines,
smears, etc.) in base hospital groups will be done by a special
personnel in small laboratories in close proximity to the wards.
Special base laboratory buildings with adequate space are being
provided for in the plans for the construction of groups of base
hospitals (5,000 to 10,000 beds).
Transportation — 1 motor cycle with side car.
13901—27 10
144
ADMINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
Base laboratories — Continued.
(3) Camp hospital laboratories —
Activities —
(a) Routine clinical pathological work for camp hospitals (300
beds) and regimental infirmaries (urines, sputum, blood
counts, dark field, diphtheria cultures, etc.)
(b) Collection of specimens from regimental infirmaries (blood
for Wassermann, etc.) to be forwarded to base and army
laboratories.
(c) Distribution of reports to regimental infirmaries.
Personnel —
1 bacteriologist.
3 enlisted technicians.
1 motor-cycle driver.
Transportation — 1 motor cycle wuth side car.
Equipment — Transportable expandible units in chests.
(4) Evacuation hospital laboratories —
(These units will be assigned to evacuation hospitals and will have
the necessary equipment to do the routine clinical ward work and special
work in wound bacteriolog}^ for evacuation hospitals).
(5) Army laboratories —
(Stationary units. Located in permanent buildings in the zone of the
advance or in the advance section, line of communications, immobilized
well equipped. Directly under the chief surgeon, A. E. F., for adminis-
trative purposes. Designated as army laboratories but will not be
mobile in the sense of being attached to any particular army and follow-
ing it as it moves. These laboratories will be organized as necessity for
them arises and will be numbered serially.)
Activities — Similar to the activities of base laboratories.
Personnel —
4 commissioned.
10 enlisted.
Transportation — -
1 passenger car (closed).
1 Ford truck or ambulance.
1 motor cycle.
(6) Corps laboratories — -
These laboratories will be motorized, mobile units, completely equipped
for general bacteriological and epidemiological investigations. They will
be numbered serially. They will not be assigned definitely to corps
but will be attached to armies, corps, or other units when their services
are required. For administrative purposes and purposes of mobility,
they will be controlled directly by the chief surgeon.
Activities — Investigation of special problems, epidemics, reinforcement
of laboratory units in the zone of the advance, etc.
Personnel —
1 commissioned.
2 enlisted.
Transportation — ^1 motorized bacteriological laboratory.
(7) Division laboratories —
(These units will be assigned definitely to divisions and will be under
the order of the division surgeon.)
Activities — General routine pathological work for the division, includ-
ing bacteriological and chemical examinations of water supplies.
When the division is in training, the laboratory unit should be attached
to the camp hospital in its particular area. When serving at the
front, one bacteriologist and technical assistant will be detached for
service in wound bacteriology at evacuation hospitals or special
surgical units near the front.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 145
Base laboratories — Continued.
(7) Division laboratories — Continued.
Personnel —
1 medical officer.
1 officer, Sanitary Corps (water).
4 enlisted.
Transportation —
The portable laboratory is to be transported on the sanitary train
of the division.
1 motor cycle with side car.
Equipment — In chests, each chest containing a complete unit for
a definite purpose. Number of units assigned dependent on char-
acter of work anticipated. Ordinarily the equipment furnished will
meet the requirements for routine clinical examinations (chemical
and bacteriological), examinations of water supplies, and wound
bacteriology.
(8) Special units —
Motorized mobile units.
(a) Bacteriological cars.
(6) Meningitis cars.
Transportable mobile units (in chests) —
(a) Meningitis units.
(b) Diphtheria units.
(c) Pneumonia units.
(d) Typhoid group, dysentery units.
(e) Wound bacteriology units.
(/) Water supply units.
(g) General bacteriological units.
(h) Camp hospital laboratory units.
(i) Division laboratory units.
Note. — These special units will be assembled at the cen-
tral Medical Department laboratory and sent where required.
Their expendable supplies (culture media, stains, etc.) will
be replenished at the central and base laboratories.
In addition to the functions outlined in this plan, the division of laboratories
assumed certain others also; e. g., the collection of statistics on routine and
special work done in laboratories, cooperation and coordination with the Chemi-
cal Warfare Service, supervision of the collection of museum and photographic
records of the Medical Department, and research in a number of medical prob-
lems. Furthermore, additional sections later were added to the division, viz.,
that of food and nutrition, and that charged with supervision of purification of
water supplies.^
Some other modifications of this original plan also proved necessary, the
more important being the following: ^ Army laboratories of a stationary type
were not organized, and mobile units were assigned to the headquarters of field
armies for use in investigations of epidemic disease in the field; corps labora-
tories were not organized, for only exceptionally could highly specialized, tech-
nical, bacteriological work, such as wound bacteriology, be done in evacuation
and mobile hospitals during active military operations; the divisional laboratory
units usually were unable to function, from the purely laboratory point of view,
during combat, and furthermore they required additional equipment when in
rest or training areas. ^
146
ADMTXT8TRATK)X, AMERICAN' f:XPKI)ITr()XAHV FORCES
However, after the chief surgeon's approval of tlie phiii detailed above,
efforts were immediately begun by the director of laboratories to carry it into
effect, the organization of the laboratory section and more particularly the
establishment of a central (headquarters) laboratory being given first considera-
tion.^ After a thorough study of the projected line of communications it was
decided that the central laboratory should be located at Dijon, which situation
presented many natural advantages. The chief reason for selection of this
locality was its proximity to the American front and training areas and to
the main line of communications.^ On a visit of inspection to that city by
the director of laboratories on December 15, 1917, a modern laboratory building
was found which constituted a part of the plant belonging to the University of
Dijon. Late in the same month arrangements were completed for taking over
this structure and here the central Medical Department laboratory was estab-
lished on January 1,1918.^ On the same date the director of laboratories moved
his office to the same point from Neufchateau, where it had been located first
in the office of the commanding officer of Army laboratory No. 1, and then in a
hut erected beside the laboratory.^
At Dijon the director's office was first established in the central Medical
Department laboratory, but in April, 1918, a temporary wooden office building
100 feet long and 20 feet wide, located on the grounds of the laboratory, was
completed and occupied by the director.^
The preliminary plans for the office provided that only two-thirds of the
building would be used for office purposes, the remainder being reserved for
storage and expansion if necessary, but even before this plan could be applied
the volume of work had so greatly increased that the entire building was arranged
for office purposes. One large room served as a combined office and library,
partitions dividing the remainder into small offices with connecting doors. ^
The structure was well lighted by electricity and was heated by stoves during
the winter months; telephone connections through a local switchboard provided
communication both with local and distant offices. Eventually satisfactory
telephone connections could be made with places as far distant as Bordeaux,
St. Nazaire, and Brest. ^ The director's office remained in this building until it
was transferred to the office of the chief surgeon at Tours in June, 1919.^
The general arrangement of the offices and the relationship of the office
buildings to the central Medical Department laboratory are shown in Figure 5.
Until February the director's office force was still limited to one stenographer,
but efficient office and other personnel was then procured, adequate to require-
ments.^
On February 6, 1918, the director of laboratories w^as directed to make
such journeys as were necessary in matters pertaining to the service of that
specialty.^ Prior to January the urgent necessity for completion of plans for
the organization of this division had been such that but little time could be
devoted to inspections.^
During the period from August to December, 1917, inclusive, the plans of
organization of the division were elaborated, definitely formulated and adopted;
from January to June, 1918, inclusive, the laboratory service underwent active
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 147
development; from July to Novembei', 1918, inclusive, it worked under stress;
and from December, 1918 to July, 1919, inclusive it underwent demobilization.^
In the spring and early summer of 1918, a considerable number of addi-
tional activities were assigned to the division and new sections were established
as mentioned above. ^
On May 22, 1918, the director of laboratories forwarded to the chief
surgeon the following letter,* which gave a general summary of organization
then effected and projected, and especially stressed the transportation needs
of the laboratory service.* Such needs became of very urgient importance
later. ^
Rut L'LGAUITE.
Fig. 5.— Ground plan, headquarters, division of laboratories, A. E. F., and central Medical Department laboratory, Dijon
1. I am inclosing herewith a table of organization for laboratory units that this office
considers necessary for the American Expeditionary Forces; as will be noted the laboratories
are divided into two basic types: Stationary and transportable.
STATIONARY LABORATORIES
2. Central Medical Department laboratory. — This laboratory is situated in the advance
section and is thoroughly equipped to do anj' work that ma,y come up. It is estimated that
it will eventually recjuire 25 officers and 50 enlisted men. So far as is possible we are cutting
down the enlisted personnel by the employment of civilian technicians and laboratory assist-
ants, thus releasing male personnel for more urgent field duties. The civilian personnel
is quite satisfactory and is in reality cheaper than enlisted personnel.
This laboratory, in addition to its permanent personnel, has established laboratories
equipped for special investigations. At the present time surgical shock and chest surgery
are the subjects of special investigation in special laboratories. The water-supply service,
A. E. F., is provided with special laboratories here. We have arranged with the intelligence
section, general staff, to organize a special chemical section here for the investigation of
148
ADMINISTRATIOX, AMEKICAX EXPEDITIONARY FORCES
correspondence and the development of invisible inks. Special problems will come up from
time to time and this laboratory will be prepared to handle them.
Referring to transportation required for this particular laboratory, it will be necessary
to send laboratory personnel out from this center to various parts of the Advance Section
and Zone of Advance for investigation of epidemic diseases. The motor cars, light, are
required for this particular purpose. It will also be necessary to deliver standardized
laboratory units and replenishment supplies to mobile units in the zone of advance, and three
motor trucks, medium, and three motor trucks, light, will be required to meet these needs.
We have adopted a standard expandable laboratory unit system in chests with the idea
that when a special investigation of epidemic diseases is to be undertaken, one of these
transportable laboratory outfits can be placed on a motor truck, medium, size \}/2 tons capac-
ity, proceed to the area to be investigated, unpack the chests and organize the laboratory
in a vacant room. On completion of work of this character the laboratory can be repacked
within an hour's time and returned to its station with its own transportation.
Laboratorj^ supplies and sera of various kinds will be required in the front areas, and
these can be taken care of (when railroad facilities are not direct or possible) by the light
motor trucks and by motor cycle with side car. The two bicycles can be used for messenger
work in the city. This laboratory has at the present time three bacteriological cars, motor,
and these cars will be used for investigation of special epidemics.
3. Base laboratories, sections Services of Supply. — Base laboratories are being organized
in each of the sections on the lines of communication. Already one has been established
Fig. 6.— Floor phm of the office of the director, division of laboratories, A. E. F.
for base section No. 1, base section No. 2, and intermediate section. Services of Supply,
and stationary laboratories are now en route from the United States for base section No. 3
and base section No. 5. These laboratories will handle the general laboratory work and
laboratory work concerned with the prevention of infectious diseases in their respective
sections. To carry out this work efficiently and effectively, transportation will be neces-
sary. One light motor car, passenger, is asked for; one motor cycle with side car; one
bicycle; and one motor truck, medium. To each of these laboratories one transportable
laboratory outfit will be supplied and one 13^-ton motor truck will be required to transport
this laboratory from place to place for the investigation of epidemics.
4. Base hospital laboratories at base hospital centers. — We have organized at each base
hospital center one laboratory well provided as to personnel and equipment. This laboratory
will serve as a central laboratory for the entire group of hospitals, and in this laboratory
it is proposed that all highly technical bacteriological and serological work will be done. In
addition to this it is the intention to establish a certain number of small clinical ward labora-
tories in connection with a certain number of wards. By carrying out this arrangement
we will conserve building space, equipment and personnel. The only transportation neces-
sary for such a unit is a motor cycle with side car and one bicycle.
5. Base hospital laboratories at base hospitals. — These laboratories will be provided for
base hospitals of from 1,000 to 1,500 beds. No transportation will be required for such units.
6. Army laboratories. — We are organizing in the advance section, or zone of the advance,
laboratory units that will be of a fixed character and will be known as Armv laboratories.
These laboratories will be so located that they will be closely in touch with troops in the line,
and it is proposed that all highly technical bacteriological and serological work for divisions
in the field be done by these units. They will also be provided with a transportable labora-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 149
tory unit for the investigation of epidemics and will care for epidemics in their particular
section. In order to carr\- out work on epidemics eflfectively, it will be necessar\- to supply
them with a IJ^-ton motor truck for the transportation of the transportable laboratorj-.
TRANSPORTABLE OR MOBILE UNITS
7. Camp hospital laboratories. — We have arranged to supply camp hospitals with trans-
portable units in chests, but as these units are permanent or semipermanent, no transporta-
tion for carrying their transportable units will be necessary. They should be provided,
however, with a motor cycle with side car, in order that they may be in close touch with
infirmaries and other units for which special work will be done.
8. Evacuation hospital laboratories. — These units are made up of the standard transportable
outfits and consists of eight chests. They should be provided with a 13^-ton motor truck
to carry their equipment. This truck will be used constantly by the pathological and museum
units attached to the laboratory of evacuation hospitals when not in use.
9. Mobile hospital laboratories. — A transportable laboratory unit consisting of eight
chests is required for each mobile hospital, and in order that it may be transported one truck,
motor, medium, will be required.
10. Divisional laboratories. — This laboratory unit is attached to each division, and its
equipment consists of three of the chests of the standardized transportable outfits. To make
this unit mobile it will be necessary to supply one light motor truck capable of carrying these
three chests. This unit will also require one motor cycle with side car.
11. In connection with the transportation provided for in this T. of O., this office is con-
vinced that the laboratory service will not and can not perform its functions properly unless
provided with transportation. In working out the organization of supplies for mobile and
semimobile units, we have endeavored to standardize equipments, and this has been accom-
plished by providing an expandable unit laboratory system in chests. These chests are so
arranged that a given number of chests will care for the work of camp hospitals and divi-
sions, while the evacuation hospitals and mobile hospitals will require the full number —
eight. The British system has been somewhat different. They have organized a unit
system consisting of a bacteriological motor car, with the idea that the necessary work
would be done in this car. As a matter of practice it has been found that usually the equip-
ment would be taken out of the car and placed in a vacant room provided the unit remained
at one place for any great length of time. These cars cost approximately $7,000. We feel
that the system adopted by us will be more satisfactory and will be much cheaper, provided
the necessary transportation is furnished. A standardized laboratory unit of chests costs,
complete, about $1,200, and a motor truck of IJ^-ton capacity will probably cost in the
neighborhood of $2,000. This makes about $3,500, while the British units cost from $6,000
to $7,000.
12. It will be necessary that the truck transportation allowed for these mobile units be
assigned very definitely to these particular laboratory units; otherwise they lose their mobiUty.
Laboratory suppUes are difficult to secure. We have heard that during a recent German
offensive on the Western Front the laboratory service for the British Army in France were
able to save their entire equipment. This was possible by reason of the fact that they had
transportation definitely assigned to them.
J. F. SiLER,
Lieutenant Colonel, Medical Corps, United States Army.
As mentioned above, the division of laboratories had been incUided among
the professional services prescribed in Circular No. 2, chief surgeon's office, A. E.
F., November 9, 1917.^ But that division, being a part of the division of sanita-
tion in the chief surgeon's office, and therefore in a somewhat different adminis-
trative position from the other professional services which were under control
of the hospitalization division, was not grouped with these when they were
reorganized by Circular No. 25, chief surgeon's office, A. E. F., May 5, 1918,
and by General Orders, No. 88, G. H. Q.. A. E. F., June 6, 1918.
150
ADMIXISTRATIOX, A:\IER1CAN EXPEDITIONARY FORCES
The director of the division of hiboratories enjoyed entire freedom in tlie
organization and development of his department except that all matters of policy
and those affecting the service in general were submitted to the chief of the
division of sanitation for final decision.^ The director was authorized to issue
circulars, memoranda, and special letters of instructions concerning matters of
interest in the laboratory service. Memoranda which were of interest to the
Medical Department at large were submitted to the chief surgeon and issued as
circulars from his office.^
At the time the office of the director of the division was established at Dijon,
that of the chief surgeon was located at Chaumont, and because of their proxim-
ity there were then no great difficulties of coordination. But after the chief
surgeon's office was transferred to Tours, in March, 1918, the unavoidable con-
gestion of telegraph and telephone lines, necessary censorship regulations, and
irregular mail facilities often caused considerable delay in receipt of orders
affecting transfer of personnel.^ This situation was remedied by granting to
the director of the division in August, 1918, authority to issue suitable orders
to personnel under his control whereby he could meet emergencies and fill
existing vacancies from the reserve staff on duty at the central medical depart-
ment laboratory.^ Thereafter the efficiency of the laboratory service was
greatly increased, particularly by promoting both the early investigation of
epidemic diseases and quick response to emergencies that developed during
combat. Better coordination would have been secured if the director's office
had been located in the office of the chief surgeon, for delays which occurred at
time in communication would have been obviated.^ But many and greater
office advantages accrued from maintenance of close contact between the direc-
tor's and the central Medical Department laboratory at Dijon.^ The labora-
tory was so located that it was less than six hours distant from 1,500,000 troops
and from hospitals with a total capacity of more than 100,000 beds. Request
was made of the hospitalization division of the chief surgeon's office that the direc-
tor be promptly apprised of the arrival and location of all hospital units arriving
overseas.^
GENERAL CORRELATION AND ACTIVITIES
In order to correlate the work of the division with the activities of the
Medical Department in general, the following, methods were employed:^
Letters covering the progress of the work and plans for the future were
written at frequent intervals to the chief of the division of laboratories in the
office of the Surgeon General at Washington, and in July, 1918, an officer was
sent to Washington in order to give more definite information concerning the
various problems confronting the laboratory service of the American Expedi-
tionary Forces.^
The director had frequent conferences with the head of the division of
sanitation in the chief surgeon's office, the progress of the work being reviewed
and special matters brought up for final action.^
Weekly reports, covering the general activities of the division were sub-
mitted to the chief surgeon and copies forw^arded to the Surgeon General.^
Copies of all reports on investigations of epidemics as well as reports that
were considered of sufficient interest were transmitted to the chief surgeon for
his information.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 151
When general or technical circulars involving action by some other divi-
sion or service were contemplated, that division or service was consulted, and
approval and cooperation secured before the circular was published.
A special mailing list was prepared, including divisions of the chief sur-
geon's office, the professional divisions, the sanitary school, the Pasteur Insti-
tute, the adviser in pathology to the British Expeditionary Force, the secretary
of the British research committee, the secretary of the research committee of the
American Red Cross, and individual officers on duty with the American Army,
the French Army, the British Army, and the Italian Army, to all of whom
special memoranda, etc., were forwarded.^
Officers of the division represented it at the meetings of the Inter- Allied
Surgical Congress.^ The director of the division attended sessions of the
research committee organized by the American Red Cross, of which committee
he was a member.^
Matters affecting the medical and surgical services were taken up through
liaison officers appointed for this purpose by the chiefs of those services. These
matters, in so far as the medical service was concerned, included, among others,
control of epidemic diseases.^
All matters relating to water supplies were taken up with the senior repre-
sentative of the Medical Department with the w^ater supply service, A. E. F.^
In the summer of 1918, it was planned to initiate conferences of special
groups of officers at stated intervals for the purpose of discussing special features
of their work and the local problems with which they had to contend.^ These
meetings were to be held every month or six weeks, at the central Medical
Department laboratory, and were to be limited to groups of officers engaged
in identical lines of work.^ One meeting was to include the commanding officers
of base laboratories operating in the different sections of the Services of Supply,
and the officers engaged in disease control; one was to include the commanding
officers of base laboratories in hospital centers; another the laboratory officers of
evacuation and mobile hospitals; another the officers in charge of division labora-
tories, etc.^ But because of combat activities it was not possible to call the first
conference until November 1 and 2, 1918.^ This was attended by the chief of
the division of sanitation, chief surgeon's office and his assistant, by the com-
manding officers of the base laboratories functioning in the sections of the Ser-
vices of Supply, by sanitary inspectors of the sections of the Services of Supply,
and others.^
After the signing of the armistice, conditions became so unsettled that it
was not practicable to continue these conferences.^
DIRECTOR'S OFFICE
ADMINISTRATIVE DETAILS
For administrative purposes the office of the director, division of laborato-
ries and infectious diseases, was divided into six general sections with one or
more officers on duty in each as assistants to the director. These sections were :
(1) Executive office and records, (2) central Medical Department laboratory,
(3) section of laboratories, (4) section of infectious diseases, (5) food and
nutrition section, and (6) water supply section.^
152
ADMINISTRATION, a:MERICAN EXPEDITIONARY FORCES
The offices of the director and those of the chiefs of all the sections were
located in the same building except that the commanding ollicer of the central
Medical Department laboratory had his office in an adjoining structure.'
While the ensuing text attempts, for the purpose of clarity, to discuss
separately the several sections of the division of laboratories and infectious
diseases, there was such close coordination and overlapping of several of these
that note should be made of that fact.' Certain officers on duty at headquarters
of this division at Dijon were also on the stafT of the central laboratory or on
that of the laboratory section.' The central laboratory while a part of the
general laboratory system, was highly individualized, and from an administra-
tive point of view was difierentiated from the section of laboratories in this
division, but the activities of the latter were often supplemented by those of
the former, as in the solution of special problems and in other matters noted
below.'
The records pertaining to all sections of the office of the director, except
autopsy protocols and statistical reports, were centralized in a single file, con-
trolled by the same decimal filing system which was in use throughout the
Army.' Incoming mail was classified by the adjutant and distributed directly
to the officers concerned. Reports and documents of general interest went
first to the desk of the director and were then circulated in the office before
going to file.' Correspondence and other matters requiring routine action
were acted on by the officer directly concerned and only such matters were
brought to the attention of the director as were considered to be of interest to
him, or concerning which his decision was required.'
Matters of general policy were taken up by the director with the officer or
officers directly concerned and if considered desirable, with all members of the
staff who might have special knowledge of the subject or from whom advice
would be of value.'
Special memoranda, circulars and forms were prepared ordinarily by the
section most directly concerned, but those of special importance were reviewed
by several members of the staff. These memoranda and circulars were of two
general types: Those covering subjects of general interest to the entire Medical
Department, and those covering technical matters pertaining to the laboratory
service.' The former were forwarded to the chief surgeon for incorporation
in official circulars issued by his office, while the latter were issued and distri-
buted directly from the office of the director as "office letters," "memoranda,"
or "forms," those in each class being given serial numbers.' A general idea
of the material forming the subject matter of circulars and memoranda may
be gained from the lists given in the appendix.
The commissioned personnel of the division of laboratories was distributed
and assigned mainly by the officer at the head of the laboratory section, with
suggestions, in some instances, from the director.' The distribution of the
special personnel on duty in the sections of food and nutrition, of water supply,
and of infectious diseases were assigned on the recommendation of the officer
in charge of those sections, respectively.'
The personnel of this division consisted of officers of the Medical Corps
with special training in laboratory procedures, sanitation, and epidemiology, or
ORGANIZATION AND ADMIXISTEATION OF CHIEF SURGEON'S OFFICE 153
other special qualifications; officers of the Sanitary Corps who were sanitary
engineers, had special knowledge of food and nutritional problems, were com-
petent to make field surveys and laboratory examinations of water supplies,
had general or special qualifications in laboratory procedure, were artists,
photographers, executives, or possessed other special qualifications; and enlisted
men, many of whom had a special technical training.^
Not more than 12 officers of the Regular Medical Corps and of the Sani-
tary Corps, who served with the division of laboratories, had any service in
the Army prior to the war.^ Two of these medical officers and one officer of
the Sanitary Corps were on duty in the office of the director, the others being
assigned to laboratory administrative positions elsewhere in the American
Expeditionary Forces.^ The remaining personnel, consisting of approximately
670 officers, was drawn chiefly from civil laboratories.^ Many of the enlisted
personnel were college graduates, undergraduate students, or men with special
technical training in laboratory work of various kinds. As with the Medical
Department generally, there was always a shortage both of total personnel
and of those competently trained.^
The personnel to carry on the activities of the division of laboratories was
acquired from various sources, mainly the following: ^ (1) Base hospitals and
a considerable number of evacuation hospitals, for the prescribed organization
of both those types of units included laboratory personnel; (2) stationary
laboratory units, of which 5 were sent to France, each consisting of 6 officers
and 12 enlisted men; (3) special units sent to France for special, highly tech-
nical activities; (4) divisional laboratory imits automatically dispatched to
France for service with divisions; (5) detachments of casuals sent to France
on cable requests from general headquarters. (6) The general medical serv-
ice of the American Expeditionary Forces whence a considerable number of
specially trained officers were drawn and assigned to duty with this division.^
All casual personnel and special units arriving in France for service in
this division were automatically ordered to the central medical department
laboratory, where their special qualifications were investigated and any neces-
sary special instruction given. ^
The individual qualification cards of officers of the Medical Department
on file in the headquarters office of the division permitted a broad general
classification of qualifications, but for the highly technical activities in which
the division of laboratories was engaged it was necessary to have a much fuller
knowledge of the special qualifications of each officer.^ A questionnaire,
covering in detail the information desired, was therefore filled in by each
officer on duty in the division of laboratories and filed in the office of the direc-
tor.^ A still better conception of the special qualifications of the individuals
was gained by direct observation of from 300 to 400 of these officers who served
on temporary duty at the central Medical Department laboratory either as
casuals or as students, taking courses of instruction.^ These officers were
interviewed by the personnel officer on duty in the office of the director of the
division, and ratings of those undergoing instruction were submitted to him.
From these sources of information and from inspections of the work being
done in the different laboratories an effort was made so to classify and dis-
154
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tribute the personnel that the necessary activities might be more efficiently
performed and elimination of the incompetent effected.^ The laboratory
personnel sent to France with the earlier base hospitals was made up, as a rule,
of highly trained and competent men. This statement also applies to many
of the special units.^ The special laboratory training of a considerable percent-
age of the officers, however, consisted only of the training ordinarily acquired
in medical schools plus a short course of training at the Army Medical School,
at the Yale Army Medical School, at the Rockefeller Institute, or at more
than one of these institutions.^ Therefore, special courses of instruction in the
bacteriology of epidemic diseases and in the bacteriology of war wounds were
given at the central Medical Department laboratory, approximateh^ 250 officers
taking one or the other of these courses.^ Because of the scarcity of trained
administrative personnel it was not practicable to form two detachments, one
consisting of casuals under the administrative control of the director's office,
and the other of permanent personnel assigned to the central Medical Depart-
ment laboratory.^ Therefore, both permanent personnel and casuals were
carried on the records of the detachment at the central Medical Department
laboratory as of a duty status, for rations, quarters, personal equipment and
for statistical and other matters pertaining to the interior administration of a
detachment.^ A list of the permanent personnel on duty at the central Aledical
Department laboratory was kept by the adjutant in the director's office. It
was understood that all other personnel was to be considered as casual and
subject to assignment by the director without previous consultation with the
commanding officer, central Medical Department laboratory.' After investi-
gation of their qualifications and any necessary special instruction, officers of
this division were assigned to appropriate stations.'
The division of laboratories was charged with the organization of new
laboratory units and the distribution of personnel under its supervision. All
requests forlaboratory personnel were referred to it, and assignments and changes
in station made on recommendation of the director.^
While in May, 1918, less than 140 commissioned officers were engaged in
activities under the supervision of this division, by November, 1918, this number
had increased to 683.^ Their distribution, by corps, grade, and general duties,
is shown in the following table : ^
Personnel on duty in division of laboratories and infectious diseases in November, 1918
Colonels
Lieu-
tenant
colonels
Majors
Captains
First
lieu-
tenants
Second
lieu-
tenants
Totals
Section of laboratories and infectious diseases:
Medical Corps
1
10
20
124
317
472
Sanitary Corps
2
6
64
76
148
Sectionof food and nutrition: Sanitary Corps
4
11
15
2
32
Section of water supplies: Sanitary Corps
1
5
15
10
31
1
11
26
146
411
88
683
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 155
PERSONNEL"
Col. Joseph F. Siler, M. C, chief.
SECTION OF LABORATORIES
Col. George B. Foster, jr., M. C, chief.
Lieut. Col. William J. Elser, M. C.
Maj. Ward J. McNeal, M. C.
SECTION OF INFECTIOUS DISEASES
Col. Richard P. Strong, M. C, chief.
Col. Hans. Zinsser, M. C, chief.
Maj. W^ard J. McNeal, M. C, chief.
Maj. Richard M. Taylor, M. C, chief.
SECTION OF WOUND BACTERIOLOGY
Lieut. Col. William J. Elser, M. C, chief.
Maj. Benjamin Jablons, M. C.
SECTION OF WATER SUPPLIES
Maj. Harry B. Hommon, San. Corps, chief.
Capt. Machael J. Blew, San. Corps.
Capt. Alvin R. Harnes, San. Corps.
Capt. Walter C. Russell, San. Corps.
Capt. Emery J. Theriault, San. Corps.
First Lieut. Henri E. St. Pieri'e, San. Corps.
SECTION OF FOOD AND NUTRITION
Maj. Walter H. Eddy, San Corps, chief.
Maj. Phillip A. Shaffer, San. Corps, chief.
Maj. David Klein, San. Corps.
Capt. Fred F. Flanders, San. Corps.
First Lieut. S. C. Dinsmore, San. Corps.
MUSEUM AND ART SECTION
Col. Louis B. Wilson, M. C, chief.
Maj. Henry W. Cattell, M. C.
LABORATORY OF SURGICAL RESEARCH
Lieut. Col. W^alter. Cannon, M. C, chief.
Lieut. Col. J. L. Yates, M. C.
" In this list have been included the names of those who at one time or another were assigned to the division daring
the period July 28, 1917, to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names have
been arrangc<i alphabetically, by grades, irrespective of chronological sequence of service.
156 ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
REFERENCES
(1) Report from Col. J. F. Siler, M. C, director of laboratories and infectious diseases,
A. E. F., to the chief surgeon, A. E. F., undated. Subject: Activities of division of
laboratories and infectious diseases, from August, 1917, to July, 1919. On file, Histor-
ical Division, S. G. O.
(2) Letter from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, August 12,
1917. Subject: Outline of laboratory organization, A. E. F. On file. Record Room,
S. G. O., 322.15-16 (A. E. F.) (Y).
(3) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919. On
file, Historical Division, S. G. O.
(4) Letter from Lieut. Col. J. F. Siler, M. C, director of laboratories, A. E. F., to the chief
surgeon, A. E. F., May 22, 1918. Subject: Table of organization for laboratory units.
On file, A. G. O., World War Division, chief surgeon's files, 451.
CHAPTER X
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
THE CENTRAL MEDICAL DEPARTMENT LABORATORY
HOUSING FACILITIES
A building, loaned for the purpose b}^ the University of Dijon, was utilized
by the central laboratory, established at Dijon on January 1, 1918. When
taken over the building was not equipped but early in February it was recon-
Fi(7. 7.— Central Medical Department laboratory, Dijon. The main building is in the center of the background
structed as a modern laboratory and completely equipped with material brought
from the United States for work of general and special character.^
By March, 1918, the buildings consisted of the initial large laboratory
structure, four barracks donated by the American Red Cross which housed
the office of the director of laboratories, a large laboratory for instruction of
student officers, five well-equipped research laboratories, an operating room
for experimental surgical research on animals, a complete X-ray installation
with photographic dark room, space for the art and museum section, and mess-
ing facilities and quarters for the enlisted personnel.^ Fixtures for gas, water,
and electricity, a very complete plumbing and sewerage system, and equipment
157
158
ADMIXISTKATIOX, AMERICAN EXPEDITIOXAKV FORCES
for general and special laboratory activities were installed in tiie i)iiildings
used for laboratory purposes. Later, four small Abincourt barracks were
added to provide animal houses and a carpenter shop, and four additional bar-
racks were erected for accommodation of enlisted personnel and storage of sup-
plies.^ The laboratory also secured two buildings for garage space and operated
a breeding farm for laboratory animals, on funds privately donated for special
research. The entire plant eventually occupied 18 large and small buildings.'
PERSONNEL
When established at Dijon, the central laboratory was staffed by officers
from Army Laboratory No. 1, at Neufchateau. By March, 1918, the staff
consisted of 16 officers, 35 enlisted men, and 12 civilian employees.' The
average personnel on duty at the central laboratory between June and Novem-
ber, 1918, was 24 officers, 93 enlisted men, and 23 civilian employees. From
November, 1918, to May, 1919, the average personnel remained approxi-
mately the same.'
LABORATORY EQUIPMENT AND SUPPLIES
One of the greatest difficulties that confronted the laboratory service in the
early months of the war w^as a shortage of equipment and supplies.' Before
the war many essential technical items, notably of apparatus, glassware, dyes,
and chemicals, had been imported from Germany. American industries that
had begun to manufacture these articles were still lacking in quantity production
in many essentials.' Furthermore, the normal peace-time stocks of dealers in
scientific apparatus and supplies were just sufficient to meet the comparatively
meger demands for the upkeep of established institutions and the initial equip-
ment of an occasional new one.' Demands such as were made by the Army in
the earlier months of the war were unheard of and they could not be met until
American scientific industries became organized for quantity production. The
situation was further complicated by priority schedules on raw materials, many
chemicals, and skilled labor, which diverted these to other war industries; and
a priority on shipping and tonnage that made the floating of supplies secondary
to the transportation of troops. The congestion at base ports, American Expe-
ditionary Forces, and shortage of transportation in France militated against
prompt handling of supplies after their arrival in France.'
With the exception of the initial equipment of three of the larger laboratories
and the laboratory equipment of a few base hospitals, laboratory supplies from
the United States were not available for issue in appreciable quantities until
about a month before the armistice. Furthermore, laboratory supplies in large
quantities were never available by purchase by us in France.'
When it became apparent that months would elapse before the automatic
supply of apparatus from the United States w^ould become available, an attempt
was made to reduce equipment and supplies to the absolute minimum consist-
ent with efficiency, and to standardize the equipment of laboratory field units. -
On August 19, 1917, an order for two motor bacteriological laboratories,
each to consist of a small but well-equipped outfit mounted on a 3-ton
chassis, was placed with a British manufacturing firm. This order contem-
plated the first use of such a unit in our service and was frankly experimental.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 159
The supply division of the chief surgeon's office, A. E. F., had made provision
for the shipment from the United States of such laboratory supplies as appeared
on the supply table of the Manual for the Medical Department, 1916, but this
list included only 84 items, which were quite inadequate to meet even the sim-
plest requirements.^ To meet the existing emergency, such supplies as were
available were purchased in France and contracts made by the supply division
for the continuous supply by French manufacturers of certain bulky items
requiring a very considerable amount of cargo space. ^ In coordination with the
supply division of the chief surgeon's office, requisitions were prepared covering
estimated future requirements with a view to their inclusion among supplies
shipped automatically from the United States.^ The shipment of laboratory
equipment according to this revised list did not begin until April, 1918, and did
not become available for issue in France in quantity until October, 1918.^
On January 12, 1918, the director was authorized to place direct with the
purchasing agent for the Medical Department in Paris, orders for the pur-
chase of standard laboratory equipment and supplies, except in the case of
special supplies desired in large quantity, or when the expense involved was
large. ^ Requisitions were also placed in England and some supplies obtained
from the American Red Cross. ^
In the detailed plan for the organization of the division of laboratories sub-
mitted to the chief surgeon, A. E. F., on January 11, 1918, the director of that
division recommended that special motorized and transportable units be pro-
vided.^ The motorized units were to be installed in their own cars while the
transportable units, packed in chests, were to be moved by any transportation
available.^ This plan, which was approved, provided for motorized laboratories
of two classes: Bacteriological cars and meningitis cars.'^
On the same date the director of laboratories wrote that several completely
equipped motorized laboratories were urgently needed.^ The next day the
chief surgeon, A. E. F., authorized the purchase of a "cerebrospinal" bacteri-
ological car to cost £1,892, exclusive of the chassis,* and on January 14 he
authorized the purchase from the French Medical Department of one motor-
ized bacteriological laboratory to cost approximately $8,000.^
In order both to conserve and standardize the equipment of field units,
the commanding officer of the central Medical Department laboratory under-
took to design a transportable laboratory in which the necessary equipment
and supplies would be reduced to approximately 150 items. ^ These items
were to be packed in eight chests so designed as to be capable of expansion in
numerous ways if necessary, to meet the essential needs of any type of labora-
tory. The selection of equipment for a set of these chests which would consti-
tute a division laboratory, also was undertaken.^
In reply to a query from chief of staff, G. H. Q., A. E. F., concerning
transportation which the division of laboratories would require, the chief sur-
geon replied, on February 4, 1918, in part, as follows: * "The increase of the
forces and the prevalence of epidemics would require that the laboratory
service be furnished among other vehicles with 6 motor trucks and 10 special
bacteriological cars." On February 11, the chief surgeon initiated a cable-
13901—27 11
160
ADMINISTRATION, A:MERICAN EXPEDITIONARY FOH(-KS
gram to the War Department asking that personnel reciuested lor divisional
laboratories be sent in accordance with the priority schedule, but that portable
field laboratories be substituted for laboratory cars.* On March 1, 1918, the
director, division of laboratories, reported that two motorized laboratories
each mounted on a 3-ton chassis were en route from England, but that it was
anticipated that eight more of these outfits would eventually be required.'"
"While most movable laboratories were to be of the type which utilized chests,
it was planned that a relatively small number of motorized laboratories
would also be employed. Under this plan the equipment for a divisional
laboratory would be contained in a set of three chests and a ^-ton truck
would be required for its movement. The laboratory for an evacuation or
mobile hospital would consist of a complete set of eight chests transportable
on a 13^-ton truck. ^' '• "
Toward the end of March, 1918, the commanding officer of the central
laboratory visited England with a view of determining the possibility of pur-
chasing laboratory material to equip the series of chests which he had devised,
and other assemblages of material.^
On April 29, he telegraphed the chief surgeon, requesting him to authorize
the purchasing officer of the American Expeditionary Forces in London to
purchase 100 transportable laboratory units at approximately $1,000 each.
The average cost of the truck on which one complete set could be transported,
he added, would be $3,400.'^ The chief surgeon complied with this request.^
Deliveries of the units which began on May 8, were completed October 24,
1918, so each division and each mobile or evacuation hospital which arrived
in France after the former date, was given its equipment before it entered the
advance zone.^ Such transportable laboratory units, attached to mobile and
evacuation hospitals, were equipped adequately for the performance of all
types of clinical and bacteriological work. Those attached to divisions were
equipped for the chemical and bacteriological examination of water supplies,
the performance of routine clinical examinations and the bacteriological exami-
nations necessary for the control of epidemics.^ This transportable equipment
was also utilized with very satisfactory results in many camp and base hospi-
tals, and in some hospital centers and base laboratories, pending the arrival
of the equipment for stationary units. ^
As noted in the preceding chapter, on May 2, 1918, the director of labora-
tories submitted a complete schedule of the transportation which would be
required by the division of laboratories and requested that this be furnished.
He also asked that motor cycles with side cars be issued to the laboratories
assigned to divisions, for these vehicles already had facilitated collection of
water samples and the prosecution of investigations in outbreaks of infectious
diseases.'^ This transportaion schedule in so far as it pertained to movable
laboratories was approved by the chief surgeon and was forwarded by him
for approval to the general staff, general headquarters,'* but despite repeated
subsequent requests, approved hj the chief surgeon, transportation for the
laboratory units in question was procured with the greatest diflficulty and only
to a partial degree with the results noted below in the consideration of
divisional laboratories.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 161
On July 8, the director of laboratories reported to the chief surgeon, A. E. F.,
that the earlier divisions arriving overseas had brought with them their labora-
tory personnel and equipment, that since that time it had been learned that
equipment could be simplified and that tonnage requirements could be reduced
by the purchase of all the materials required in England, but that field trans-
portation was essential if these units were to be of value. Similarly, on the
16th of the same month, he reported that the laboratories with mobile and
evacuation hospitals had already rendered invaluable service, but that neither
the laboratories of the hospitals mentioned nor those of divisions could function
properly without transportation, and he urged its provision. Other pleas and
arguments for transportation were forwarded, but because of the general short-
age of transportation throughout the American Expeditionary Forces, they were
only partially successful.'^
Because of the considerations mentioned in the letter of May 22, 1918, quoted
in the preceding chapter, and the further fact that the laboratory cars being
of special design and equipment, could be manufactured in limited numbers,
none other than the four above mentioned were procured.'*
On November 4, the chief surgeon wrote the director of the Motor Transport
Corps that the time consumed in the manufacture of specially constructed
laboratory trucks and bacteriological cars had been so protracted, and the diffi-
culty of their transport to France so great, that ordinary cargo trucks had been
substituted for them and that the specially constructed laboratory trucks were
not needed.'^
When the Armistice was signed two of these motorized laboratory units were
attached to the general laboratory, one was with Army laboratory No. 1 at
Neufchateau, and one with the Second Army.^ Motorized laboratories, or
field laboratory cars, as they were officially designated, are further discussed
under Army laboratories below.
Circular No. 40 of the chief surgeon's office published July 20, 1918, provided
that the laboratories of the American Expeditionary Forces would be of two
general types, stationary and transportable. The latter were to serve evacua-
tion and mobile hospitals and divisions, and their equipment was to consist of
standardized, expendable units in chests.
In the period from July to November, 1918, a large number of hospital
centers were established and the equipment and organization of these were
expedited.
In September, 1918, a bulletin was prepared by the commanding officer of
the central laboratory, which covered in detail all matters relating to the pro-
curement of laboratory supplies by Medical Department units, A. E. F.^ This
bulletin which provided for a standardization of equipment was distributed to
all units. It is reproduced in the appendix.
On September 19, 1918, the Surgeon General wrote that he desired that the
field laboratories be numbered, and he allotted to the chief surgeon numbers
from 1 to 45, inclusive, for such of these formations as already were overseas or
en route. Records of the Surgeon General's office at that time showed that
laboratories had been sent to France with 31 divisions, but had not accompanied
(3 others. In reference to this record the director of laboratories stated that
162
ADMIXISTHATIOX, AMEHICAX FA'PEDITIOXAHV FORCES
in point of fact many of these units had not actually accompanied their divi-
sions from the United States; that some had come after them, and that in all
instances it had been necessary for the director of laboratories to find personnel
in the American Expeditionary Forces who could be trained and assigned to
this service.^' In view of the signing of the armistice the proposed enumera-
tion of laboratories engaged in field service never became effective."
ACTIVITIES
As soon as the central laboratory was thoroughly organized the develop-
ment was begun of those phases of its activities which related more particularly
to the general activities of the laboratory service throughout France.^
The central laboratory came into more intimate contact with the American
Expeditionary Forces in general than did any other section of the division of
laboratories.^ It was planned that the officer commanding this institution
would, with those at the head of other sections of the division, have his main
office in that of the director of laboratories where he would be engaged only
in larger problems affecting the service of the laboratory to the entire American
Expeditionary Forces and that his adjutant would care for the administrative
details intrinsic to the central laboratory itself.^ But because of shortage of
personnel, this plan was not practicable and the commanding officer of the
central laboratory, in addition to supervising its professional work, and con-
forming its general activities to the plans of the director of the division, dis-
charged in great detail many administrative duties connected with its organiza-
tion, equipment, and operation.^
The central laboratory at Dijon and the other laboratories in the division
of laboratories were highly coordinated, and except as specified below, their
activities were developed concurrently.^ These common interests included
technical advice on general bacteriology, immunology, serology and other
laboratory procedures, control of epidemics, bacteriology of war wounds,
special instruction, personnel, laboratory equipment and supplies, gross and
histopathology, museum and art service, photographic history of Medical
Department activities, inspections, medical and surgical research, and liaison
with other services.^
The activities of the central Medical Department laboratorj'^ which was in
reality the headquarters laboratory for the American Expeditionary Forces
conformed to those itemized on the project submitted January 11, 1918, which
is quoted in the preceding chapter. These activities may be summarized as
follows: '
Bacteriology. — ^The work consisted in the standardization of technical
bacteriologic methods; the investigation of new technical methods; the prep-
aration of all culture media for stocking transportable laboratory units and
mobile laboratories in the zone of the advance; laboratory studies on the inci-
dence of communicable diseases, notably influenza, pneumonia, diphtheria,
meningitis, and intestinal diseases; the isolation, intensive study, and classi-
fication of the aerobic and anaerobic bacteria concerned in wound infections
and gas gangrene; experimental and practical tests of the efficacy of antitoxic
sera in the prophylaxis and therapy of gas gangrene; the identification of cul-
ORCiAXrZATrOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 163
tures of microorganisms received from other laboratories; the preparation of
bacterial antigens and vaccines; the propagation and study of lice concerned
with the transmission of trench fever. These activities were carried on in
addition to the ordinary routine bacteriologic examinations.^
Serology. — This included standardization of the Wassermann test and
manufacture and supply of amboceptor and antigen to all laboratories per-
forming the test. The diagnostic sera furnished the laboratories of the Ameri-
can Expeditionary Forces for the identification of pathogenic microorganisms,
as well as human sera for typing donors and recipients for blood transfusion,
were prepared in this division. A considerable volume of routine serologic
work, notably Wassermann tests, was also accomplished.^
Pathology. — Pathology w^as concerned wdth the performance of all autopsies
at Base Hospital No. 17, at Dijon, the gross examination and histologic study
of operative and autopsy tissues; the collection and preparation of specimens
for the Army Medical Museum, and the review of the protocols of all autopsies
performed in the American Expeditionary Forces. The latter activity was
of value in checking errors in diagnosis. A collection of photographs, moving-
picture films, paintings, charts, etc., was prepared for the Army Medical
Museum.^ The administration of the pathological service is considered at
greater length elsewhere in this volume.
Chemistry. — The activities of the chemical laboratory covered routine
medical chemistry, the examination of foods for the Food and Nutrition Section
and the Quartermaster Department, toxicological examinations, investigations of
the medical properties of mustard gas, examination of drugs and other supplies
furnished the Medical Department, and sanitary and industrial water analyses.'
During battle activities this division manufactured many thousand liters
of gum-salt solution for intravenous use in the resuscitation of the seriously
wounded.' The laboratory also prepared standard solutions and reagents for
transportable laboratories and such other laboratories as were not equipped
to prepare their own.' So much of the chemical service as pertained to
the water supply or food and nutrition sections is discussed with those subjects
elsewhere in this volume.
Surgical research. — In the laboratory of surgical research experimental
studies on animals were fruitful in their bearing on the prevention of wastage
from battle casualties. The cause, prevention, and treatment of surgical shock
were studied experimentally here and the results applied practically at the front
during the Chateau Thierry and subsequent military operations. Experimental
attempts to place wounds of the chest in the category of those amenable to
treatment by "debridement," and studies of the relation of various anesthetics
and methods of anesthesia to the production of shock were also made.'
Epidemiological investigation. — Perhaps the most important work of the labo-
ratory from the practical point of view w-as that concerned with the labora-
tory and epidemiologic investigation and control of communicable diseases.'
Specially trained commissioned and enlisted personnel with mobile equipment
were held in reserve at this laboratory for the prompt investigation of epidemics
or threatened epidemics anywhere in the American Expeditionary Forces. By
bacteriologic detection of early cases of communicable diseases, mild cases
164
Ar)>riXlSTRATIOX, AMERICAN' EXPEDITIOXAR V FORCES
missed clinically, and carriors, this laboratory did much to prevent the spread
of influenza, pneumonia, diphtheria, meningitis, and enteric infections, and thus
decreased the wastage concomitant with outbreaks of these diseases when not
detected early and eft'ectually controlled.'
Supplies. — The supply division of this laboratory was charged with assem-
bling, equipping, and issuing transportable laboratory equipment to mobile
units; replenishing expendable items and replacing those that had become
unserviceable; issuing to mobile laboratory units and to camp hospitals various
culture media and reagents required for bacteriologic work in the field; and
issuing to all Medical Department units in the geographic region served by the
central Medical Department laboratory, the various biologic products used in
the diagnosis, prevention, and treatment of infectious diseases.' During the
period of active participation of our troops at the front, the greater portion of
these supplies was delivered by courier service, necessitating the constant
operation of numerous motor trucks and motor cycles.'
Courses of instruction. — From its inception this laboratory conducted
courses of instruction in professional subjects.' One hundred and fifty-eight
student officers were given two-week courses of instruction in the bacteriology
of war wounds; while in the laboratory of surgical research a six-day course,
repeated weekly, was given to prospective members of shock teams. This
course covered the experimental evidence that had been gathered concerning
the cause, prevention, and treatment of surgical shock, and its practical applica-
tion to the resuscitation of the seriously wounded. Selected student officers in
lesser numbers were also given special courses in epidemiologic laboratory
methods, in serologic work, and other laboratory procedures.'
Cooperation with Chemical Warfare Service. — In August, 1918, close contact
was established with the consulting pathologist of the Chemical Warfare
Service, A. E. F., and arrangements were completed for study of the effects
produced on human beings by known and unknown types of gases.
REFERENCES
(1) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file, Historical Division, S. G. 0.
(2) Report from Col. J. F. Siler, M. C., director of laboratories and infectious diseases,
A. E. F., to chief surgeon, A. E. F. (not dated). Subject: Activities of division of
laboratories and infectious diseases, from August, 1917, to July, 1919. On file.
Historical Division, S. G. O.
(3) Letter from the general purchasing officer, A. E. F., to Daird and Tatlock (Ltd.)
London, August 19, 1917. Subject: Motor bacteriological laboratories. On file
A. G. 0., World War Division, chief surgeon's files (322.3271).
(4) First indorsement, Hdqrs., A. E. F., chief surgeon's office, to director of laboratories,
A. E. F., January 12, 1918, on letter from director of laboratories, A. E. F., to the
chief surgeon, A. E. F., January 7, 1918. Subject: Purchase of laboratory equip-
ment. On file, A. G. O., World War Division, chief surgeon's files (322.3271).
(5) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., January
11, 1918. Subject: Organization of the division of laboratories and infectious
diseases. On file, A. G. O., World War Division, chief surgeon's files (321.630).
(6) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., January
11, 1918. Subject: Mobile motor bacteriological laboratory. On file, A. G. C,
World War Division, chief surgeon's files (322.3271).
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 165
(7) First indorsement from the chief surgeon, A. E. F., to the director of laboratories,
A. E. F., January 14, 1918, on letter from the director of laboratories, A. E. F., to
the chief surgeon, A. E. F., January 11, 1918. Subject: Mobile motor bacteriological
laboratory. On file, A. G. O., World War Division, chief surgeon's files (322.3271).
(8) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., February 4,
1918. Subject: Expansion of transportation for laboratories. On file, A. G. O.,
World War Division, chief surgeon's files (321.630).
(9) Cablegram from General Pershing, A. E. F., to The Adjutant General and to the
Surgeon General, U. S. Army, February 11, 1918. Copy on file, A. G. O., World War
Division, chief surgeon's files (322.3271).
(10) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., March
1, 1918. Subject: Motor laboratories. On file. A. G. O., World War Division,
chief surgeon's files (322.3271).
(11) Report of the chief surgeon, A. E. F., to the commanding general, S. O. S., A. E. F.,
April 17, 1919. Subject: The Medical Department, A. E. F., to November 11,
1918. On file, Historical Division, S. G. O.
(12) Telegram from Maj. George B. Foster, M. C, to the chief surgeon, A. E. F., April 29,
1918. On file, A. G. 0., World War Division, chief surgeon's files (322.3271).
(13) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., May 2,
1918. Subject: Schedule of transportation. On file, A. G. O., World War Division,
chief surgeon's files (451).
(14) First indorsement from the chief surgeon, A. E. F., to the director of laboratories,
A. E. F., May 6, 1918, on letter from the director of laboratories, A. E. F., to the
chief surgeon, A. E. F., May 2, 1918. On file, A. G. O., World War Division, chief
surgeon's files (451).
(15) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., July 8,
1918. Subject: Transportation. On file, A. G. O., World War Division, chief sur-
geon's files (322.3271).
(16) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., July 16,
1918. Subject: Transportation. On file, A. G. O., World War Division, chief
surgeon's files (322.3271).
(17) Letter from Lieut. Col. J. F. Siler, M. C, director of laboratories, A. E. F., to the
chief surgeon, A. E. F., May 22, 1918. Subject: Table of organization for laboratory
units. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(18) Report on mobile laboratories by Capt. C. O. Rinder, M. C, (not dated). On file,
Historical Division, S. G. O.
(19) Letter from the chief surgeon, A. E. F., to the director of laboratories, A. E. F., Novem-
ber 4, 1918. Subject: Bacteriological cars. On file, A. G. O., World War Division,
chief surgeon's files (322.3271).
(20) Letter from the Surgeon General, U. S. Army, to the chief surgeon, A. E. F., September
19, 1918. Subject: Mobile laboratories. On file, A. G. O., World War Division,
chief surgeon's files (322.3271).
(21) Second indorsement from the director of laboratories, A. E. F., to the chief surgeon,
A. E. F., October 24, 1918, on letter from the Surgeon General, U. S. Army, to the
chief surgeon, A. E. F., September 19, 1918. Subject: Mobile laboratories. On
file. A.' G. O., World War Division, chief surgeon's files (322.3271).
(22) Sixth indorsement from the director of laboratories, A. E. F., to the chief surgeon,
A. E. F., November 21, 1918, on letter from the Surgeon General, U. S. Army, to
the chief surgeon, A. E. F., September 19, 1918. Subject: Mobile laboratories. On
file, A. G. O., World War Division, chief surgeon's files (322.3271).
(23) Letter from pathologist of Chemical Warfare Service to Maj. William Elser, M. O. R. C,
through director of laboratories, A. E. F., August 5, 1918. Subject: Instruction to
pathologists, cooperating with Chemical Warfare Service. On file. Historical
Division, S. G. O.
CHAPTER XI
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
THE SECTION OF LABORATORIES;" TECHNICAL WORK OF LABORATORIES
THE SECTION OF LABORATORIES
The laboratory section of the division of laboratories was distinct from
the central laboratory, but closely connected with it.^ Its headquarters at
Dijon exercised technical supervision over the Medical Department laboratories
throughout the American Expeditionary Forces, and was charged with their
inspection and supply, the pathological service of the American Expeditionary
Forces, special research, the collection of museum specimens, photographs,
and other art records of medical department activities, cooperation with the
water supply and gas defense services, and the destruction of rodents.'
From the viewpoint of the nature of their activities, the laboratories of
the American Expeditionary Forces were divisible into two general types which
were comparable, respectively, to the laboratories which served boards of
health in civil communities, and those which served hospitals.'
The base laboratories located in the sections of the Services of Supply,
and the mobile units attached to armies and the divisional units were concerned
mainly in the control and prevention of transmissible diseases, while the prin-
cipal activities of all other units were similar to those carried on in laboratories
pertaining to the larger and better hospitals in civil communities in the United
States.'
Also, from the viewpoint of equipment, the laboratories of the American
Expeditionary Forces could be classified into two general categories: Station-
ary or mobile.' The equipment furnished the stationary units was quite
similar to that used in hospitals in civil communities in the United States
though in some respects it was not so elaborate. For example, provision of
apparatus for blood chemistry was considered but was excluded because of its
very questionable practical importance under war conditions.' On the other
hand, the equipment furnished laboratory units attached to the headquarters
of the armies, to evacuation and mobile hospitals, and to divisions was packed
in special chests to facilitate transport. These units were constantly moving
from place to place as the zone of battle activity shifted from one section to
another.'
The general laboratory system for the American Expeditionary Forces is
shown diagrammatically in Figure 8.
As sh(fwn by Table 4, 278 laboratories conforming to the different types
outlined above were in the service of the American Expeditionary Forces on
November 11, 1918, the date the armistice was signed.'
» The Medical Department laboratories which did not pertain to the division of laboratories of the chief surgeon's
office are discussed in other chapters of this volume. Thus the dental laboratory is discussed under the chapter pertaining
to dental division of the chief surgeon's ofTice.
Id/
168 ADMINISTRATION', AMEKIC'AN KXPKDITION AHV lOUCECi
Table 4. — Tijpcs and numbers of laboratories in operation in the American Expeditionary
Forces, May, 1917, to April, 1919 '
1917
1918
1919
May 1
June 1
July 1
3
■*<
i.
Oct. 1
Nov. 1
Q
B
X!
Mar. 1
Apr
Ma\
1 Junr
1 July
en
3
<;
a
u
o
1 Nov.
1 Dec.
1 Jan.
a>
1 Mar.
1 Apr.
Central Medical Department labora-
tory
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Base laboratories, sections of Serv-
ices of Supi)lv "
1
1
1
1
1
1
3
3
5
5
7
7
7
7
10
10
10
10
9
9
8
8
Bas(> laboi alories, in hospital centers
(iiicliidol in next line)
1
1
1
2
2
5
7
11
14
16
17
17
11
9
9
8
Base hosiiital laboratories
1
5
7
7
8
9
13
14
15
19
20
25
33
47
57
84
87
112
112
82
66
47
45
1
2
3
3
4
24
24
25
25
33
33
42
45
51
56
63
58
61
59
3
3
3
4
8
8
8
12
23
25
37
37
24
20
9
IS
1
2
3
5
7
10
12
13
3
5
4
1
American Hcd Cross hospital labora-
3
3
3
3
3
3
3
3
3
3
4
4
4
8
15
18
18
19
19
19
14
12
9
8
3
3
4
5
6
8
14
21
33
35
36
36
28
21
16
13
Total.
3
4
9
11
11
13
15
20
30
32
60
63
77
92
128
154
218
232
278
284
224
192
155
153
Base hospitals with British
3
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
3
1
1
1
» In this table Array Laboratory No. 1 is listed as a base section laboratory.
St:R\ icf:s oi
Supply
liASE Sections Intermediatf: Section
Advance Section
Z.C3rvJE
Ad\?Cnci:
Fig. 8.— Diagram showing types of laboratories in the American Expeditionary Forces
INSPECTION OF LABORATORIES
In January, 1918, certain officers of the laboratory service made a iiurried
visit of inspection to the then existing centers of activity of the American
Expeditionary Forces, in order to acquire first-hand knowledge of the laboratory
personnel and equipment then available, to inspect available sites for the
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 169
establishment of base laboratories in the sections of the Services of Supply
and to expedite the organization and development of those units. ^ This was
the beginning of a system of general inspection which later was actively devel-
oped.' This inspection service was under the charge of the officer command-
ing the central laboratory, but it was quite impossible for him to cover more
than a small part of this phase of the work alone and at the same time perform
his other duties. When new areas were to be occupied by the American
Expeditionary Forces or new projects were contemplated, that officer visited
the area concerned and after consultation with its senior medical officer, made
a survey of the general situation from the viewpoint of laboratory require-
ments, conferred concerning the latter's recommendation, and submitted a
report to the director of laboratories covering the situation, with recom-
mendations to meet it.' When the director, or other officer, returned from
a trip of inspection a conference was held and verbal reports were made, fol-
lowed by a written report that was circulated in the office of the director of
the division.'
This inspection service gave the director and his assistants an infinitely
better conception of existing conditions than could have been obtained other-
wise, resulted in a much higher degree of coordination in the laboratory service
at large, and enabled the director on many occasions to make decisions of
much greater value to the service than would have been possible had this
system of inspection not been in force.'
STATIONARY LABORATORIES
Base Laboratories Assigned to Sections of the Services of Supply
In accordance with the original plan of organization one base laboratory
was established for each section or other subdivision of the Services of Supply.'
These units were under the direct control of the section surgeon and were
located at the headquarters of each section, except that the laboratory for the
intermediate section was at Tours, that for the advance section at Neufchateau,
and that for base section No. 3, at Winchester, England. These base labora-
tories occupied permanent buildings and were completely equipped for general
laboratory work, affording general and special laboratory facilities for troops in
the section who were not served by other laboratories.'
Their activities consisted of clinical examinations, general and special
bacteriology, general and special serological work, the distribution of culture
media, laboratory examinations of water supplies, the investigation of out-
l)reaks of epidemic diseases and such other activities as the section surgeon
deemed advisable.' They were established as rapidly as the necessity for them
arose and personnel and equipment became available.' The first unit of this
type. Army laboratory No. 1, was established as mentioned above, at Neuf-
chateau, in September, 1917, and the last at Le Havre, in September, 1918,
where it served Base Section No. 4. By that time a laboratory of this type
was operating in each section or other subdivision of the Services of Supply.'
In the original plan of organization for these units provision was made
for the transportation necessary to carry out field surveys of water supplies,
to investigate outbreaks of epidemic diseases and to forward therapeutic sera
170
ADMINI^^TKATION, AMEKKAX KXI'EDITIONAH V FORCES
emergencies, but the transportation problem in the American Kxpeditionary
P\)roes was of such a nature that vehicles were not always available for the
effective prosecution of these duties throughout the areas they sought to serve.'
The following brief history of the base laboratory for Base Section No. 5 is
illustrative, to a degree, of those of other sections of the Services of Supply.
Base Laboratory, Base Section No. 5
This laboratory was organized in February, 1918, under the title of sta-
tionary laboratory No. 2.^ This occurred in Washington, D. C, where the
various officers and men connected with it assembled and remained on duty
until their departure for France, May 1, 1918. On arrival in France there
were no available supplies for the laboratory, those originally shipped having
failed to arrive, and substitutes were extremely difficult to procure. These
defects, however, were gradually overcome.^ Shortly after its arrival in this
section the name of the laboratory was changed to base laboratory, base sec-
tion No. 5, under which title it continued to operate.^ It gradually developed
into a concrete organization so staffed and equipped that practically any type
of laboratory diagnosis or research could be performed.^ Its greatest activities
were the study and control of infectious diseases in base section No. 5.
About June 12, 1918, the base laboratory absorbed that of Camp Hospital
No. 33, whose premises it occupied and enlarged to four rooms. Permanent
fixtures were installed, but six weeks later, when other quarters became available,
the base laboratory left this location, which was reoccupied by the laboratory
of Camp Hospital No. 33.^ In August, 1918, the base laboratory was installed
completely equipped in a house in Brest, formerly a private residence, but
which lent itself well for the purposes.^
In the organization of this unit various departments were created, each in
charge of the officer best qualified for that particular work. As far as possible
these departments were kept strictly separated that their work might be unham-
pered by the necessity of their respective personnel undertaking other work for
which they w^ere less qualified.^ The departments consisted of office and
records, property, bacteriology, pathology and serology, chemistry, and water
control. In the investigation of infectious diseases in this base section the labo-
ratory was entirely dependent upon the activities of its own personnel to secure
specimens for examination.^ The respiratory infections w^hich sw^ept through
base section No. 5 in the fall and winter of 1918 were studied by the bacterio-
logical and pathological departments. Cultures were made from the sputum
and the various organs at autopsy. All organisms secured were carefully typed
and, when possible, preserved for future study. The bacteriological and patho-
logical work done in common with these diseases was of an advanced and
extremely thorough character. All this work was done under the direct
supervision and at the direction of the base surgeon base section No. 5.
Complete liaison, both official and unofficial, existed between this organi-
zation, the local hospitals, and the Engineer Corps. ^ Most of the laboratory
activities pertained to the service of these agencies. The chief association with
the engineers related to the water supply of Brest, and that with hospitals to
the control of infectious diseases.^
ORGANIZATION' AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 171
In addition to the duty indicated above this organization exercised a
general control and supervision over the smaller laboratories attached to hospi-
tals in and about Brest, and in a way served as a supply depot not only for
laboratory material but also for therapeutic and diagnostic sera.^ The thera-
peutic sera were secured by requisition, as were some of the diagnostic sera,
but most of the former were prepared by the department of bacteriology con-
nected with the base laboratory.^ Hospitals in the vicinity were supplied sera
on requisition by means of the light truck above mentioned. All trans-
Atlantic transports requiring sera were supplied in like manner on telephonic
request that was later confirmed in writing. Because of the fact that they were
frequently demanded in emergencies, these supplies were sent out day or night,
for the laboratory operated throughout the 24 hours of the day.^
A great handicap, which this laboratory experienced and which caused
marked detriment to complete efficiency, was inadequate transportation.
After great difficulties this laboratory secured a light truck, which alone
made it possible for its personnel to cover much ground and secure the speci-
mens requested in connection with the control of infectious diseases.^ The one
vehicle permanently supplied was not sufficient to meet the demands, and the
procurement of other transportation from the Motor Transportation Corps
was very uncertain and inadequate. This feature caused much loss of valuable
material and time. Another handicap was the fact that supplies were limited,
for it was always difficult and sometimes impossible to obtain them.^
Base Laboratories for Hospital Centers, and Hospital Laboratories Serving in
Centers
Plans for the organization of the laboratory service had considered the
conservation of personnel, equipment, supplies, and construction, in order to
release tonnage and to utilize resources to the best advantage.^ In the labora-
tory service of the large hospital centers which were made up of several base
hospital units great economies were thus effected. Each base hospital included
in its personnel two or more commissioned laboratory officers, a varying number
of enlisted technicians, and a complete laboratory equipment. By centraliza-
tion of the laboratory service the efficiency was increased, personnel released,
equipment conserved, and construction diminished.' Therefore, in each hospital
center one base laboratory for the entire service of the center was organized
and one small clinical laboratory established for each base hospital unit.
The laboratory for the center was part of the headquarters organization, and
its commanding officer the representative of the commanding officer of the
center in all matters relating to the laboratory service. Its personnel consisted
of selected officers and enlisted technicians drawn from the hospital units
comprising the center; its equipment was drawn from the same sources.'
Standard plans for the laboratory buildings for the centers and for smaller
clinical laboratory buildings for each unit were prepared in the office of the
director of laboratories, A. E. F., and turned over to the hospitalization division
of the chief surgeon's office for inclusion in the general plans of construction.'
The original plans provided for two standard barracks for the base laboratory
and one small building for each hospital unit functioning in the center, but the
172
ADMIX ISTHATIOX, AMERICAN EXPEDITIONARY FORCES
accommodations for the base laboratory were later reduced to one building
because of scarcity of materials.'
The base laboratory for the center in general performed such routine
clinical and pathological work as might be necessary, all highly tecliiucal
bacteriological and serological work for the center, and prepared cidture media
and special reagents, which it issued to the subsidiary clinical laboratories.'
Those organizations operating in the several base hospital units composing
the center carried on the clinico-pathologic work for their respective units.'
The general method outlined above was that followed in the large hospital
centers of temporary construction.^ In the large centers which utilized per-
manent buildings that were a considerable distance apart it was not always
possible to centralize the work so definitely.* However, by November, 1918,
a laboratory service which conformed in general to the method outlined above
had been established in all hospital centers operating in the American Expe-
ditionary Forces.*
In those hospital centers where permanent buildings were utilized the
laboratory services were housed in such rooms or buildings as were found most
suitable for their purposes without extensive alterations.^ The laboratories,
therefore, at these centers varied considerably in size and character, ranging
in size, for example, from a temporary wooden building erected for laboratory
work at the hospital center at Limoges to an entire hotel equipped for laboratory
purposes at the hospital center at Vichy
At all the hospital centers except that at Vichy the laboratory work was
organized in conformity with Memorandum No. 8, July 23, 1918, division of
laboratories and infectious diseases.^ As this memorandum is reproduced in
the appendix it is sufficient here to state that it provided for a laboratory
officer who, as a member of the staff of the commanding officer of the center,
would exercise control over its entire service, in so far as his specialty was
concerned, and for the establishment of a center laboratory and unit labora-
tories.^ Each of the hospitals composing the center was to be served by a
unit laboratory. The center laboratory w^as to perform such examinations
as required greater time and more technical skill, while the unit laboratories
were to perform ordinary routine clinical pathological examinations.^
In order to illustrate the laboratory activities at these centers there follows
the history of that service at Mesves and at Vichy. The organization and
activities of the laboratory service at Mesves, which grew to be the largest
center in France, were typical of those in other centers,^ except Vichy. This
service at Vichy is, therefore, described also because of its unique character.
Typical Laboratory Organization of a Hospital Center (Mesves)
The first base hospital assigned to Mesves, arrived August 1, and on August
3, a laboratory officer for the center was assigned.^ Efforts were inaugurated
and continued to provide accommodations, equipment and organization for
the laboratories of base hospitals as they successively arrived. Construction
w^as expedited, by loaning to these units a Medical Department tool chest,
by which construction of much apparatus, shelving, furniture and other articles
was expedited— apparently a minor matter, but one which proved of very
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 173
great importance. Supplies were procured on requisition from intermediate
medical supply depot No. 3.^
In conformity with Memorandum No. 8, division of laboratories and
infectious diseases, July 23, 1918, the laboratory organization for this center
comprised (1) a central laboratory whose commanding officer was a member of
the staff of the commanding officer of the center, and supervised all its labora-
tory activities; and (2) unit laboratories, viz, one for each of the hospitals
composing the center and the convalescent camp. The work of these de-
partments was divided as follows:^
Center laboratory: (a) Special pathology (gross and miscroscopic) ; (b)
special bacteriology (pneumococcus type, typhoid, and dysentery); (c) Serology
(agglutination and complement fixation reactions) ; (d) general board of health
for center (water analysis, carrier work); (e) preparation of media, purchase
and requisition of supplies).
Unit laboratories: (a) Gross pathology (autopsies on all patients dying in
hospital) ; (h) bacteriology (general culture work, blood, throat, wound, etc.) ;
(<■) general clinical pathology (urine, sputum, blood, feces, etc.); (d) prepara-
tion of Dakin's solution, care of unit water supply, etc.
This partition of duties w^as inaugurated August 15, 1918, and continued
unchanged, though in September it was apprehended that laboratory supplies
available for incoming units might not be adequate for the performance of all
the duties allotted them. Laboratory work, however, was simplified by the
practice of distributing patients, according to their ailments, among the hos-
pitals best equipped and otherwise qualified to care for them.^ The distribu-
tion of duties proved highly satisfactory, but a conviction grew that centraliza-
tion of post-mortem service and burials might have been advantageous, although
this would have deprived clinicians of opportunities to attend autopsies in
which they were interested.^
The center laboratory, until September 17, occupied quarters in common
with those of Base Hospital No. 67, when it moved to a special building provided
for it. This was 100 by 20 feet in dimensions and was later supplemented by
a cool room 6 feet by 6 feet 6 inches, and an animal house 13 by 26 feet. These
buildings were occupied several weeks before they were equipped with light,
water, or sewer connections.^
Each unit laboratory centrally located in the hospital which it served
occupied a building 20 by 40 feet, divided originally into an autopsy room, a
morgue, and a clinical laboratory, but several changes were made in the interior
plan of these structures. Each laboratory built most of its interior fittings.
All laboratory supplies reaching the center were invoiced to the center
laboratory officer and by him issued on memorandum receipt to the unit
laboratories. In connection with such supplies, many economies and improvi-
sations proved necessary. The supplies most difficult to obtain were those
commonly used articles not listed in Memorandum No. 21 from the division
of laboratories and infectious diseases, e. g., stoves, books, basins, pens, wire,
etc. Animals, except mice, were procured without difficulty.^
Records were kept in the following manner: Request slips were made out
in the wards and on these slips laboratory findings were entered, the slips then
174
ad:mixistkatiox, American kxi'kditioxahv fohce.s
being returned to the wards. Retained laboratory records consisted of (1)
a journal or daybook in which all specimens or requests were listed; (2) a file
of index or ledger cards on which the reports mentioned above were transcribed.
All the work done on a given case was entered on one or more of these cards.
This system simplified clerical work and facilitated cooperation with the clinical
services.^
General reports of infectious diseases were carried on spot maps and on
separate card indices for the more important diseases — pneumonia, diphtheria,
typhoid, dysentery, meningitis, and scarlet fever. These records were obtained
from (1) the morning report of infectious diseases, (2) from individual reports
of cases which were required by a special memorandum of the commanding
officer of the center, and (3) from the medical consultant. Each case of diph-
theria, meningitis, and typhoid fever was personally investigated by an officer
from the center laboratory. Routine reports of water analyses were made to
the center sanitary inspector and to each hospital. The locations of all Lyster
bags were posted on spot maps, to facilitate checking the routine bacteriological
examinations.^
The laboratory staffs of the entire center consisted of 29 officers, 7 nurses
or civilians, who had had previous laboratory experience, and 63 enlisted men.
Of this number 5 officers, 1 technician, and 15 enlisted men served at the center
laboratory, while the others were distributed among 8 base hospitals, 2 provi-
sional base hospitals, 2 evacuation hospitals, and the convalescent camp.^
The idea of developing the laboratory service from a central laboratory
with subsidiary laboratories in each hospital organization proved practical and
efficient. As each hospital occupied somewhat the same position in the center
that the regiment held in a division, this organization, more than any other
factor, simplified the development and operation of the laboratory service.
The old and established functions of the laboratory proved of most value,
but the preparation of Dakin's solution and the supervision of the water sup-
ply in each hospital by its laboratory, in addition to the regular bacteriological
examinations of the camp water supply, were other valuable services. Wound
bacteriology and pneumococcus typing proved of little practical importance.
With the exception of influenza and influenza pneumonia, there were no
epidemics in this center. Diphtheria was the most prevalent of the carrier-
borne diseases (151 cases), and the number of diphtheria carriers detected was
correspondingly high (112 cases). The presence of diphtheria and of virulent
diphtheria-like organisms in wounds was frequently noted. Twenty-six cases
of cerebrospinal meningitis were treated, of which 12 died. Twenty-five of
these cases developed in this center. Seventy-three cases of typhoid fever, one
case of paratyphoid A, and two cases of paratyphoid B were treated, of which
total, 21 were believed to have originated here. Thirty-eight of these cases
were verified bacteriologically.^
The Laboratory Service, Hospital Center, Vichy
The organization of the laboratory service at the hospital center at Vichy
differed from that in other centers because of the fact that it appeared advisable
to centralize all laboratory personnel and equipment. This decision arose
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 175
from the fact that the hospitals comprising the center operated in some 80
hotels which varied in their capacity from 50 to 1,200 beds. Because of the
consequent unevenness in the distribution of buildings and bed capacity,
operation of unit laboratories would have been difficult. In one hotel, accom-
modating 1,200 beds, one small subsidiary laboratory was established but
this was the only departure from this plan for centralization.^
The laboratory equipment of the five base hospitals at this center was,
therefore, assembled at the center laboratory to which all Medical and Sanitary
Corps ofl&cers belonging to the laboratory staffs of the various base hospitals
were assigned. Enlisted men who had had previous experience as laboratory
technicians, photographers, and artists from all organizations were similarly
assigned.^
The laboratory and its enlisted personnel occupied an entire hotel with the
exception of three small rooms which were assigned to the American Red
Cross for office purposes.^
In this, as in other centers, an experienced laboratory officer who was
assigned to the staff of the commanding officer of the center, organized and
controlled its laboratory service, and was responsible for its activities.^
The laboratory staff here consisted of the following personnel:^ Medical
officers, 9; Sanitary Corps officers, 2; civilian employees, 4; enlisted men, 35;
French employees, 7; total, 57. This personnel was distributed among the
following departments: Administrative, pathological (including clinical and
neuropathological), bacteriological, serological, art, photographic, and preparation
of media.^
The administrative department had charge of the laboratory building, its
proper policing, discipline of the enlisted personnel, the cleaning of glassware,
operation of stock rooms, collection of specimens, and the issue of laboratory
reports.^
The assistant director of the laboratory took complete charge of any large
bacteriological problems that arose, such as extensive investigations for diph-
theria, meningitis, or typhoid carriers, and was authorized to detail as his
assistants any subordinate member of the laboratory staff. ^
So far as possible the laboratory staff of each of the five base hospitals
composing this center performed the routine laboratory work of their respective
hospitals; e. g., clinical pathology, wound bacteriology, etc. Therefore, the
service for each base hospital was left in charge of its own pathologist who was
responsible to the laboratory officer of the center through the assistant director
of the laboratory.^
The pathological department had entire control of the autopsy service
and of surgical pathology. The laboratory officer of each unit performed
practically all the autopsies pertaining to it, but the brains and spinal cords
were removed by the neuropathologists and their technicians. All patients
dying at this center were autopsied, a stenographer taking the dictated protocol
at the post-mortem table. Almost every autopsy included an examination of
the brain, spinal cord, and accessory sinuses of the head.^ This department
was able to prepare microscopic sections of the important viscera from most
13901—27 12
176
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
of the autopsies, to study them, prepare microphotographs and, with the aid
of the art and photographic departments, to make drawings of gross and
microscopic lesions. Clinical pathological meetings which the entire medical
staff of the center were requested to attend were held three times a week in the
lecture room of the laboratory. At these sessions clinical histories of all cases
coming to autopsy were read and discussed, the gross anatomic material was
demonstrated, and microscopic sections, drawings, charts, etc., were exhibited.^
Fig. 9.— Pathological room in the laboratory, Vichy hospital center
Wassermann tests, the typing of pneumococci, weekly water analyses
and such other procedures as required more or less routine work, were assigned
to a few officers and men and the individual base hospitals' laboratory staff
was thus relieved of these duties.^
Though serology was done by the department of that name there was
always opportunity for the laboratory staff of each base hospital to perform
any of this work, if they so desired and had the time.^
The art and photographic departments had charge of all the medical
art work of the center. Reenforced by a special group sent from the United
States, this department was engaged in taking photographs of clinical cases,
making black and white drawings, and colored drawings of gunshot wounds,
ORGANIZATION AND AD:MINISTRATI0N OF CHIEF SURGEON'S OFFICE 177
mustard gas burns and peripheral nerve injuries. It also took photographs
or made drawings of surgical specimens, autopsy lesions and constructed
plaster or wax models of facial injuries and other lesions. When the armistice
was signed, this department was prepared to furnish on request, medical photo-
graphs and artists to other hospitals. It was planned and to a large degree accom-
plished that this center be made a collecting point for medical art work in
the American Expeditionary Forces.^
The basement of the hotel utilized for laboratory purposes, contained
the morgue for the entire center with a central autopsy room. Another room
on this floor used for the preparation of bacteriological media was equipped
with hot and cold water, gas and electricity. In a third room were stored the
coffins which were made by the Quartermaster Department while a fourth
room was shelved and used for the storage of antitoxins, sera, vaccines, etc.®
Offices of the laboratory officer and his assistant and a small medical library
were on the ground floor. Another room accommodated a large clinical and
bacteriological laboratory which provided a desk bench for the pathologists
and laboratory personnel of all the hospitals in the center. Most of the routine
work was done in these rooms. On the same floor were a lecture room seating
about 100 persons (also used for a museum and for the display of the work
of the art and photographic departments) and a media and chemical supply
room which served the entire laboratory.®
On the first floor were located the pathological, art, and photographic
departments. These afforded facilities for officers engaged in histology and
the preparation of gross pathological specimens for museum purposes, for
artists engaged in medical art work, for a modeler of plaster and wax prep-
arations for face masks, etc. Here were provided storage of pathological
specimens for shipment to the Army Medical Museum, a portrait studio,
and facihties for developing and mounting photographs. The brains removed
from all cadavers were hardened, studied, and stored for shipment to the Army
Medical Museum.®
The second and third floors of the hotel were used for living rooms for
the laboratory personnel, about 40 being quartered there. All the rooms in
this building were w^ell equipped with water (hot and cold), gas, and electricity.®
The laboratory equipment and apparatus were exceUent. Much of the
equipment was brought to France by the several base hospitals, but addi-
tional articles were obtained from the medical supply depot and the central
Medical Department laboratory. The equipment compared very favorably
with that seen in most large civil institutions. An elaborate equipment for
neuropathological work, consisting of large brain microtomes, etc., costing about
$18,000, was shipped to the center from the United States but was never
received.®
The methods of procedure employed by the laboratory in the service
of the scattered hospital establishments were comparable to those used by
departments of health in a civil community supporting a diagnostic bacteri-
ological laboratory.®
As glassware containers for the collection of specimens were quite limited,
small stations supplying this material were established in the largest of the
178
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
hotels occupied by the several hospitals. These culture stations, as they were
called, were usually located in the pharmacy of the building. At one time 22
of these stations were in operation, and at each the laboratory maintained an
adequate supply of the containers for urine, feces, or sputum; diphtheria
culture tubes, wound culture tubes, and "venereal outfits," the last mentioned
consisting of glass slides and swabs for taking smears.^ From each station
containers for the collection of specimens were distributed as required to smaller
buildings and conversely here were collected specimens and requests for
laboratory service.
Pasted on each container w^as a mimeographed blank for the entry thereon
of appropriate data. Similar detached blanks were kept at the culture stations
for use as requests upon the laboratory for special services.
Fig. 10.— Bacteriological laboratory, Vichy hospital center
In an emergency, e. g., a blood transfusion, or a leucocyte count in an
appendicitis case, there quest was sent direct to the laboratory by an orderly,
and dehvered to the pathologist of the hospital in which the soldier was a
patient. This officer was responsible for an immediate laboratory examination.
None of the Army forms or blanks were employed in the laboratory service
here.^
Three enlisted men, who acted as culture collectors, visited each of the
culture stations three times daily, employing a motor cycle and side car.^
All specimens brought to the laboratory by the culture collectors or sent
direct by a hospital were noted in numerical sequence on an entrv book at the
ORGAXIZATIOX AXD ADMIXISTEATION OF CHIEF SURGEON'S OFFICE 179
receiving office. The specimens were then distributed for examination and the
results of these examinations were noted upon report blanks, the laboratory
retaining a carbon copy for its file, the original copy being sent to the hospital
and ward from which the specimen came or for which the examination was
made.^
Though the laboratory at Vichy existed for a year, it operated actively
only for five months. During this time, 44,767 laboratory examinations were
made, including practically all the common tests, reactions, and procedures
required by modern clinical medicine in bacteriology, serology, clinical pathology
and pathological anatomy.^
Base Hospital Laboratories for Base Hospitals Not Operating in Centers
The laboratories of detached base hospitals performed all routine clinical
and pathological work for the organization they served. Their installation
was a matter of local administration and their operation presented no
difficulties.^
Many of the following details, taken from the history of the laboratory
activities of Base Hospital No. 27, are illustrative of the activities of those
establishments in detached base hospitals generally. This unit was selected
for discussion here because of the completeness of its history.^
The staff of the laboratory originally consisted of 3 medical officers, 1
trained nurse, and 3 enlisted men. One officer was engaged in pathology,
another in bacteriology, and the third (who gave part of his time to ward work)
in clinical microscopy, parasitology, and chemistry. Late in November, 1918,
a Sanitary Corps officer joined the staff, but at intervals one or more officers
were detached for periods of three months or less. The services of civilian
photographer and artist were made available to this unit and thus some valuable
material in this field of endeavor was procured.^
The laboratory of Base Hospital No. 27, which was located at Angers, first
occupied two rooms in a permanent building. Since these rooms were over-
crowded, a temporary structure was obtained into which the laboratory moved
as soon as the new building was completed. This building was centrally located
and was of the wooden barrack type, with cement floor and plaster walls. The
floor plan included two workrooms, measuring 6 by 12 meters, with an incu-
bator room 2.5 by 2 meters and a storeroom 2 by 2 meters between them, one
on either side of a short passage connecting the two large rooms. ^ The work-
rooms contained benches, along both sides, and center tables. Large sinks, sup-
plied with hot water and adapted to cleaning glassware, etc., were provided for
each room, and a sufficient number of small sinks for the side or center tables.
Both rooms were wired for electricity, with numerous ceiling and side lights and
a number of floor plugs at the sides of the room. Ample shelf space was pro-
vided, the storeroom being shelved to the ceiling. Gas connections were
installed along all the side tables. A hot-air steriHzer, a paraffin oven, and
a large centrifuge were operated in the incubator room, and the Arnold steril-
izer and the autoclave in the bacteriological room. As far as possible, the
reserve supply of laboratory materials w^as kept in the storeroom.^
180
ADMIXISTKATIOX, AMERICAN EXPP:DITI0N AK V FORCES
When the temporary structure was occupied, the rooms whence the labora-
tory moved were thoroughly equipped as a morgue and as a fixation room for
specimens/
The equipment originally brought to France was that estimated on the
basis of the needs of a 500-bed hospital for one year, but when the bed capacity
was doubled (or counting emergency beds, quadrupled), a requisition was sub-
mitted for corresponding additions to equipment. Availability of gas and
electricity secured the issue of apparatus not considered in the original hst of
equipment/
Arrangements for the delivery of specimens to the laboratory were left to
the respective ward surgeons, but phenolphthalein tests, diagnostic lumbar
pimctures, procurement of specimens for Wassermann tests, blood cultures, and
blood counts were all attended to on request to the laboratory staff/ Each
specimen was accompanied by a requisition slip upon which the reports desired
were entered and was returned to the proper ward by the laboratory personnel.
Laboratory records were kept for the most part in separate ledgers, one for
each class of work, e. g., blood counts, urine analysis, etc., but general bacteri-
ological findings were recorded in one book and wound bacteriology findings in
another, each in numerical sequence. Record of examinations of surgical
pathological tissues were entered on the original requests for examination.
These were retained at the laboratory and duplicates of the findings noted were
sent to the wards. Autopsy records were made on appropriate forms with his-
tological notes appended when necessary to make the diagnosis complete.
Wassermann tests were recorded on cards, each day's list being entered on a
separate card.''
The chief activities of the laboratory were clinical pathology, anatomic
pathology and clinical bacteriology. A considerable part of the bacteriological
work was incidental to the epidemiological study of cultures from this and
other hospitals in the vicinity of Angers.^ The laboratory also made the water
analysis for this region.
The somewhat limited official personnel and lack of trained technicians
necessitated such close cooperation and application to the routine work in hand
that research work was precluded.^
Camp Hospital Laboratories
Effort was made to furnish each camp hospital with laboratory service in
accordance with its requirements.* This was not entirely uniform, for these
hospitals varied greatly in size and in the nature of their service. Some func-
tioned as base hospitals; others were little more than evacuating infirmaries,
or varied between these two extremes. In November, 1918,58 camp hospitals
were operating with the American Expeditionary Forces and there is record of
laboratory service in 51 of these.
The following notes from the history of the laboratory of Camp Hospital
No. 15, exemplified to a degree the activities of these units. ^ This hospital
was organized in France from casual personnel. Its capacity was 700 beds,
expansible to 1,000 beds in emergency. Located at Camp Coetquidan, which
accommodated 20,000 troops, the hospital began to admit patients November
1, 1917.»
OBGANIZATIOX AND ADMINISTEATIOX OF CHIEF SUEGEON'S OFFICE 181
The laboratory staff consisted of one officer and four enlisted men. At first
equipment was very limited but was augmented from time to time as resources
permitted by American and French apparatus. The laboratory occupied two
rooms, with floor areas of 50 and 25 square meters respectively, in a centrally
located permanent building and utilized rooms in a neighboring structure as a
morgue and an animal house. ^
Requests for examinations as well as specimens were sent to the labora-
tory by ward surgeons. Findings were recorded in note books and reports
then rendered the ward officers. Requests from officers outside the hospital
were sent through the receiving ward, and reports returned through the same
channel.^
An important part of the laboratory service was the periodic examination
of water supplies in villages where troops were located throughout the sur-
rounding territory, and sanitary surveys, with studies pertaining to epidemi-
ology among the troops occupying the area. As meningococci were discovered
in the course of the influenza epidemic at Camp Coetquidan, approximately
8,000 cultures for these organisms were examined, of which 662 were positive.
Because of limited equipment, chemical examinations were few.^
MOBILE LABORATORIES
Army Laboratories
In the original plan of organization, a laboratory unit for each army was
provided, but it was thought best to await developments before the project
was further defined.^ Until July, 1918, all laboratory investigations of out-
breaks of epidemic diseases in the advance section and zone of the armies
were performed by personnel and motorized laboratories — i. e., "field labora-
tory cars" — sent out by the central Medical Department laboratory or Army
laboratory No. 1.^ During the Chateau-Thierry operation, a field laboratory
car was attached to the First Corps for the investigation of epidemic diseases
and it was understood by the chief surgeon of the Paris group, of which that
corps then formed a part, that this car was available for the service of the
entire group. The work of this unit in the Chateau Thierry sector proved to
be of great value, for it demonstrated that much of the so-called diarrhea and
dysentery occurring there was true bacillary dysentery, typhoid or paraty-
phoid.^
In August, 1918, it became evident that there should be attached to each
army a laboratory unit equipped to do general bacteriology, serology and
examination of water supplies.^ A transportable laboratory equipment for
service of the first army was assembled and shipped to Toul just prior to the
St. Mihiel operation (September 12, 1918). As special personnel was not
immediately available, the equipment was installed at the Toul hospital center
where the laboratory served the center and also met the emergency require-
ments of the First Army.^
During the early phases of the Meuse-Argonne operation, a field laboratory
car was attached to the First Corps of the First Army.^
182
ADMINISTRATION, AM?:RICAX EXFEDITIONAHV FORCES
When the Second Army was formed, a field laboratory car was attached
to the office of the surgeon of that army. It operated under the sanitary
inspector. Second Army, in the investigation of epidemic diseases.
When the Third Army was organized to constitute the Army of Occupation
in Germany, a survey of the laboratory requirements was made and the per-
sonnel and equipment necessary for its service were supplied.^ Army labora-
tories were established at Coblenz and at Trier, that at Coblenz being supple-
mented by a mobile laboratory.^
The laboratory service of the Third Army illustrates the full development
of this specialty in this field. On March 16, 1919, it included 2 army labora-
tories, 10 hospital laboratories with 2 annexes, and 8 divisional laboratories;
i. e., 1 for each division.^
The army laboratories were staffed and equipped to perform all the ordi-
nary duties of laboratories serving large cities or even States. The personnel
of the unit located at Coblenz consisted of 10 officers and 24 enlisted men,
excluding those assigned to the field laboratory car which also served this
army and which was attached to this unit.^ It included a commanding officer,
executive and supply officers (one officer sometimes discharging the duties of
both assignments) a pathologist and histologist, bacteriologist, water analyst,
serologist, chemist (with exceptionally broad attainments, especially in the
field of toxicology), three clinical laboratory experts, and a skilled technician.
At the army laboratories autopsies were performed, histologic diagnoses and
Wassermann tests made, bacteriologic differentiations conducted, water samples
tested and chemical analyses made of food, beverages, medicines and supplies,
e. g., chlorinating materials for water purification.^ Each of these units also
conducted a clinical laboratory service for the hospital wherein it was located
and issued supplies to other laboratories in their respective areas. The labora-
tory at Coblenz performed the usual laboratory service for Evacuation Hospi-
tal No. 27 (formerly No. 6) and sent out officers to conduct autopsies at other
hospitals.^
Attached to the Third Army laboratory at Coblenz was a field laboratory
car which was staffed by one officer and three enlisted men. This unit was of
especial value during the initial emergency and in the prosecution of surveys of
meningococcus carriers.^
The army laboratory at Trier occupied space in Evacuation Hospital No. 12,
for which it performed all the clinical laboratory service in addition to its other
duties, which were similar to those outlined above for the laboratory at Coblenz.*
Ten laboratories each adequately equipped with material packed in eight
chests, served the 10 evacuation hospitals, which in the Third Army served as base
hospitals.^ These hospitals varied in capacity from 400 to 1,800 beds and in
the character of the cases treated. In some units the cases w^ere almost entirely
medical, in others many cases were surgical; a few units were largely devoted
to the specialties. The laboratory service in each of these hospitals naturally
conformed to the character of the patients treated therein. In very general
terms this service included examination of urine, sputum, blood, cerebrospinal
fluid, feces, and the bacteriology of wounds, epidemics, venereal, cutaneous, and
ocular diseases, i. e., the usual lines of investigation connected with hospitals.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 183
The staffs of some laboratories also performed autopsies for the hospitals which
were not thus served by the army laboratories.^
No laboratories, other than the eight assigned to divisions, were provided
for the field hospitals, of which 35 were in operation. These divisional labora-
tories, each provided with 8-chest equipment, were utilized to make water
analyses, epidemiological studies and urgent clinical laboratory examinations.^
Field Laboratory Cars
Each of the field laboratory cars, which on occasion reenforced the labora-
tory service of armies, was essentially a completely equipped unit, relying on
Fig. 11.— Field laboratory car
its own motor power, but was supplemented by additional transportation con-
sisting of a Ford car and a motor cycle with side car.'° The unit could be shifted
and moved rapidly to meet varying conditions in the field as well as to cover a
large territory and was independent of field, evacuation, and base hospitals.
The additional transportation permitted sanitary surveys covering a large area
and facilitated the collection of specimens for examinations.^*^ Three of the
cars were the Peerless type and one a De Dion Bouton. They were specially
designed and equipped to meet field conditions, for oftentimes the laboratory
would work in a division removed from hospitals and other laboratories.
The equipment was compact and provided with a work bench and compart-
ments for the apparatus and supplies. The arrangement made work in the
car possible and prevented breakage while the car was being moved. The
provisions made for actually doing work in the car constituted one of its greatest
184
AD^rrXISTRATIOX, A:\rERICAX EXPEDITIONARY FORCES
advantages, but usually a room in some building was utilized for making media,
washing glassware, and for a storeroom. Occasionally one was fortunate
enough to be located where the apparatus could be set up in a separate room.'"
The equipment consisted of incubators, autoclave, hot air sterilizer, distilling
apparatus, ice chest, water bath, Wassermann outfit, centrifuge, microscope,
hemocytometer, water testing outfit, material for spinal punctures, blood cul-
tures and the usual laboratory accessories. A storage battery and generator,
connected w^ith the motor, provided electric lights. This was of great help, for
often it was necessary that work be done in the car at night. This apparatus
also gave excellent illumination for microscopical examinations. '° A gravity
water system was provided, consisting of a water tank fastened on the roof of
Fig. 12.— Front of interior of field laboratory car
the car and connected with a faucet. A sink drain was also provided. Sup-
plies were carried in the car to make the necessary media, a complete supply
of diagnostic as well as therapeutic sera, and reagents for the Wassermann test.
The equipment made possible the performance of the following laboratory
tests Routine clinical examinations, such as those of urine, blood, sputum,
smears and body fluids; examinations for typhoid, dysentery, and enteric ail-
ments generally; examination to determine positive diagnosis of meningitis and
exammation for carriers; examinations for diphtheria cases and carriers, and
performance of Schick tests; investigation of respiratory epidemics, especially
pneumonia and influenza; water analyses, bacteriological; Wassermann fixa-
tion test. These laboratories were not called upon however, for this work.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 185
Fig. 13.— Rear of interior of field laboratory car
186
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Fig. 14.— Interior of field laboratory car showing water still, autoclave, and sterilizers
ORGAXIZATIOX AND ADMINISTEATIOX OF CHIEF SURGEON'S OFFICE 187
The field laboratory car aided the sanitary inspector of an army to cope
with epidemiological problems and it was in this capacity that it was of greatest
use, though it was often called upon to assist in establishing clinical diagnoses.'*^
Being attached to army headquarters under the immediate supervision of the
sanitary inspector, reports of its findings were made to him direct. The
peculiar value of the laboratory cars rose from the fact that the divisional
laboratories usually were unable to handle the larger epidemics and sanitary
surveys, while performing their normal duties. The stationary laboratories
were not provided with transportation for extensive field work though the
collection of samples was of the greatest importance, while the excellent trans-
portation facilities of the laboratory cars enabled them to reach sites where
their services were needed and to carry supplies adequate for several months.
These supplies usually were replenished from evacuation and base hospitals.
The personnel consisted of 1 or 2 officers, 2 technicians (preferably sergeants
or sergeants, first class), and 2 chauffeurs.'^
These laboratories aided greatly in the investigation and control of typhoid
fever in the 77th and 79th Divisions; meningitis in the 7th and 90th Divisions;
diphtheria in the 32d and 35th Divisions; pneumonia and influenza in the
26th Division and in the labor battalion at Jonchery.'*^
The most important advantages which these laboratory cars presented
were the following: '" The unit could function anywhere in the field, requiring
no special housing or additional equipment and could, therefore, operate in any
area occupied by the troops. It was supplied with its own light and water
systems. Being supplied with its own motor power it was ready for immediate
service and the transportation could not be diverted for other use, thus ensuring
a mobile organization. The unit was able to handle large epidemics and to
cooperate with the army sanitary officer in solving special problems and making
surveys. It thus permitted other laboratories and those with divisions to con-
tinue their normal duties without interruption. On the other hand, the chief
disadvantages of a field laboratory car were, the initial cost of the car and its
special equipment, which was about $7,500; the car being of special design,
could be manufactured only in limited numbers, and in case of motor trouble
the whole organization was unable to function.'*'
EVACUATION AND MOBILE HOSPITAL LABORATORIES
The laboratory equipment for each evacuation and mobile hospital was
assembled in eight chests which could be packed and unpacked quickly and
could be easily transported.* It was adequate for all types of clinical and gene-
ral bacteriological work, for the performance of autopsies, and the collection
and preservation of museum specimens. As a rule, only one laboratory officer
and two technicians were assigned to the laboratory units which served hospitals
under consideration though a larger personnel originally had been contemplated.*
The personnel prior to assignment was given a special course of instruction
in wound bacteriology. It was planned that these units would perform clinical
patholog}^ and autopsies as well as general and wound bacteriology and collect
and preserve museum specimens, and work of this general character was per-
188
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
formed at those evacuation and mobile hospitals which were partially immobi-
lized and operating in quiet sectors, but after July, 1918, when a war of move-
ment began, the activities of many of these units necessarily changed.*
During 1918, the number of evacuation hospitals, each of which was
equipped with a laboratory, increased as follows, until the time of the armistice:
March, 1; April, 2; May, 2; June, 4; July, 8; August, 8; September, 13;
October, 18; November,18."
The first evacuation hospital (No. 1) was established near Toul in March,
1918, where it operated throughout the remainder of the war." Except during
periods of active military operations its services were to a degree comparable
Fig. 15.— Transportable laboratory, in eight chests
to those of a base hospital, but during active engagements they w^ere of the
character which its name indicated. As at all times it was almost exclusively
a surgical hospital, its chief laboratory activities were wound bacteriology and
post-mortem pathology. Similarly, Evacuation Hospital No. 2, established
in April, at Baccarat, was engaged chiefly in the treatment of battle casualties
and its laboratory during that period was occupied in corresponding service."
Wound bacteriology occupied intensively the laboratories of evacuation
hospitals during the period from July, 1918, to the armistice; but during periods
of greatest battle activity, laboratory officers often were detailed to assist
in the treatment of patients." After the onset of the influenza epidemic in
October, 1918, the laboratories were engaged also in the study of infectious
diseases and frequently made the diagnoses for the ward surgeons. Post-
ORGANIZATIOX AND ADiMINISTRATION OF CHIEF SURGEON'S OFFICE 189
mortem examinations which they conducted on all bodies acted as a check
against gross errors and furnished clinicians with invaluable information.
Autopsies and histological and bacteriological examinations of specimens were
made the occasion of clinico-pathological conferences.
During the Meuse-Argonne operation some of the evacuation hospitals
were specialized to a degree, a number of them receiving medical cases and a
number of others surgical. Their laboratories supplied information required
for diagnosis and treatment and for the prevention of the wider spread of
infectious diseases. In general terms the equipment of these laboratories was
very satisfactory.^^
Fig. 16.— Chests of transportable laboratory opened to show contents
When American troops took over their sector in occupied Germany this
was divided into two districts, that of Coblenz and that of Trier. Seven
evacuation hospitals served the six divisions in the Coblenz or Bridgehead
district, and two, the two divisions in the district of Trier. Since these units
operated as advanced base hospitals and some of them specialized on certain
types of cases, the activities of their respective laboratories were modified
accordingly. The laboratories in each district were supplemented by an army
laboratory which conducted the more highly technical examinations in bacte-
riology, chemistry, pathology and serology. The personnel of the army
laboratories also performed the duties of consultants in special problems,
especially surgical pathology, conducted depots of laboratory supplies and
apparatus and performed autopsies for the hospitals in their vicinity.
190
ad:ministration, American expeditionary forces
Fig. 17
ORGANIZATIOX AND ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 191
With a few isolated exceptions the work of the laboratories in the evacua-
tion hospitals would have compared favorably with that in the average civihan
general hospital, for in spite of the deterrent influences of campaign they
proved their utility — in fact their indispensability.^^ The laboratories proved
to be of immediate clinical value in both medicine and surgery and collected a
number of specimens for the Army Medical Museum.
The laboratories of mobile hospitals were especially engaged in wound
l)acteriology, for these units w^ere organized to receive the nontransportable
wounded.^- They made, however, a number of examinations in other fields,
as blood and throat cultures, differential blood counts, examinations of joint,
Fig. 18
spinal, and chest fluids, of blood, sputum, urine, urethral smears, and feces.
Serum for Wassermann tests was collected and sent to designated laboratories.
Autopsies were performed and museum specimens collected.
Some of these laboratories moved quite frequently, that with Mobile
Hospital No. 1, for example, changed station nine times in five months.^-
Some used tentage but when possible a room in a permanent or temporary
building was employed. The equipment issued was found to be ample. Many
technical expedients were employed in the eft'ort to expedite reports to the
attending surgeon. ^-
DIVISIONAL LABORATORIES
A laboratory attached to each division was staffed by two officers and
four technicians,^ who constituted a part of the staff of the division surgeon.
13901—27 13
192
ADMINISTRATION", AMERICAN' FA'PEDITIOXARY FORCKS
In close cooperation with the division sanitary inspector, tliese units were
engaged chiefly in control of epidemic diseases, in the inspection ol water
supplies, and supervision and control of water purification.^ In ert'ect they
were under the control of the sanitary inspector. The equipment issued
these units w^as packed in three chests and was not adequate for general hacteri-
ology, for it was planned that work pertaining to that specialty would he
performed in the laboratories of evacuation and mobile hospitals.^ Such nuite-
rial as was furnished for work of that character was adequate only for the
performance of routine clinical examinations.*
After the armistice began, when divisions went into training areas, many
of these laboratories requisitioned and procured additional chests to complete
Fig. 19
equipment adequate for general laboratory work, including general bacterio-
logy.^ All the divisional laboratory units with the Third Army were supplied
with complete transportable laboratory equipments, in eight chests each, thus
permitting general bacteriological and clinico-pathological w^ork.^
On July 7, 1918, in Memorandum No. 5, division of laboratories and
infectious diseases, the personnel, transportation, and duties of the divisional
laboratory unit were prescribed in some detail.^ The provisions of this circu-
lar were later republished and somew^hat amplified, in Memoranda Xos. 5 and
7 from the same office ^ (see Appendix).
These units usually were located at division headquarters, especially when
the division was in a rest or training area or at headquarters of the sanitary
train. In trench warfare or in training or rest areas the divisional laboratories
OKGAXIZATIOX AND ADMIXISTKATIOX OF CHIEF SURGEOX'S OFFIC E 193
usually occupied two rooms in some building, preferably where heat, light, and
water were available. During battle, as a rule, they were from five to seven
miles behind the front, often in open fields, by the roadside, in tents, dugouts
or unused buildings.'^ Under combat conditions it was found expedient to
divide the laboratory, the bacteriologist and sufficient personnel being located
with the bulk of the laboratory equipment at one of the field hospitals, preferably
the surgical hospital or one used for evacuation purposes.'^ This part of the
laborator}' supervised the preparation of Dakin's solution and dichloramin-T
and performed general bacteriological and pathological services. The other
part, with the water supply officer and two enlisted men with the necessary
Fk;. 20.— Showing preparations for shipi)in(; portable laboratories from the central Medical Department lahoiatory,
Dijon
equipment, tested for poisons the water supplies in advanced positions, selected
water points, and examined treated water for free chlorine.'^ Facts learned by
this party were promptly reported to the water-supply engineers, who then
supplied the personnel and equipment necessary to produce a satisfactory
drinking water. The water supply officer was charged with purification of this
water if necessary and with successive checks upon it. Chemical analyses that
icciuired the use of standard solutions presented difficulties that could hardly
be overcome in the field, but it was found expedient to test all water sources
for poison during advances. This was readily feasible.'^
Also in training or rest areas the laboratory cooperated in the location of
water sources, determined the quality of their outflow, and performed the chem-
ical and bacteriological tests incident to the control of water service.'^
194
AD:\riXISTRATIOX, AMP:K1CAX EXPP:D1T1()NAKY fokces
No hard and fast rule could be laid down for methods of procedure in
rest areas, trench or open warfare. Methods in one field were not applicable
in another, but when the division was engaged in trench warfare they were
similar to those followed when in a rest or training area. Under the latter
circumstances as much work as possible was placed on a routine basis.
Whether at the front or in training or rest area the value of these units
was clearly demonstrated, for they very materially strengthened the service of
the sanitary inspector. A case of suspected epidemic disease arising in a regi-
ment was immediately reported to the division surgeon and was sent to a field
hospital where cultures were taken and forwarded by courier to the laboratory.'^
If a diphtheria culture was found positive, contacts also were examined within
two hours. The usual routine work arising in field hospitals was handled very
readily by a courier service.'^
The success of laboratory activities was commensurate with the ability of
the unit to maintain close contact with the division surgeon and sanitary
inspector, to adapt itself to field conditions, and to make the most of the limited
facilities at hand.'^
While some of these units did admirable work and were considered indis-
pensable by some division surgeons, a large percentage were unable to function
properly under combat conditions. The principal reason for this failure was
lack of transportation. These laboratories had been included in the tentative
tables of organization formulated for the American Expeditionary Forces, and
adopted in August, 1917, but no transportation had been provided for them at
that time.' For some reason, unknown to the division of laboratories, they were
incorporated in the priority shipment schedule as "mobile laboratories" and as
Services of Supply units.' Several efforts were made to secure transportation
for these formations, and the inclusion of the personnel and their transportation
as divisional units was recommended by the director of laboratories in the proposed
revision of the Tables of Organization, when these were under consideration dur-
ing the summer of 1918. This proposed revision had not been approved on the
date of the declaration of the armistice.' Had even a motor cycle been avail-
able for each of these laboratories there is but little doubt that water discipline
would have been better throughout the division, with a consequent decrease in
the prevalence of typhoid and paratyphoid fevers and dysentery.' Lack of
transportation in a number of cases caused the elimination of these laboratories
as divisional units. '^
In January, 1919, on special request of the division of laboratories, G-4,
general headquarters, directed that one motor cycle with side car be issued to
the divisional laboratory of each division still in France. This transportation
permitted much closer and more satisfactory supervision of chlorination of
water supplies in divisional areas.'
TECHNICAL WORK OF LABORATORIES
Many types of technical laboratory work (e. g., gastric analyses, tumor
diagnoses, etc.) of peace time had little place in the laboratory service of the
American Expeditionary Forces. Instead of these, large numbers of exami-
nations of relatively few ordinary types prevailed, with occasionally a highly
specialized study to meet an emergency.*
ORGAXIZATIOX AND AD]MINISTRATION OF CHIEF SURGEON'S OFFICE 195
The officer in charge of a laboratory assisted the attending medical officer
and the surgeon by making urinalyses, blood-cell examinations, etc., and by
determining the types of bacteria in wounds/ His work was final in the diag-
nosis of many infectious diseases, and for the specific prevention and treatment
of these he cooperated in the administration of vaccines, therapeutic sera,
salvarsan, etc. He was consultant to the epidemiologist concerning the essen-
tial cause of a prevailing disease, the identification of immune carriers, and the
character and extent of water pollutions.* He inspected in large part the
chlorination work of the water-supply service and in some measure the profes-
sional work of attending medical officers by determining at autopsy any error
in diagnosis or treatment.*
The technical work of the laboratory section of the division of laboratories
was so modified by the stages of development in its organization, by the incidence
of epidemics and by active military operations that its history, for present
purposes, is divided roughly into four periods: (a) From the first landing of
troops, June 10, 1917, to November 30, 1917. Toward the latter part of this
period a large number of cases of pneumonia developed. (6) From December
1, 1917, to May 31, 1918. It was during this period that activities of the hos-
pitals of the American Expeditionary Forces began to be actively concerned
with battle casualties, (c) From June 1, 1918, to November 30, 1918, the
period of serious epidemics and of greatest battle activity, during which time
the laboratories generally were concerned largely with enteric disease, influenza,
and wounds, (d) The period of demobilization after December 1, 1918.'^
The first period, that from June 10, 1917, to November 30, 1917, was one of
tentative organization when the laboratories were engaged chiefly with the
clinical pathology and bacteriology incident to ordinary illness and to accidents
in a small body of troops in the services of supply or in training.
On August 28, 1917, the director of laboratories submitted to the chief sur-
geon, A. E. F., certain suggestions concerning autopsies, the rendition of autopsy
protocols, and the scope of the latter, and recommended that a bulletin con-
cerning these matters be issued from the chief surgeon's office. The Wasser-
mann service was begun in September, 1917.'^ In the few laboratories then
operating (4 camp hospital laboratories, 8 base hospital laboratories, and 2 sec-
tion laboratories) a small but important autopsy service was begun. Very
meager data concerning the technical laboratory work of this period are avail-
able, since no monthly reports were made.'^
In the second period, from December 1, 1917, to May 31, 1918, additional
laboratories in 12 camp hospitals, 3 evacuation hospitals, and 10 base hospitals,
as well as the central Medical Department laboratory began to function, and
the organization of the division of laboratories and infectious diseases was com-
pleted, thus greatly increasing the facilities for all types of technical work.''
Early in this period epidemics of pneumonia, diphtheria, scarlet fever, and men-
ingitis among our troops taxed these facilities to their full capacity for routine
clinical and bacteriological examinations.'^ At the end of this period the system
of monthly laboratory reports was begun, but the available information for most
of the period was quite incomplete.'^
196
ADMINISTRATION', AMKIUCAX KXI'KIJITIOXAHV FOKCES
Whoii the German offensive of May 28, 1918, in the Marne area hroufjht
relatively great numbers of American wounded into our hospitals, the Medical
Department was still very greatly undermanned in its laboratory as well as in
its other services.'^ So great was the need for medical attention that in many
organizations all laboratory officers were diverted from laboratory work to the
more direct care of the wounded. From this time until the signing of the
armistice, laboratory officers were never available in half the number necessary
to make the routine technical examinations, while research was, in general,
wholly out of the question.'^ How^ever, laboratory officers succeeded in organ-
i/>ing and developing their laboratories, in doing most of the absolutely essential
clinico-pathologic work, and in meeting emergencies, such as the performance of
large numbers of bacteriological examinations and of autopsies incident either
to battle casualties or to epidemics of enteric diseases, influenza, diphtheria,
meningitis, etc.'^ Until the 8-chest transportable laboratory units became
available, the laboratory work was accomplished with equipment relatively so
inadequate that the results obtained would have been considered practically
impossible by laboratory personnel prior to the war.'^ By November 1 the total
number of laboratories in operation had greatly increased, as shown by Table 4,
the personnel w^as advantageously distributed, and officers had learned to virtu-
ally "make bricks without straw." This third period of the laboratory activi-
ties of the American Expeditionary Forces — i. e., from June 1, 1918, to Novem-
ber 30, 1918 — stands out preeminently as an index of how much may be done
under most difficult conditions.'^
The available information concering the technical work for this period
is fairly good. In May, 1918, a standard form (No. 5) for laboratory reports
to the director of the division of laboratories had been devised and after June,
1918, this report was received monthly from most of the laboratories in opera-
tion in the American Expeditionary Forces. In October, 1918, this form was
revised and improved.'^ This monthly report, which was intended primarily
to supplement the direct supervision from the office of the director of the
division of laboratories, presented sufficient clinical information, concerning
the activities of the hospital under "data for comparison," to enable the
reviewer to determine something of the character and amount of work which
should have been done by the laboratory and the personnel available for its
accomplishment.'^ Activities were divided into six groups among the person-
nel of the laboratory. All attempts to determine the clinical incidence, as of
infectious diseases, were purposely omitted since it w^as believed that these
more properly belonged to special reports of the section of infectious diseases
and other agencies. The number of "positive" examinations in certain dis-
eases was given merely to aid the reviewer in determining whether the clinician
was underusing or overusing the laboratory.'^ For example, a very high
percentage of "positives" usually indicated underuse and a very low percentage
suggested overuse. The careful review of each report immediately upon its
receipt, and, if necessary, its return wath a critical indorsement thereon, did
much to improve the weak points in the service of some laboratories.'"^
The signing of the armistice marked the beginning of the fourth period of
activity of the laboratory service. Many of its officers who had entered from
0R(;AXTZATI0X and administration of chief SURGEON'S OFFICE 197
civil lite lofiuested orders for their return to the United States.'^ These requests
could not well be refused, though the quota of laboratory personnel was still
far below that of any other branch of the medical service.'^ The situation was
aggravated by the fact that at this very time the appearance of typhoid fever
iu a number of organizations rendered necessary extensive bacteriologic exam-
inations; thorough examinations for venereal disease were being conducted
among troops in training areas, and potential danger points, which demanded
increases of local laboratory service, were created by the concentration of
troops in embarkation camps and at base ports. Because of decreased per-
sonnel and of the increased service demanded, much of the technical service
of the laboratory division even in this final period was performed under stress.
Fortunately, however, early in this period the receipt and distribution of labora-
tory supplies had been greatly expedited and this fact, coupled with the transfer
of material from organizations being demobilized, greatly improved the physi-
cal conditions under which the service was rendered.'^
As was inevitable, not all hospitals in the American Expeditionary Forces
were staffed by attending medical or surgical officers well trained in the selection
of cases in which clinico-pathologic examinations might be of assistance; nor
were they all sufficiently trained in interpreting the results of these examinations.
In some instances serious diagnostic errors were made which might have been
prevented by even a urinalysis; in others the laboratory was called upon to
make large numbers of difficult examinations in a search for the specific cause
of a disease which was scarcely even suggested by the symptoms. Personal
supervision by medical and surgical consultants did much to improve the clini-
cal services in this respect but this was obviously inadequate to cover with
sufficient detail the activities of several hundred hospitals. In hospital centers
the assignment of the laboratory officer of the center to the headquarters staff
greatly increased the efficiency of the laboratory service of the center and
promoted its coordination with the other professional services.'^
THE CLINICO-PATHOLOGIC SERVICE
The clinico-pathologic service up to November 30, 1917, constituted the bulk
of the laboratory work, though it was far from large. During this period, there
wore few patients in hospital and, as the troops were mostly in the Services of
Suppl}^ or in training areas, clinicians were able both to study their cases care-
fully and to utilize the laboratory facilities to good advantage. Many of the
cases in hospital during this period were suffering from acute infectious diseases
of respiratory types, though true pneumonias did not reach a high rate until
December. A relatively high venereal rate which occurred in November, 1917,
made necessary many routine laboratory examinations. The laboratory records
for this period, however, are very meager, since regular monthly reports were not
then made.
The clinico-pathologic work for the second period, from December 1, 1917,
to May 31, 1918, was similar to that of the first. The epidemic of pneumonia,
beginning in the fall of 1917, gradually subsided, but a relatively large number
of patients with other diseases, particularly meningitis, scarlet fever, diphtheria,
and measles, were in hospital, and on these patients a large amount of clinico-
198
ADMIXI.STHATIOX, A:\rERICAX EXPEDITION AKY FOKCES
pathologic work of a routine character was necessary. The rehitively high
venereal rate in December, 1917, dropped materially toward the end of this
period.
The total amount of clinico-pathologic work done during the first and second
periods was low in relation to the number of cases in hospital and to the number
of both commissioned and enlisted personnel. This was due to difficulties in
providing accommodations for laboratories, to lack of equipment, to untrained
enlisted personnel, and in some instances to "overtrained" commissioned
personnel. Many of the base hospitals in the American Expeditionary Forces
w^hich first arrived in France were manned on the laboratory side, as
well as in the other professional departments by highly trained specialists.
A number of these had been concerned in their recent civil experience only with
teaching or research and a considerable period elapsed before some of them could
readjust their ideals so as to properly evaluate simple routine clinico-pathologic
examinations, such as those of urine and blood.
For the third period — i. e., from June 1, 1918, to November 30, 1918 — the
records were fairly complete, though during this period the laboratory service
being to the extent of only about 40 per cent of its normal strength, was so
greatly overworked that preparation of detailed reports was very difficult.
During the fourth period following December 1, 1918, a marked decrease
in trained laboratory personnel developed though the continuance of influenza,
the outbreak of numerous small epidemics of typhoid fever, and the more careful
venereal survey of all troops, necessitated a large amount of laboratory work.
It is not the purpose to give here numerical summaries of laboratory work,
how^ever, certain points of interest relative thereto should be mentioned.
Leucocyte counts showed a gradual monthly increase which was not
commensurate with the greatly increased number of patients in hospital, and did
not reach even an approximately proper proportion till February, 1919. This
was most noticeable in the relatively small number of differential counts made
and was probably due to failure of clinical officers to appreciate the importance
of this diagnostic procedure or their failure to insist upon the necessity for such
counts.
Malaria examinations, which reached their highest number in August, 1918,
w^ere notable for their rarity though they probably covered the necessary field
more completely than any other laboratory procedure.
Examinations of feces for parasites and ova and for entameba were
altogether too few. There was little time for these during periods of great stress
but during the fourth period they might have been more numerous. It is
unfortunately true, however, that laboratory personnel properly trained in the
technique of these examinations was seriously lacking. There was a sudden
increase in the number of examinations for intestinal parasites in August, 1918,
which continued until November of that year.
Urine examinations were fairly numerous, but their distribution and quahty
were very irregular. In many hospitals the specimens were intelligently selec-
ted, properly collected, and carefully examined. In some, this w^as not the
case. In others very few such examinations were made.'^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 199
In examinations of sputum for tubercle bacilli, as well as in those of urine,
relaxation in thoroughness w as prone to occur. Specimens which the labora-
tory officer knew were not intelligently selected or collected were apt to be
superficially examined, thus rendering negative reports of little value. In
some hospitals as many as four or five hundred specimens were examined
with only four or five "positives" reported. It is true that these were intended
as controls in cases of recovery from influenza and pneumonia, but it was
suspected that in many instances the lack of care in the collection of sputum
and the hasty search for bacilli made the negative findings of relatively little
value. The number of examinations of sputum for tubercle bacilli gradually
increased reaching their highest point in January, 1919.^^
The number of examinations for gastric contents was relatively small
in comparison with such as would have been necessary for an equal number
of patients in civil hospitals. Most of the military patients being young,
robust, and subject only to wounds and acute diseases, there was little neces-
sity for the examination of gastric contents with a view of reaching a diagnosis
of gastric ulcer or cancer.'^
In addition to the chemical laboratory tests which were made in most
suspected cases of this character, great reliance was placed upon roentgenology.'^
The occurrence of sporadic cases of true epidemic meningitis at widely
separated points in the American Expeditionary Forces, kept the whole Medical
Department on the alert. While it can not be demonstrated beyond per-
ad venture that had no measures been taken, serious epidemics of meningitis
would have developed, yet it is probable that the early accurate diagnosis
and the vigorous methods instituted in most instances immediately on the
development of a single case, served in large measure to prevent epidemics.'^
In this service the laboratory officer rendered inestimable assistance to the
attending medical officer.'^
Smears for gonococci showed a gradual monthly increase though not
reaching a considerable proportion until February, 1919.'^
Dark field examinations for Treponema 'pallida were considerably though
not sufficiently increased after the armistice began. It was difficult to find
enough officers to make the large number of necessary dark field examinations
in a competent manner.'^
Except in the few instances noted above, the general quahty of the clinico-
pathologic examinations was good. A large number of clinicians had been
trained in civil practice to expect and more or less intelligently to interpret
these examinations. This counteracted the tendency on the part of some
laboratory officers to relegate this work to untrained personnel.''^
Up to November 30, 1917, very few post-mortems were made in the American
Expeditionary Forces. The chnical service before that date was very light,
the attending medical officers and surgeons had time to study their cases
with great care, and thus the necessity for a post-mortem examination of
tlie few cases that died was not very apparent.'^ Of the post-mortems that
were made, the records either were incomplete or in some instances lost,
so that but 14 protocols for this period — representing about one-fourth of
the deaths — were received in the offices of the director of the division of lab-
200
ADMIXISTEATION, AMKRICAX KXJ'KDITIOXAKV FOHCES
oratories. Most of these autopsies were made at Army laboratory Xo. 1,
Naval Base Hospital No. 1, and Camp Hospital No. 33.'"
During the period from December 1, 1917, to May 31, 1918, the number
of autopsies increased in May to 57 per cent of the total number of deaths
in hospital. This was due in part to the fact that on April 2 Circular No. 17,
(q. V. in the Appendix) was issued from the chief surgeon's office.'^
By the end of May, 1918, there were in the American Expeditionary
Forces laboratories serving 25 base hospitals, 8 evacuation hospitals, 32 camp
hospitals, 4 Red Cross hospitals, and 1 mobile hospital, besides Army lab-
oratory No. 1, the central Medical Department laboratory, and the base
laboratory of the intermediate section, or a total of 70 hospitals and 72
laboratories, in addition to those pertaining to divisions.'^
Less than 15 pathologists in the American Expeditionary Forces were then
capable of making post mortems and intelligently interpreting the results.
This condition was due in part to the long neglect of the autopsy service in
many civil institutions in the United States with inevitable reduction in the
number of pathologists, and in part to the overshadowing status of bacteriology
in military laboratories.^^ The autopsy service had not been established as a
routine procedure in the xVrmy but on the contrary, autopsies were made only
on the written authority of the commanding officer of a hospital. However,
in the American Expeditionary Forces the need of a routine autopsy service
amounting in fact to a professional inspection of the diagnostic and thera-
peutic measures of officers engaged in clinical service, rapidly became apparent
during the summer of 1918. Surgeons were called upon with little time for
study or reflection to diagnose and treat enormous numbers of gunshot wounds
with which they had had little or no previous experience. Even those who
were well grounded in the general principles of surgery were forced to make
decisions and institute treatment thereon without sufficient opportunity for
study. As a result, there were many errors in diagnosis and corresponding
errors in treatment. The worst of these could be determined only by the
pathologist. Likewise, medical officers attending cases of gas poisoning,
influenza, and pneumonia were confronted by conditions with which they
were totally unfamiliar, and frequently were forced to make diagnoses and to
institute treatment with a very meager knowledge of the facts. Here autop-
sies proved of tremendous importance for they afforded knowledge of patho-
logic 'lesions which the physicians treating the case could use in their subse-
quent diagnoses and treatment. When, in the fall of 1918, and in the follow-
ing winter, numerous isolated epidemics of typhoid fever began to appear,
the symptons and physical signs, in many instances, were so obscure that the
clinicians failed to make proper diagnoses and the pathologist was the first
to recognize the true nature of the disease on the autopsy table.
The director of the division of laboratories, in June, 1918, requested that
10 competent pathologists be cabled for from the United States, in addition
to those coming over with hospital organizations.'^ These 10 pathologists
arrived in due time and assisted materially in improving this service. The
activities in forward areas were now covered to better advantage bv dividing
the territory into sectors and placing at Baccarat, Toul, Souilly, and Paris,
OHGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 201
respoctivoly, coinpetent pathologists attached to an evacuation or base hospi-
tal, with orders to act as consultants in their specialty for the surrounding
areas. '•'^ In addition to these measures, the importance of autopsies was
brought to the attention of laboratory officers and commanding officers of
hospital organizations by inspectors from the division of laboratories, by
letters, and by indorsements on monthly reports. As a result, the autopsy
service rapidly improved, though there were never sufficient competent pathol-
ogists in the American Expeditionary Forces to cover the needs at all points.
There were not more than 50 or 60 pathologists among the 685 medical officers
in the laboratory service when the armistice was signed, but the service had
so increased during the summer and early fall of 1918, that autopsies were
performed on 95 per cent of all deaths in hospital. In October the total number
of autopsies reached 8,896.'^ This was but 85 per cent of the deaths then
occurring in hospitals for the autopsy service like every other was overwhelmed
by the enormous number of deaths from influenza and by the battle casualties
of the Meuse-Argonne operation.
The greatest nuinber of deaths occurred in the base hospitals. After
July, 1918, many more autopsies were done in camp hospitals than in evacua-
tion and mobile hospitals for they not only were more numerous but many of
them actually functioned as base hospitals. An attempt was made to study
hattle casualties, particularly gas poisoning, by centrally located laboratory
officers who could be concentrated by the use of motor transportation at any
point where casualties occurred. This plan, which was then employed in the
i^'rench service, usually failed because of lack of transportation.'^
Pearly in July the recording and cross indexing of autopsy protocols was
l)egun in the office of the director of division of laboratories, but inadequate
assistance rendered progress in this direction very slow.'^
After the signing of the armistice, the release from duty elsewhere of a few
competent pathologists made it possible to place the analysis of the autopsy
protocols concerning a few diseases, on a better basis. In order to facilitate
this work in the central laboratory and to obtain the benefit of the review
by the competent pathologists scattered throughout the American Expe-
ditionary Forces, three office letters concerning, respectively, influenza and
pneumonia, gunshot injuries, and war-gas poisoning w^ere sent out to laboratory
officers selected because of their ability and experience.'^ These office letters
gave forms for the analysis by the laboratory officer of all cases coming to
autopsy under his individual observation. On the receipt of these analyses
in the office of the director of laboratories they were compiled and coordinated
with one another and with scattered protocols from other laboratories. Two
other compilations were undertaken, one on typhoid fever and another on
tuberculosis. In addition to these, however, the other autopsy protocols con-
tained a wealth of data for further study on a number of subjects; e. g., men-
ingitis, dysenteries, and cardiovascular lesions.'^
One field of post-mortem examinations which might have yielded invaluable
results from the purely military standpoint was entered by but one pathologist
in tiie American Expeditionary Forces. This was the examinations of the
hodies of soldiers killed in battle.'^ This service did not necessitate the making
202
ad:mixistratiox, American expeditionary forces
of autopsies, but was limited to a study of the site and character of iinnieduitely
fatal injuries by a medical officer who had a good knowledge of anatomy and
some appreciation of the character and effects of missiles.'^
KEFERENCES
(1) Report from Col. J. F. Siler, M. C, director of laboratories and infectious diseases,
A. E. F., to chief surgeon, A. E. F. (undated), on the activities of division of labora-
tories and infectious diseases, from August, 1917, to July, 1919. On file. Historical
Division, S. G. O.
(2) Report on the Medical Department activities of base section No. 5, A. E. F., undatefl,
made by the surgeon, base section No. 5. On file. Historical Division, S. G. O.
(3) Report on the Medical Department activities of Camp Hospital No. 33, by First Lieut.
George R. Cowgill, S. C. On file. Historical Division, S. G. O.
(4) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file. Historical Division, S. G. O.
(5) Report on the laboratory service of hospital centers in converted permanent buildings,
undated, by Maj. Harrison S. Maitland, M. C. On file. Historical Division, S. G. 0.
(6) Report of hospital center at Mesves, undated, prepared under the supervision of the
commanding officer of the center (not dated or signed). On file, Historical Division,
S. G. O.
(7) Report on the activities of the laboratory. Base Hospital No. 27, A. E. F., January 20,
1919, by the officer in charge of the laboratory. On file. Historical Division, S. G. 0.
(8) Report of laboratory of Camp Hospital No. 15, A. E. F., April 1, 1919, by Capt. M. L.
Holm, M. C. On file. Historical Division, S. G. O.
(9) Report on the laboratory situation in Third Army, by Lieut. Col. W. M. L. Copliii,
M. C, March 18, 1919. On file. Historical Division, S. G. O.
(10) Report on mobile laboratories, A. E. F., undated, by Capt. C. O. Rinder, M. C. On
file. Historical Division, S. G. O.
(11) Report on the laboratory service of the evacuation hospital, January 3, 1920, by Maj.
Arthur U. Desjardine, M. C. On file, Historical Division, S. G. O.
(12) Report on the laboratory work of Mobile Hospital No. 1, A. E. F., by Capt. A. A.
Johnson, M. C, officer in charge of laboratory, January 1, 1919. On file. Historical
Division, S. G. O.
(13) Report on the laboratory work of Mobile Hospital No. 39, January 2, 1919, by First
Lieut. William S. Keister, M. C. On file, Historical Division, S. G. O.
(14) Report on the laboratory service of divisional laboratories, A. E. F., undated, by Capt .
Lucius A. Fritze, M. C. On file. Historical Division, S. G. O.
(15) Report on the pathological service, division of sanitation and inspection, American
Expeditionary Forces, undated, by Colonel Louis B. Wilson, M. C. On file. His-
torical Division, S. G. O.
(16) Letter from directer of U. S. Army Laboratory No. 1, to the chief surgeon, A. E. F.,
August 28, 1917. Subject: Post-mortem examinations. On file, A. G. O., World
War Division, chief surgeon's files (321.630).
CHAPTER XIT
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
SECTION OF INFECTIOUS DISEASES; SECTION OF WOUND BACTERIOLOGY
SECTION OF INFECTIOUS DISEASES
In November, 1917, the director of laboratories planned the organization
of a subdivision to be called the "subdivision of infectious diseases." It was
proposed that this work be placed under the direction of an assistant director
of laboratories, who should act as general advisor to the chief surgeon, A. E. F.,
in all matters pertaining to communicable disease.^ The officer assigned to
this position on December 1, 1917,- had begun the organization and formula-
tion of plans of procedure when, in the following month, he was assigned to
the trench fever commission. Thereafter, until midsummer of 1918, he was
unable to take an active part in the subdivision of infectious diseases, but being
frequently consulted by letter and by personal interview, offered many helpful
suggestions.^ In February, 1918, another officer was appointed assistant
director in charge of the section of infectious diseases, and with the cooperation
of the first incumbent, perfected the organization of the section.^
FUNCTIONS
The functions of this section were outlined as follows : ^
The function of the subdivision of infectious diseases is to provide an instrument for
tlie prompt epidemiological and bacteriological investigation of transmissible diseases among
troops of the American Expeditionary Forces. It constitutes, therefore, direct liaison
between the division of sanitation and inspection and the laboratories, and is grouped with
the latter only because its activities require the occasional mobilization of laboratory facili-
ties and because its personnel should be capable of directing on the spot any laboratory
work which the thorough study of any given situation may require. While operating from
the laboratories as bases, therefore, this subdivision constitutes actually a part of the machin-
ery of sanitation.
The duties of the subdivision of infectious diseases consist in:
1. Epidemiological and laboratory studies of outbreaks of transmissible diseases in the
American Expeditionary Forces, having as primary purposes the discovery of source of out-
break, its mode of dissemination, and its control.
2. The study and organization of new prophylactic measures.
3. The investigation of special problems which may arise in connection with the control
of epidemics.
4. The inspection of laboratories in so far as their diagnostic work, carrier examination,
and epidemiological work are concerned.
5. The organization of mobile laboratories for epidemiological work in base sections.
6. The preparation of circulars and literature concerning infectious disease for submission
to the chief of the division of sanitation and inspection, laboratory, and infectious diseases.
7. Advisory cooperation with the various sanitary and medical authorites in the hospi-
talization and isolation of infectious diseases.
Organization. — There will be a central office of this subdivision at the central Medical
Department laboratories, A. P. O. No. 721, American Expeditionary Forces, which will be in
cliarge of officers delegated to this work by the director of laboratories.
203
204
ADMIN ISTHATIO.V. AMKHICAX KXI'EI)IT1()^ AK^' FOHCK.S
The activities of this office will iiichicle:
(a) The selection of personnel to carry on tiio work of the sul)(li\ i>i()ii.
(h) The supervision of the work of tliis personnel w lienever necessary in a given oiit-
lireak.
(c) Periodical inspection of the laboratories of the front area in regard to their work on
infectious diseases, and similar inspect on of other laboratories of the American Expeditionary
Forces when so instructed by the director of laboratories.
{d) The maintenance at the central medical laboratories of records of the activities uf
this subdivision.
(e) The study of special problems tliat may arise in connection with transmissible disea.M'.
(/) In the advance section and zone of the advance, the officers assigned to the work will
keep in constant touch with the incidence of infectious disease and personally investigate any
focus which seems to them or to local authorities to call for investigation. They will personally
undertake similar investigations in the base sections when instructed to do so.
There will be assigned to the base laboratory in each base area and to each army labora-
tory an officer who is ready to carry out similar work in his respective area at the direction of
the division of sanitation, inspection, laboratories, and infectious diseases. He wall be ready
to proceed to any point in the base section when notified by the chief surgeon of the section
to do so. His orders will come through the commanding officer of the base laboratory to whom
he will be responsible for the proper performance of the laboratory work and the return of the
property he may take with him. He will take with him from the base laboratory a mobile
laboratory car or any material and personnel he may lequire for the particular work to b(
done. If, in the opinion of the authorities concerned, any situation becomes sufficient!}
grave to require advisory cooperation of the officers in charge of infectious diseases at tlu
central medical laboratories, a telegraphic request will be made on the central medical labora-
tory and the director of laboritories will send one of the officers in charge of the sul)division
of infectious diseases to the point where advice is needed.
In the advance section and zone of the advance similar liersonnel will be assigned for
similar purposes to the Army laboratories. But in addition to this, these areas being directly
accessible to the central medical laboratories, the officers assigned as assistant directors for
infectious diseases will keep in constant touch with infectious disease occurring in these areas
and proceed without further orders to any point where infectious disease is reported, in
order to investigate whether further study, segregation, etc., is needed.
Suggested mode of procedure. — When the occurrence of cases seems to call for the detailed
study of local conditions, orders will be issued to the officer stationed at the respective base
laboratory who will proceed to the station indicated. On arrival, he will report, to the local
chief surgeon and will familiarize himself with local laboratory facilities and arrange cooper-
ation with local laboratory personnel. He will consult local sanitary officers and obtain a
careful liistory of the outbreak from its beginning, will visit commands and quarters from
which cases have been taken, make spot maps of occurrence, trace contacts, and investigate
relations of case to case. He will study relations of outbreak to w^ater and food supply and
will proceed to organize and carry out any laboratory work or serum tests necessary to eluci-
date the situation and control the disease.
In consultation with local medical authorities he will inaugurate sanitary measures
aimed at control of the disease and on completion of the work will submit a report, incor-
porating specific recommendations. A duplicate copy of this will he sent to the chief of the
division of sanitation and inspection, laboratories, and infectious diseases. One copy will
l;e left with local chief surgeon, and one will be retained as a record of the subdivision of
infectious diseases.
In the advance section and zone of the advance, the officers in charge of the subdivision
of infectious diseases will supplement this system by visiting as promptly as possible all
locations where infectious disease is occurring, and determine by personal investigation whether
the situation requires special study.
The duties of this section as finally prescribed were published in Circular
No. 40, chief surgeon's office, July 20, 1918. (See Appendix, p. 958.)
ORGANIZATION AND AUIM INISTEATION OF CHIEF SUEGEON'S OFFICE 205
It was not proposed that this section would engage in research, except in
so far as the study and suppression of outbrealvs of disease necessitated. Its
primary purpose was the early discovery of foci of infection, the prompt tracing
of cases to the point of their infection, and the suppression of diseases traced in
this manner before they could reach epidemic proportions.^
Though the foregoing plans had been formulated for the development of
this section of the director's office, no personnel was at first available to carry
these into effect.* Such outbreaks of epidemic diseases as did occur were in-
vestigated by field parties sent out from Army laboratory No. 1 at Neufchateau.*
Only four divisions were in France at the end of December, 1917, and the only
epidemic diseases requiring investigation by this section were small outbreaks
of meningitis, diphtheria, scarlet fever, influenza, and pneumonia.* Water sup-
])ly surveys were carried out in very considerable portion of the then existing
divisional training areas by field parties from Army laboratorj^ No. 1, and it
became evident, from these early surveys, that approximateh^ 85 per cent of
the water for drinking purposes was contaminated. This initial estimate of
the water-supply situation in France was confirmed by surveys at a later date.*
All matters relating to transmissible disease were referred to the section
of infectious diseases, for it was concerned mainly in the investigation of epi-
demics, development of the organization for their control and prevention
throughout the American Expeditionary Forces, the preparation of bulletins
relating to prevention and control of transmissible diseases, the standardization
of methods for combating them, and standardization of the use of therapeutic
sera which were of value in this w^ork.* Reserve personnel for the investigation
of epidemics was attached to the central Medical Department laboratory at
Dijon, and most of the investigations of epidemics conducted under the control
of the director of laboratories and infectious diseases w^ere prosecuted in coopera-
tion with and under the direct supervision of the commanding officer, central
Medical Department laboratory.* The duties assigned to the division of labora-
tories and infectious diseases by Circular No. 40, chief surgeon's office, and the
memorandum quoted above, indicate how closely the central laboratory and
the section of infectious diseases were associated.* In April, 1918, preliminary
steps were taken to coordinate the central office of the section of infectious
diseases with those engaged in similar service in the several administrative sec-
tions of the Services of Supply.*
Because of rapidity with which American troops arrived and of the large
territory over which they were distributed, decentralization of the epidemiolog-
ical service became necessary for proper supervision and prompt action.^ In
the original plan it had been contemplated that a standard uniform method of
control throughout the American Expeditionary Forces would be adopted and
that a selected and trained officer qualified to make epidemiologic and bacteri-
ologic studies of outbreaks of infectious diseases w^ould be stationed in every
section of the Services of Supply. Each section epidemiologist was to have
available a main laboratory adequately equipped for the performance of any
diagnostic or other laboratory work. It was expected that this officer ordi-
narily would handle problems arising in his section but that in emergencies he
would obtain extra personnel and equipment from the director of laboratories
206
ADMINISTRATION, A^[ERK'AN EXPEDITIONARY FORCES
and infectious diseases.^ Later, after conferences with medical representatives
from the various administrative sections of the Services of Supply, and after
receipt of their replies to a circular letter sent them concerning the adoj)tion
of methods for control of infectious diseases, a somewhat different plan for the
organization of epidemiologic service in these sections was formulated.' This
plan, which was generally adopted, with some variations to meet particular
local problems, provided that the several sections of the Services of Supply
would solve their respective problems.' However, in each section an epidemi-
ological service with laboratory facilities was established, and though each such
epidemiological service operated more or less independently of the central
administration of the division of laboratories and infectious diseases, it called
upon the central laboratory for advice, personnel, and material, w^henevcr
needed, and was in constant communication with it.'
Also it had been planned that in the advance section and zone of the armies
the epidemiologic w^ork would be centralized at the office of the director of labora-
tories and infectious diseases, that through the office of the respective chief
surgeon, the director would be kept constantly informed concerning the inci-
dence and location of infectious diseases, and that he would have sufficient
personnel and mobile laboratory equipment immediately to give assistance
where necessary.^ In point of fact the control of infectious diseases among
troops in the army zone remained under the direct supervision of the director
of laboratories until the later summer months of 1918.'
Arrangements for the prevention and control of epidemics among the troops
in the zone of the armies utilized and expanded resources and methods already
provided by Tables of Organization.^ The division sanitary inspector, as assist-
ant to the division surgeon was, as theretofore, primarily responsible for the
health of the division. He attended to all ordinary matters affecting sanita-
tion in which duty he was assisted by two officers previously not provided in
our service, viz, the laboratory and water supply officers.^ The divisional
laboratory officer w^as in charge of a small laboratory equipped for clinical pathol-
ogy but inadequate for extensive cultural work; the divisional sanitary
inspector of water, who had had some training in general bacteriology, per-
formed examination of water supplies.^ As soon as resources of personnel
permitted, these officers, intended for these positions, were given an intensive
course of training at the central laboratory at Dijon, before they were assigned
to divisions.^
Some divisions came to France without laboratory officers, but they were
furnished them after arrival from personnel assembled and equipped by the
section of infectious diseases.'
It was intended that the divisional laboratory officer should act not only
as a technical laboratory worker for the division but should assist, the sanitary
inspector in making epidemiologic surveys and sanitary inspections.' It may
be said, in passing, that in many cases this could not be effected because of the
lack of transportation.' This divisional organization was cjuite adequate
under ordinary circumstances to deal with conditions that threatened the
health of the troops, but because of insufficient laboratory equipment and
shortage of personnel, it was necessary in any considerable outbreak of com-
municable disease to send reenforcements.'
ORGANIZATION AND ADMINISTEATIOX OF CHIEF SURGEON'S OFFICE 207
The duties of the division sanitary inspector of water were reduced to their
simplest forms. He supervised the chlorination of drinking water in the division,
gave appropriate instructions, kept in touch with any water problems that
arose, and constantly reported concerning the purification apparatus available.^
Laboratories adequately equipped for the examination of all water supplies
were not available for issue to the divisions.^
Because of insufficient personnel and laboratory equipment in a division
wherewith to combat epidemics, Bulletin No. 32, G. H. Q., A. E. F., May 27,
1918, was issued, which provided that such resources could promptly be aug-
mented whether troops were in the lines or in training areas. This bulletin
authorized an army or division surgeon to communicate in emergencies directly
with the director of laboratories and to request assistance; the director of
laboratories was authorized to send such personnel and equipment as might be
necessary, and to cooperate to the extent of his resources.
The section of infectious diseases was active throughout the advance
section and assisted in the control of outbreaks of diphtheria, scarlet fever,
measles, meningitis, influenza, and diarrhea, employing in this service additional
laboratory personnel and equipment; e. g. mobile laboratory cars, constructed
and completely equipped according to the English plan (with some modifica-
tions) for the investigation of such epidemics as might arise. ^ Usually they
were manned by one commissioned officer, a driver and a technician, dispatched
on telegraphic requests either from the central Medical Department laboratory
at Dijon or from Army laboratory No. 1, at Neufchateau (where one of these
cars was stationed), according to the area from which the request was received.^
Sometimes the local laboratories of base or evacuation hospitals were utilized,
and additional resources were dispatched in response to telegrams to the director
of laboratories at Dijon. ^
To further meet the requirements of field investigations of outbreaks of
epidemic disease the laboratory service began, about April, 1918, to assign to
duty at the central Medical Department laboratory special, well-trained medi-
cal officers whose primary duty was the direction of field parties engaged in the
investigation of epidemics."^ Usually there were from two to four such officers
engaged in activities of this character. There were also mobilized at the
central laboratory for use by these parties several special laboratory units
consisting of equipment packed in chests and two of the motor laboratories
mentioned above.*
Laboratory methods securing early diagnosis, detection of carriers, and
practical measures of control of infectious diseases were standardized and put
into general operation.^
In July, 1918, American troops actively engaged in the Chateau-Thierry
sector suffered very extensively from diarrheas and dysenteries.^ During the
period from July to November, 1918, the activities of this section were greatly
decentralized so that by November its functions were mainly those of adviser
to the chief surgeon's office in general policies relating to the prevention and
control of transmissible diseases.*
13901—27 14
208
ADMINISTRATION, AMERICAN EXPP:DITIC)NAR V FC)Rr?:S
Meanwhile decentralization had continued so that tlie several adminis-
trative sections of the Services of Supply were relatively independent of centnil
supervision and in each a special base laboratory had been established.'
As American troops concentrated in the advance section and in the zone
of the Army, and more and more divisions began to participate actively in
combat, other daughter organizations w^ere split off from the central office of
the section of infectious diseases, to serve the several corps or armies.' It was
decided, as the result of experiment, that these organizations should belonfr
to armies rather than to corps.' Therefore a sanitary inspector was assigned
to the Second Army and a system similar to that in the administrative sections
of the Services of Supply w^as put in operation but modified to suit moving
troops. In consequence, the sanitary organization of an army also became
largely independent, (except for personnel and laboratory supplies) of the
central office.' When the Third Army was organized, for the occupation of
the American sector on the Rhine, a sanitary division was created, as part
of the office of the army surgeon.' The duties of the section of infectious
diseases in so far as the Third Army was concerned, pertained especially to
coordination, supervision, inspection, advice, and provision of personnel and
equipment.'
As a result of this sectional organization, with trained men in definite areas
or assigned to service of bodies of troops, and the aid of mobile laboratories, it
w^as possible to render prompt assistance, make surveys for carriers, correct
sanitary defects, and materially aid in the prevention and suppression of epi-
demics.^ Numerous investigations w^ere made of outbreaks of measles, menin-
gitis, influenza, pneumonia, diarrhea and dysentery, typhoid and paratyphoid
fevers, scarlet fever, diphtheria, and similar diseases. The sources w^ere sought
out and recommendations for their control made.
Concurrent with the development of its field service the section of infectious
diseases prepared circulars pertaining to control of infectious disease, and con-
ducted instructional work.' This latter activity which at first was limited to
consultations with laboratory officers intended for assignment to divisions,
developed into a course of instruction in carrier investigation and other technique
needed in field work concerning communicable diseases and the supervision of
drinking water.'
When the armies had been organized with epidemiological facilities this
service, for all the larger units of the American Expeditionary Forces, had become
decentralized.' Thereafter the duties of the section of infectious diseases were
more of a supervisory and advisory character than those of actual participation
in the solution of problems, as they had been formerly.'
The section of infectious diseases continued to act as adviser of the chief
surgeon, A. E. F., in the formulation of broad policies of sanitation, and in the
circularization of information relative thereto, until it was abolished.' Its
activities were absorbed into the chief surgeon's office after headquarters of the
division of laboratories moved to Tours in June of 1919.'
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 209
SECTION OF WOUND BACTERIOLOGY
After a study of bacteriologic investigation of war wounds as conducted by
our allies, and a survey of the organization employed for this purpose, at La Panne,
liouieuse, Epernay, and Chalons, a section charged with the supervision and
correlation of such work in the American Expeditionary Forces was established
in the division of laboratories in March, 1918. Its purpose was to be the dis-
semination of information on this subject and the determination of the circum-
stances under which a delayed primary or secondary suture of a wound might
best be performed. Secondary and delayed primary closure were being practiced
among our allies only after laboratory findings indicated the advisability of
such practice and the provision of personnel and equipment for obtaining similar
findings in the American Expeditionary Forces was deemed advisable.^
The scientific value of the examination of war wounds was subordinated to
practical needs in the organization of this section, for few statistical data appar-
ently were being collected by the laboratories of our allies where research work
was being conducted. The prime services rendered by this section were assist-
ance to surgeons who had not had much experience in treatment of war wounds,
the provision of a control which would complement professional acumen of the
more experienced surgeons, and, in time of stress, would relieve them of making
close studies which otherwise would have been necessitated clinically.®
It was planned that a trained wound bacteriologist and an assistant would
be assigned to each mobile, evacuation, and base hospital, and that this person-
nel would be increased as resources in general laboratory personnel permitted.
This additional personnel was to be organized in teams which were to be trans-
ferred as required. The entire service of wound bacteriology was to be under
tiie control of an assistant to the director of laboratories, who was to provide,
train, and distribute these specialists, supervise their activities and conduct
appropriate research.® It was planned that a statistical bureau would collect
(hita concerning the bacteriology of war wounds from all hospitals in the
American Expeditionary Forces and that an agency which would distribute
literature on this subject would also be established. Studies at the central
hiboratory were to supplement those in the several hospitals and the central
laboratory was to prepare and distribute media and reagents both in order
to lessen the work of the laboratories at the front and in order to standardize
materials. Such research as was to be conducted was to be of immediate
practical value.®
But these plans did not fully materialize: The paucity of officers did not
permit the formation of teams as planned; lack of transportation prevented the
central laboratory renewing prepared media, ingredients for media being sub-
stituted therefore.
Oflicers who, in their replies to a questionnaire, were found to have the
necessary training in general bacteriology were ordered to the central laboratory
at Dijon where they were given an intensive course in wound bacteriology. This
c()nii)rised laboratory instruction, autopsy demonstrations, and a certain
amount of training at the bedside. Classes consisted of about 20 officers, whose
course of training lasted two weeks. The number instructed at the central
Medical Department laboratory totaled 134.®
210
ADMINISTRATION, AMERICAN KXPEDITIONARY FORCES
A few officers were trained at other points, viz, 7 at Epernay, 0 at Aut(j-
chir No. 21, 7 at Evacuation Hospital No. 1, and 4 in hospitals belonging to
the Allies. When the armistice was signed, officers trained in wound bacteri-
ology were assigned to all evacuation, mobile and base hospitals except the most
recent arrivals and a few of the hospitals serving at hospital centers. The
number of wound bacteriologists thus assigned were as follows:'' Evacuation
hospitals, 16; mobile hospitals, 13; Red Cross military hospitals, 10: base
hospitals operating separately, 18; base hospitals in hospital centers, 66.
Though there was inadequate time to work it out, the plan was to provide
one officer trained in wound bacteriology for each 500 surgical beds and recall
from time to time officers already instructed to receive further instruction in
newer methods and to discuss their several problems, administrative and
professional.^
The most difficult problem experienced by this section was the preparation
of records and the collection of statistical and other data. Two blank forms
were devised, one relatively very brief for use in periods of stress, the other
more thorough, to be used in periods of relative quiet, but only a relatively
small number of organizations found it possible to collect fairly complete
records.^
A monthly statistical report form was also called for but this wag utilized
by only a small number of organizations. These units, however, went far
toward collecting the information desired.*'
Special investigations concerning gas gangrene, the use of antigas gan-
grene and antitetanic sera, and the possible infection of wounds by attendants
were undertaken. Research seeking the recovery and identification of organ-
isms concerned in wound infection and the value of certain smears and indi-
cators was also undertaken at the central laboratory.*'
On October 29, 1918, the head of this service reported as follows to the
director of laboratories : ^
At present the central organization of the section of wound bacteriology is still under-
manned. While an adequate number (considering the number of laboratory officers in the
American Expeditionary Forces and the needs of other sections of this division) of wound
bacteriologists for service in the field is now available, the administrative force in the central
office is inadequate properly to control the work of the officers in the field, to analyze and
arrange the statistical evidence which is rapidly accumulating, and finally to verify the
identification of bacterial species recovered from important cases.
The most important single need of this section is an officer with consideraljle laboratory
experience whose duty it will be to make frequent inspections of all the laboratory units
engaged in the bacteriologic study of war wounds with a view of determining the efiiciency
of the workers in this field, of raising the standards of the work done by correcting obvious
defects and stimulating enthusiasms for this particular work, both among the laboratory
officers and among those engaged in the surgical care of the wounded, and finally of collect-
ing data which might serve as a basis for the improvement of the service. The rapid
increase in the number of hospital organizations in the American Expeditionary Forces and
the extent of the area which they occupy makes such additional assistance necessary.
Two additional officers to conduct research concerning the bacteria found
in wounds, an officer to analyze reports received, and two file and record clerks
for headquarters were also required. These needs were obviated by the
declaration of the armistice on November 11 and the section as such sub-
mitted its final comprehensive report on December 4, 1918.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 211
REFERENCES
(Ij Report on general plan, organization, and development of the section of communicable
diseases, A. E. F. (undated), by Lieut. Col. Hans Zinsser, M. C. On file, Hi.storical
Division, S. G. O.
(2j Letter from The Adjutant General of the Armj- to Lieut. Col. Richard P. Strong, C,
December 1, 1917. Subject: Appointment as assistant director of laboratories. On
file, A. G. O., World War Division, chief surgeon's files, 201 (Strong, Richard P.).
(3) Report on division of laboratories and infectious diseases, subdivision of infectious dis-
eases, A. E. F. (undated), by Lieut. Col. Hans Zinsser, M. C. On file, Hi.storical
Division, S. G. O.
(4) Report from Col. J. F. Siler, director of the division of laboratories and infectious dis-
eases, to the chief surgeon, A. E. F. (undated). Subject: Activities of the division
of laboratories and infectious diseases, from August, 1917, to Juh', 1919. On file,
Historical Division, S. G. O.
(5) Report from the chief surgeon, A. E. F., to The Surgeon General, L^. S. Army, May 1,
1919. Subject: Activities of thechief surgeon's office, A. E. F., to May 1,1919.. On
file, Historical Division, S. G. O.
<6j Report on the section of wound bacteriology, A. E. F., December 4, 1918, by Lieut.
Col. William J. Elser, M. C. On file, Historical Division, S. G. O.
CHAPTER XIII
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
SECTION OF WATER SUPPLIES; SECTION OF FOOD AND NUTRITION; MUSEUM
AND ART SECTION; LABORATORY OF SURGICAL RESEARCH
SECTION OF WATER SUPPLIES
The entire question of water supply and purification in the American
Expeditionary Forces is dealt with in Volume VI of this history. Therein
i-cference is made to the fact that stationary laboratories were established in the
Services of Supply, A. E. F., for water analysis in certain Medical Department
genei"al laboratories. One of these laboratories was the central Medical Depart-
niont laboratory at Dijon. ^
In addition to water analysis, a subject which is outside the scope of the
I)resent chapter, the necessity existed for supervising water supply activities in
the zone of the advance, not otherwise cared for by the water supply service,
A. E. F. This supervision centered in the central Medical Department labora-
tory at Dijon. Until the latter part of September, 1918 (except for a short
period that is referred to below), the water supply activities of the division of
laboratories were supervised by the section of infectious diseases.^ It was
during May, 1918, that efforts were made to organize a definite section in the
central laboratory for coordinating water supply. Such a section was estab-
lished and charged with the coordination of Medical Department activities
pertaining to water supplies in the zone of the advance. However, since the
officer then assigned to the section was retained therein only a short time, it
was not until the following early fall that water supply work of the Medical
Department in the zone of the advance was definitely coordinated.^
On September 27, 1918, an officer of the Sanitary Corps, expert as regards
water supply and analysis, was assigned to organize a section of the central
laboratory having to do with control of such water supplies in the zone of the
advance as come within the province of the Medical Department.^ Thereafter,
that section was engaged in the supervision of water surveys in all training
areas in the Advance Section, the assignment of proper Medical Department
personnel, the instruction of divisional personnel in water survey work, including
control of chlorination of water supplies, and coordination with the officer in
charge of the laboratories in the water supply service.^ The chief of the water
supply section in the division of laboratories and infectious diseases was the
representative of the Medical Department, in its liaison with the water supply
service, A. E. F. made; plans pertaining to Medical Department activities con-
nected therewith, and distributed the laboratory facilities which were made
available for water analyses.-
214
ADMINISTRATION, AMERICAN EXPEDITIONARY FOHCES
SECTION OF FOOD AND NUTRITION
In August, 1917, there was organized in the Office of the Surgeon General
a division of food and nutrition, whose officers were authorized by the Secre-
tary of War on October 16, 1917, to inspect food supplies in camps, to endeavor
to improve the mess conditions, and to study the suitability of the ration and
the food requirements of the troops. Officers of this division were sent to camps
in the United States where they gave instruction to cooks, mess officers, and
unit commanders and also made extensive studies of ration suitability and
requirement.^
On January 18, 1918, the chief surgeon, A. E. F., requested that suitable
officers be sent to France for similar services in the American Expeditionary
Forces,* and one month later the commander in chief, A. E. F., made the same
request by cable. ^ Accordingly, six officers were selected for this purpose and
on March 1, the Surgeon General wrote the chief surgeon, A. E. F., that they
would report for service after having studied food conditions in England."
The Surgeon General outlined the nature of the services these officers
already had rendered and suggested that they be authorized to make a thorough
inspection and study of all food supplies and mess conditions and report to
General Pershing, through the chief surgeon, A. E. F., on the following subjects:^
The quality of all Army subsistence supplies; the adequacy of the field ration
(permissible and desirable modifications of the ration from the standpoint of
transportation difficulties) ; balancing of menus (the desirability from the stand-
point of economy of simultaneous menus for entire divisions) ; improvement in
mess conditions with a view to the greatest conservation of food consistent
with adequate feeding; suitability of hospital dietaries; suitability of rations
used in prison camps with a view to greater economy; correlation of practical
experience of other armies with regard to rations and mess conditions and its
application to our own forces.
This letter was accompanied by documents which described the work
already performed by the food and nutrition service in Army camps in the
United States.'^
Among the members of this initial group and the personnel who reinforced
it later were men who in civil life had been State food commissioners, experts in
the Bureau of Chemistry, physiologists, biochemists, organic and analytical
chemists, State and city food inspectors, and those who had had practical ex-
perience in the large packing houses in the United States.^ Members of the
section throughout were selected because of their knowledge of its specialties,
with the result that collectively they were qualified to solve the scientific and
practical questions pertaining to its activities.* The officers composing the
first group sent overseas had received training from three to six months in
the camps in the United States, and the others who came later received train-
ing during variable periods.* Having been trained in the United States,
where saving privileges on the garrison ration were permitted, members of
this section were not as familiar as could have been desired with preparation
of the garrison ration if it were not supplemented b}^ purchases nor with the
possibilities of the rolling kitchen — i. e., with basic conditions pertaining to
the preparation of food in the American Expeditionary Forces.*
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 215
The officers composing the initial group remained in England from March
16, to April 2, 1918, studying the British system of rationing and its admin-
istration and making a preliminary survey of the service of food in American
rest camps/ One officer who was detached to remain in England and to
attempt correction of the nutritional defects there discovered in the American
service remained on this duty until the end of November, 1918/ The other
members of the group proceeded to France, where they reported to the chief
surgeon, A. E. F., April 12. The chief of this service was assigned to duty
under the director of the division of laboratories and infectious diseases,
with office at Dijon, and the other members to different sections of the Serv-
ices of Supply, in order that they might conduct inspections therein concern-
ing food and nutrition, make practical recommendation, and improve the
subsistence of troops/ When these assignments were made the chief surgeons
of the sections concerned were notified of the nature of the work the officers
would perform, and their cooperation was requested.^ After these inspections
were completed the members of the group held a conference at Dijon, where
they discussed the defects they had noted in food suppl}^, its preparation
and service/
In order to promote the correction of these faults and to study nutritional
I'equirements that would eventuate if it became necessary to reduce the quan-
tity of the ration, the chief surgeon, A. E. F., directed that a food and nutrition
section be established under the control of the director of the division of labora-
tories and infectious diseases/ To this section the following duties were
assigned/ Kepresentation of the chief surgeon, A. E. F., in matters pertain-
ing to the nutrition of troops; investigation of Army food requirements and
consumption; advisory service in the specification of rations and dietaries;
inspection of food supplies and mess conditions with troops, hospitals, and
prison camps; instruction in food inspection and handling, mess management,
and other measures for the maintenance of nutrition and for the conservation
of food/ The organization of this section was announced in Circular No.
37, chief surgeon's office, in June, 1918, and in the following month its duties
as noted above were published in Circular No. 40, chief surgeon's office, July
20, 1918. It acted on all matters of importance pertaining to the food supply
of the American Expeditionary Forces, maintaining close liaison with the
chief quartermaster, A. E. F., and with the fifth section of the general staff,
A. E. F., which w^as charged with instruction and training.^
Based upon a survey which four officers of this service made in May and
June, 1918, of the food conditions in six divisions in the advance section, finding
it advisable that personnel qualified to give instruction be attached to these
organizations for more or less permanent duty, moving with them in successive
changes of station, the representative of the Medical Department with the
fifth section of the general staft", on July 8, 1918, submitted the following memo-
randum to the acting chief of staff G-5 :
Subject: Project for Instruction in Cooking and Food Conservation.
1. Cooking schools. — Instruction in food values, selection and balancing of the ration,
mess management, cooking, use of the rolling kitchen and improvised cooking devices, arrange-
ment, cleaning, and care of kitchenequipment,storage, preservation, and conservation of foods,
216
AD^riXISTHATIOX, A^rKHI(■A^' EXPKDIIIONAKV FORCKS
and kitchen sanitation is given to selected replacements in tlic school for Army cooks in con-
nection with the scliool for bakers at the base division, first cori)s. Similar schools are i)ro-
jected in other base divisions.
2. Field parties. — Officers of the food and nutrition section of the Medical Department
have been visiting the various divisions and base sections in France for jiurposes of obser\ a-
tion and instruction, and three are now on duty with the United States troops in England.
Action has been taken to secure additional trained officers of the food and nutrition section
from the United States in order to give sufficient personnel for extension of the work. Field
parties (consisting of one officer of the food and nutrition section, one butcher, and two cooks)
will be assigned to a certain area corresponding to that covered by the division of any army
corps and will be kept moving from division to division within that area. They will obs(>r\c
the methods of distribution and handling of the ration, mess management, cooking, kitcluMi
economy, serving and food conservation, and will establish temporar\^ centers of instruction
for mess sergeants and the methods and procedures adapted to the conditions found.
3. Source, control, and distribution. — Officers engaged in this work will come from the
officers of the Sanitary Corps, food and nutrition section of the Medical Department. Tiic
butchers will be secured from the enlisted men of the Medical Department, Quartermaster
Corps, and from replacements trained in the cooking schools. Control of field parties and per-
sonnel attached to base sections and various headquarters will lie in the sanitary section of the
office of the chief surgeon in cooperation with G-5. Control of the instructors of the various
schools will lie with the commandants of these schools, or the commanding officers of the base
divisions in cooperation with G-5. Distribution will be tentatively as follows:
At Medical Department laboratory: officers
Officer in charge food and nutrition section (general supervision) 1
Officer on duty in the food laboratory 2
Officers for emergency examination and instruction 2
On duty at base section in England 3
On duty at base sections in France 5
On duty at First Corps schools 2
On duty with hospitalization section, chief surgeon's office 1
On duty with chief quartermaster 1
On duty at cooking schools 2
19
Butchers
Cooks
10
4
Officers
Field parties:
For 5 army corps _
Services of Supply troops
2
.5
2
7
14
<• 26
« Including 19 from above.
Increases in personnel and parties will have to be made as necessity arises.
With the approval of the assistant chief of staff G-o and the cooperation
of the chief quartermaster, the section now organized field parties, each of which
consisted of one officer from the food and nutrition section, one butcher, and
two cooks, with the grade of noncommissioned officer, the last mentioned being
drawn from the Medical Department, Quartermaster Department, and replace-
ments.^ During the period of its greatest activity about 40 noncommissioned
officers, cooks, and butchers were assigned to the nutrition service, most of
them being incorporated into the field parties. These units were sent to divi-
sions at the front training areas, military schools, and later to organizations in
sections of the Services of Supply." Before a party reported to the organization
OBGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 217
to which it was temporarily assigned, the adjutant general, A. E. F., sent to
tlie commanding officer concerned the following form letter:
1. In compliance with instructions from these headquarters a field party of the food and
nutrition section, Medical Department, has been assigned for temporary duty with the
organizations of your command.
2. This field jiarty is charged with the investigation of ration conditions as to trans-
I)ortation, handling, preparation, and conservation, and instruction of mess sergeants and
cooks as to field mess management, field cooking, and conservation within these organizations.
3. It is desired that the officer in charge of the field party be given proper authority
und support in order that he may carry out the duty to which assigned. The officers in
charge of the field party have been directed to make reports to the director of the Medical
Department central laboratory, A. E. F., and authorized to make reports to the division
surgeon of the organization with which he is on duty, or as you may direct. Attached find
a copy of "Duties of field food and nutrition officers," which will fully explain the duty
required of this party.
Duties of Field Food and Nutrition Officer-s
procedure on reporting to the organiz.\tion
1. Report through adjutant to the commanding officer. Present to him your orders,
with a statement of your duties, and request that local orders or authority be issued. Sug-
gest that the local order authorize you to inspect all food materials from their receipt by the
organization to their consumption by the men; to inspect condition of all kitchens and the
efficiency of their administration; to give instruction to mess sergeants and cooks in mess
administration and in the storage and preparation of food, and to make recommendations
to organization commanders, mess officers, and to the commanding officer in matters affecting
the proper feeding of the men and the conservation of food.
2. Report to the division surgeon or senior medical officer, explain your mission, present
to him your instructions, request his advice, and follow his suggestions.
3. Consult witli the railhead officer, division quartermaster, or subsistence officer and
supply officers and examine food supplies to obtain information re the ration issued, the
various components, their percentages, quality, period of issue, storage facilities, and method
of distribution.
4. Visit all kitchens in the organization; note and record in each the points covered in
the outline of the reports. Give individual instruction personally, and through noncom-
missioned officers of the field party, to mess sergeants and cooks for the improvement of the
mess and avoidance of waste. See that they know what the ration is and whether they get
all of it. Consult organization commanding officers and make recommendations to them
where desirable.
5. Choose one or more centrally located kitchens illustrating conditions in the area and
develop them as models for the practical instruction in cooking, mess administration, and
avoidance of food waste. Build here model l>read boxes, shelves, meat safes, work tables,
grease traps, and any other devices which can be made of the materials at hand or obtainable.
Assemble here, with the permission of the proper authorities, the officers, mess sergeants,
cooks, and men of different units and demonstrate the advantages of your devices, the impor-
tance of good meals, and the necessity of avoiding waste. Accept and stimulate suggestion
and criticism. Devi.se a system of competition between messes, involving the recognition
and public mention of excellence.
6. If accompanied by the noncommissioned officers, cooks, mess sergeants, or butchers,
distribute them at various points in the area so as to give the necessary practical distribution
over the whole organization as quickly as possible.
7. Your first duty is to improve the food as served to the men. Fooc^ conservation is
merely giving the men more and better food and putting less in the garbage pail and extracting
or saving for mess consumption or commercial use all material of value. In training areas
and in positions not exposed to shell fire there should be no food waste; material not used
should be deducted from the following issue, with corresponding reduction in transportation,
tonnage, and drain upon resources at home.
218
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
With troops occupying trenches or positions under shell fire there will be frequent
and inevitable waste of food as well as of other material. Your duty under such conditions
is to urge that such food be allowed and delivered as will make possible the proper feeding of
the men in spite of unavoidable waste. Study the food needs of the men and take steps to
insure that the needs are complied with.
Report on anj' unusual requirements of particular troops.
8. Make reports weekly to the food and nutrition section, A. P. O. 721.
9. Notify the food and nutrition section one week in adv^ance of the time that your
work within a division is to be completed, requesting orders to move to another organization.
REPORTS
1. Officers will make oral or written reports to commanding officers through division
surgeons or other officers under whose direction they work. These reports should contain
a brief statement of conditions found and specific recommendations for their improvement.
Avoid long reports. Don't criticise unless you are able to have the fault corrected. Be
sure that your recommendations are practicable — otherwise don't make them. Correct
faults by informal conference and suggestion or by your own efforts before writing reports
about them. Always pay due respect to military courtes}- and the limitations of your
authority, which is only advisory.
2. In addition to reports within the organization, officers will make regular reports
weekly by mail to the director of laboratories, food and nutrition section, A. P. O. 721, and
special reports by telegraph whenever necessary. Officers in the various sections of the
Services of Supply will similarly report to the chief surgeon in that section.
3. The outline below will serve as a guide in inspections and in the preparation of
weekly reports. Adhere to the numbers as stated and it will permit considerable aljbrevia-
tion. In reports after the first, from each division it will usually not be necessary to repeat
items under A. B., etc., covered in the first report.
To: Director of laboratories, food and nutrition section.
Heading: Organization; date covered by report.
Party No.: Number of report-
Contents:
A. Information obtained at the railhead or chief supply point.
1. Storage facilities.
2. Amount of reserve food on hand, (1) garrison ration, (2) field ration, (3) reserve
ration (4) trench reserve ration, (5) travel ration.
3. Wastage at railhead or in reserve storage.
4. Ration being issued with proportion of each component and substitute.
5. Period of issue; system of issue.
6. Quality of food material.
7. Desirable ration changes.
8. Arrangements for food salvage.
9. Faults requiring correction.
10. General comments.
B. Transportation of food.
C. Conditions at regimental food dumps or similar food supply points (Nos. 1 to 10,
as under A).
D. Report on mess inspections.
(1) Name of organizations; (2) commanding officer; (3) mess officer; (4) mess ser-
geant with his knowledge of ration efficiency; (5) number of men fed; (6) number of cooks
and efficiency; (7) general appearance of kitchen (good, fair, poor, excellent); (8) stove
facilities roller kitchens, fuel; (9) cooking utensils; (10) storage facilities; (11) sanitation —
kitchen surroundings, personnel; (12) w^aste, garbage, amount, character, disposal, reasons;
(13) menus — character; (14) water supply; (15) arrangements for washing mess kits and
dishes; (16) character of service — mess hall, tables, line system, billets, dugouts, trenches,
marmites; (17) is food good and are men satisfied; (18) shortage or overdraft shown on
ration slips; (19) conditions requiring correction and your action; (20) where pos.«ible
ORGAXIZATIOX AND ADMINISTEATION OF CHIEF SURGEON'S OFFICE 219
calculate or estimate the gross and net food consumption. Record any significant facts
not covered above, such as weather conditions, activity of the men, etc., which affect the
food consumption; remarks; (21) estimate the amount of food purchased by individual
men from data obtained from the canteens, from inquiry from the men or from stores in the
vicinity; (22) estimate the amount of food purchased by the organization to supplement
the ration; its source; (23) estimate of wine consumption.
E. Give in detail such methods of instruction and demonstration as you have used,
with comment on their success.
A field party under the immediate direction of the division surgeon and the
sanitary inspector of the organization to which it was assigned (or corresponding
officers in other commands) inspected the food supply from its receipt at railhead
to its consumption; investigated mess management and mess sanitation;
studied the methods of issuing and distributing rations, food preparation, and
service, and, by informal conference with those concerned and by practical
demonstration, corrected as far as possible any faults in supply, preparation, or
conservation of food.^ The parties were given a degree of independence which
enabled them to develop their own resourcefulness and to adapt their activities
to the conditions which the immediate occasion demanded. ^ These parties
worked in close conjunction with divisional agencies, especially the first section
of its general staff, the sanitary inspector, the inspector general, the quarter-
master, and the several organization commanders. They made detailed
inspections of kitchens and instructed personnel, either individually or in groups,
gave demonstrations and lectures, and distributed circulars. From January
to June, 1919, they gave most of their time to schools which they conducted
for mess sergeants and cooks. The program which these parties sought to
follow was one which they believed would insure, under mutable conditions, that
food was regularly provided and handled to the best advantage in so far as
storage, preparation of menus, cooking, serving, sanitation, and economy were
concerned.'*^
The field parties did not follow inspections by elaborate reports, for they
were primarily engaged in constructive criticism and instruction at each mess
inspected, but such reports as were necessary and required were made to organ-
ization commanders and to supply officers.^ Weekly reports were sent by these
parties to the food and nutrition section in Dijon in order that it might be kept
apprised concerning the suitability of the ration under changing conditions, the
quality of supplies, defects detected, progress being made, and other matters.^
These reports formed the basis for recommendations pertaining to the ration
which this section submitted. It wrote, for example, an order which was
adopted with but few changes by the chief quartermaster, A. E. F., and which
was published as General Orders, No. 176, General Headquarters, A.E.F., 1918.^
Until September, 1918, when 20 additional officers pertaining to this service
arrived from the United States, and two others were assigned thereto from other
duties, only the five officers of this section originally serving in France were
available there for the service of this section.'' One officer of the group first
sent, had remained as stated above, in base section 3 (England) ; two, at Dijon,
were engaged in development of the organization of the section, solution of
problems referred to its headquarters and in special investigations, while the
other three served with field parties which visited different divisions.^ As but
220
Al>.MlXISTRATIOX, AMKHR'AX KXrKDITlOXAHY FOHCES
few organizations could be given attention for any considerable period a read-
justment and concentration of effort became necessary in the armies, and a plan
was adopted which contemplated that the field parties be sent to headquarteis
of different corps in order that they might serve their constituent divisions, but
until troops returned to billeting areas after the signing of armistice, the shift-
ing of troops was so frequent that this method proved unsatisfactory. There-
after it was the reverse.^
After the group of 20 officers above mentioned had joined the section,
September 1, 1918, others gradually were added, until 43 were on duty with it
when the armistice was signed. ' Of this total, four officers belonged to the
Medical Corps and all others to the Sanitary Corps. ' Seventy-three enlisted
men, most of whom were serving in the field parties, also were serving in this
section at that time. By December, 1918, parties had been attached to IS
divisions for periods varying from a few weeks to several months; and w^ith five
of these, two or more parties had been on duty at different times. After
January 1, 1919, field parties assigned to army corps served six other divisions
and eventually they had served 8 corps and 26 divisions.'
After October 18, 1918, when the director of laboratories and infectious
diseases was authorized to issue travel orders for the movement of these groups
their mobility and value in meeting emergencies was greatly increased.^ Such
orders were issued for specific purposes only; e. g., investigation of epidemics of
food poisoning, inspection and prompt recommendation concerning the preser-
vation of food, and similar purposes.'
After the strength of the food and nutrition service was increased in Sep-
tember, 1918, additional field parties were organized, and soon thereafter it
became possible to provide officers for base sections Nos. 1, 2, 5, and 7 (in addi-
tion to base section No. 3, provided for at the outset) and for the intermediate
section. ^ Officers or parties also were stationed at 10 large camps for consider-
able periods, and repeated inspections w^ere made of supply, preparation, service
and conservation of food as well as other matters pertaining to the mess service
at practically all camps in base sections. Many other inspections which sought
to be of constructive value w^ere made of other organizations including hospitals
in the base and intermediate sections. In base section No. 3 where four officers
were on duty for more than five months, practically all organizations were
inspected, many of them repeatedly. ^
The most important problems which confronted the section of food and
nutrition during the winter of 1918-19 were the following:' (a) Inspection and
report upon needs of labor organizations requesting increases in the ration in
accordance with General Orders No. 176; (6) continuation of the inspection
and instruction w^ork in base sections with added emphasis on the messing
conditions in the embarkation camps; (c) continuance of instruction to divi-
sional troops in the first, second, and third Armies and the development of
instruction concerning cooking in their component units; (d) the appointment
of special inspectors to safeguard the nutritional interests of our troops on return-
ing commercial liners; and (e) assistance in solving the food problems of the
section of civil government in the occupied territory in Germany.' The food
and nutrition section also provided a representative for investigation and advice
OKGAXIZATIOX AND ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 221
(oncoiiiino; matters pertaining to his specialty in the Third Army and another
who supervised messing conditions in the district of Paris, and investigated
questions of factory sanitation that were of interest to the Quartermaster
Corps/
From November to May the following new features developed in the
woik of the section:^ The supervision and assistance in the organization of the
large embarkation messes at the base port. This covered base sections Nos.
1, 2, 5, 6, and the embarkation center at Le Mans. At these same base ports
a member of this section in each base served officially on the boards which
inspected transports to determine the proper food equipment of the same.
At advanced general headquarters one of our officers served as food and nutri-
tion consultant on the staf? of the officer in charge of civil affairs and there
rendered valuable service in determining the food supply of the occupied
territory.
From January to June, 1919, the officers assigned to army corps (where
they were attached either to the corps surgeon's office, to G-1 or G-3 of the
corps) exercised general supervision over the nutritional service of divisions and
devoted much of their time to the development of schools for mess sergeants
and cooks. ^
Of the numerous investigations ° which this section conducted the following
were practically noteworthy, viz, food conditions in the zone of the armies, on
the Murman coast, and in the sections of the Services of Supply; food service in
hospitals; caloric value of the ration; laboratory examinations and analyses of
food; inspection of factory conditions pertaining to food supplies; special prob-
lems regarding bread and meat issues; rations for later troops and food supply
and its service on transports, especially on commercial liners hired for transport
purposes by the United States.^
The services of the food and nutrition section for the American Expedi-
tionary Forces as a w^hole was terminated May 26, 1919, but was continued so
long as circumstances required in the administrative sections of the Services
of Supply and in the remaining army corps, the work being so arrainged that
officers employed therein could automatically be released when their services
W(M'e no longer necessary.'
MUSEUM AND ART SECTION
For the purpose of collecting suitable medical museum specimens, the
Surgeon General, in January, 1918, requested authorization from the command-
ing general, A. E. F., to send to France a medical museum unit with a desig-
nated director.'^ After receipt of the authorization, and a period of two
months spent in planning for the collection of museum material in the camps
and cantonments of the United States, the director of this unit was ordered
fo England in order that he might study both the collections made and methods
of collecting employed by the British Army, and was then sent to France for
further duty.'- In the meantime Circular No. 17 had been issued by the
chief surgeon, A. E! F., calling attention to the importance of collecting museum
specimens and giving brief directions for their preservation.'^
° For (letnils concerning Ihese investigations, consult Chap. VI, Sec. II, Volume VI, of this history.
222
ADMIXISTRATIOX, AMERICAX EXPEDITIONARY FORCES
The collection of museum and ait material in France was made a respon-
sibility of the division of laboratories, for it early became apparent that the
procurement of pathologic material would be wholly dependent on the effi-
ciency and activity of the officers who performed autopsies.'^ The first task,
therefore, w as the improvement of the necropsy service in the American Expedi-
tionary Forces, which at that time, because of lack of personnel for such
service, was very inadequate. During the summer of 1918 it became evident
that there existed a great need for a routine service of this character which
would afford a means of professional inspection of the measures which medical
officers employed in their care of patients.'^ This inspectorial need was filled
in satisfactorily, and, although the number of pathologists was constantly so
limited that they could not give more than incidental attention to the col-
lection and preservation of pathologic material, their collections were more
extensive than could have been hoped for under the circumstances.^^
Since General Orders, No. 15, H., A. E. F., January 24, 1918, limited
the practice of photography in the American Expeditionary Forces, in so far
as obtaining a pictorial history of the war was concerned, to the Signal Corps,
the chief surgeon, A. E. F., in March, 1918, approved an elaborate schedule
for the taking of photographs by that corps for the purpose of illustrating
the medical history of the war.^^ In order that other technical photographs
might be procured, a request w^as made early in May for the privilege of cabling
for photographers and artists who were then in readiness to proceed from the
Army Medical Museum in Washington, but this was disapproved by the
general staff, A. E. F., in view of the existing tonnage situation, and in the
belief that the requirements of the Medical Corps could be met successfully
in this particular by the personnel and facilities already available, in both the
Signal and Engineer Corps.
On May 3, 1918, the director of laboratories notified the chief surgeon
that provision was contemplated for photographic work on anatomical mate-
rial in the advance section and in the central Medical Department and base
laboratories.^^ It w^as believed that a sufficient number of men for this pur-
pose could be found in the American Expeditionary Forces, and it was planned
to train them, at the central laboratory, in the simple laboratory procedures
so that they could serve both as laboratory assistants and as photographers.'^
Another acquisition desired by the museum and art service of the division
of laboratories was a number of artists who could make sketches of anatomi-
cal specimens and of medical and surgical procedures.'^
In July, the division of laboratories reported to the chief surgeon, A. E. F.,
the lack of men in the Signal and Engineer Corps who had special training in
preparing medical illustrations and urged the necessity for special training
along such lines in order that good results might be procured.'^ As a result,
a cabled request was made to the War Department that a museum unit, con-
sisting of a cinematographer, a photographer, and four artists, with complete
equipment and supplies for six months, be sent to France. One officer and
seven enlisted men, equipped for making moving pictures,' arrived in France
September 14, 1918, pursuant to this cablegram.'^
General Orders, No. 78, G. H. Q., A. E. F., May 25, 1918, amended pre-
vious orders on the use of cameras in the American Expeditionary Forces, and
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 223
charged the Medical Department with making technical photographs of sur-
gical and pathological interest. To carry out this responsibility, the officer in
charge of the museum and art section made a survey of the Medical Department
personnel and pertinent equipment in the American Expeditionary Forces.
Several men were found who had been trained in photographing medical sub-
jects, but because of the order previously issued concerning the taking of
photographs, almost no hospitals were found equipped with photographic
apparatus.'^ Those that were so equipped were authorized to place their
equipment in use.'^ A few cameras were procured from French sources, 3 were
borrowed from the Signal Corps, and 24 from the Roentgenologic department
of the professional services.'^ A limited amount of photographic supplies was
obtained from French sources.'^
An examination of the feasible sources of supply — American, French, and
British — revealed the fact that nothing but formalin was obtainable for the
fixation of pathologic specimens, except in a few base hospitals which had first
arrived in France and which had brought with them a small supply of alcohol.'^
The only materials available for color preservation were sodium or potassium
acetate and nitrate, one or the other of which was obtained after long delay
from the French. These materials, photographic and pathologic, were placed
in the central medical supply depot, but the facilities there for distribution
either of these or of the other Medical Department supplies used in the museum
and art service were inadequate.'^
After a careful survey of the situation, Circular No. 42 was issued by the
chief surgeon's office.'^ This 'circular, which gave technical instruction con-
cerning the collection and preservation of specimens, is reproduced in the
appendix to this volume.
As a result of these efforts, the increase in the total number of pathologists,
their assignment at advantageous points, and personal appeals while inspecting
laboratories, much interest in the collection of museum material was developed.'^
But the battle activities in June and July so overwhelmed the laboratory divi-
sion that very few pathologic specimens were collected at that time.'^
On September 15, 1918, the director of laboratories wrote, through the
chief surgeon, to the chief quartermaster under whom the officer in charge of
salvage was operating, stating that it was important that certain articles
of interest to it, which were employed in allied armies or in that of the enemy,
be collected and transferred to the Medical Department.'^ These articles
included drugs, sera, chemicals, apparatus, instruments, etc., and ordnance.
He stated that the Army Medical Museum was charged with the collection of
such material and the provision of arrangements whereby it would be made
available for future studies and requested that such articles of the character
mentioned as had been selected by a medical officer be transferred to the divi-
sion of laboratories for shipment to the Army Medical Museum in Washington.'^
In October and November the epidemic of influenza, coinciding as it did
with the Meuse-Argonne operation, the period of greatest battle activity in
the American Expeditionary Forces, again overwhelmed the pathologists,
though by this time their number had materially increased.'^ By this time,
13901—27 15
224
ADMINISTEATIOX, AMERICAN EXPEDITIONARY FORCES
also, an excellent necropsy service had been developed, but only relatively
slight attention could be given to the collection of specimens.'^ Nevertheless,
despite the limited personnel and the lack of equipment, of supplies, of con-
tainers, of transportation, of time, and in fact of everything except a multitude
of specimens, upward of 6,000 pathologic specimens were collected, preserved,
and shipped to the Army Medical Museum.'^ Most of these related chiefly
to war wounds and to gas poisoning.'^
Early lesions of war gas poisoning were especially difficult to obtain, owing
to lack of transportation facilities and of pathologists, and to the necessity for
the collection of specimens for immediate study at the pathologic laboratory
in the Chemical Warfare Service, with which the Medical Department attempted
to cooperate in every possible manner. However, a small but a fairly repre-
sentative collection of these lesions was assembled. By December 26, 1918,
most of the pathologic specimens from gas-poisoning cases had been forwarded
to the laboratory of the Chemical Warfare Service for study, and the others,
which had been held at the central laboratory, had been shipped to the Army
Medical Museum.'^ A number of good specimens illustrating the more striking
types of lung lesions occurring during the epidemic of influenza in the fall of
1918 were preserved.'^ Lesions illustrating the often unique course of typhoid
and paratyphoid fever in men who had received specific prophylaxis also were
collected in considerable numbers during the fall and winter of 1918-19. Fairly
good collections were made of specimens illustrating lesions of the brain, and of
peripheral nerves and certain other conditions.'^
About 2,000 microscopic slides of tissue were collected and shipped to the
United States.'^
A small collection of missiles which had caused injuries and which had been
removed at surgical operations was preserved, but most of these were returned
to W'Ounded soldiers, pursuant to Circular No. 42, Chief Surgeon's office. A
fairly complete collection of unused small-arms missiles and fixed ammunition of
the several belligerent nations, a few specimens of heavy ordnance missiles and
of their fragments, and a representative collection of rifles, pistols, bayonets,
trench knives, and other weapons were forwarded to the Army Medical Museum.'^
On January 13, 1919, the commander in chief instructed army commanders
and the chiefs of all technical and supply divisions concerning the collection of
material for historical and exhibition purposes.'^
A large collection of helmets, which showed evidence that they had either
warded off missiles or been penetrated by them, a small number of pieces of
body armor, and other metal objects such as canteens, mess kits, trench mirrors
etc., which also showed they had been struck by missiles, were collected and
shipped to the museum.^ A number of surgical instruments and other items
in Medical Department armamentarium, which had been developed or materi-
ally modified in our service, or in those of our allies, or in that of the enemy dur-
ing the progress of the war were collected and shipped.'^
In September, 1918, several artists (medical illustrators, w^ax modelers,
and others) had arrived in France attached to Base Hospital No. 115, which was
stationed at Vichy. An art and photographic section was therefore established
in Vichy in the center laboratory of the hospital center, using this personnel
ORGANIZATION AND ADMINISTEATION OF CHIEF SURGEON'S OFFICE 225
and its equipment.'^ Other artists were assigned from to time to time to this
art section and were ordered out therefrom to various hospitals in the American
Expeditionary Forces where opportunities afforded making illustrations of medi-
cal or surgical subjects. This group produced 35 casts of surgical cases, about
200 drawings and paintings, and more than 1,000 photographs of technical
subjects.'^ In addition to these illustrations and photographs, which were
centered at Vichy, a number of other drawings, paintings, and photographs of
technical subjects were made in other hospital centers, particularly at Allerey,
Beaune, Chateauroux, and Paris.
The cinematographer, photographers, and artists cabled for in August, 1918,
reported for duty to the director of laboratories in the following month.
This personnel was distributed as advantageously as possible, principally to
cover the activities of combat divisions. Here they remained on duty until the
signing of the armistice. Late in September, 1918, the museum section of the
division of laboratories had been charged with the duty of cooperating with the
Signal Corps in making photographs for the medical and surgical history of the
war.'^ The Signal Corps, though it had been authorized in March, 1918, to
prepare such photographs, had been able to cover but little of the medical
activities of the American Expeditionary Forces except the more popular sub-
jects which were needed for propaganda purposes. After the signing of the
armistice and as soon as the general photographers of the Medical Department
could be released from their duties with combat divisions, a photographic
bureau of the Medical Department was established in Paris for making and
collecting photographs and moving pictures Olustrative of the medical activities
in the war.'^ Personnel of both the Medical Department and of the Signal
Corps were assigned to this duty.^^
The negatives of the medical pictures taken by the Signal Corps photog-
raphers were developed by them and two prints of each made for the Medical
Department bureau, the negatives being retained by the Signal Corps. The
negatives made by medical personnel were developed, printed, and filed in the
Medical Department bureau. This bureau filed more than 10,000 still pictures,
titled and cross indexed, supplied about 5,000 proof copies to hospital organi-
zations for use in their several histories, and furnished 1,500 prints for medical
officers of the general staff of general headquarters.^^ The bureau also photo-
graphed about 350 dental specimens. It made about 40,000 feet of moving-
picture film of surgical and medical subjects, such as activities in and around
hospitals, rehabilitation of convalescent patients, care of psychiatric cases,
etc., and filed about 20,000 feet of other motion pictures made by Signal Corps
photographers. Nineteen copies of the motion picture, "Fit to fight," were
made for circulation in the American Expeditionary Forces. Two other
propaganda pictures — "Fit for America" and "How to avoid typhoid fever" —
and six copies of a two-reel anatomic picture concerning venereal diseases were
also made.'^
The Roentgenologic division of the professional services, on request from
the division of laboratories, packed and shipped about 2,000 selected X-ray
plates from their point of origin directly to the Army Medical Museum. These
were selected for their technical quality as well as for their scientific interest and
226
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCEf^
covered in a number of instances special series of cases or series which showed
different stages in the treatment and healing of the same case.'^
Immediately on the signing of the armistice it became obvious that trans-
portation facilities for specimens, not only within the American Expeditionary
Forces but also from base ports to the United States, would be exceedingly
limited. A supplemental museum circular (No. 58) was therefore issued
from the chief surgeon's office December 2, giving directions for expediting
transportation and calling attention to the desirability of obtaining material
showing stages of healing, etc.^^ As a result of this circular the transportation
of pathologic specimens directly to base ports from their points of origin instead
of through collection centers was materially expedited, as this proceedure
required that dependence be placed on a large number of shippers for report
of details concerning the individual specimens they forwarded, there even-
tuated in some instances a lack of the detailed information desired.'^ The
shipment of museum material to the United States was greatly hampered by
the inevitable confusion incident to general shipping conditions in France and
to the lack of tonnage at the close of the war. All the specimens, however,
were carefully packed, and it was believed they would not materially deteri-
orate even if delayed one or two years in transit.
LABORATORY OF SURGICAL RESEARCH
In order that use might be made of the unusual opportunities which the
World War afforded for the study of certain conditions, such as shock and
hemorrhage, which occur both in military and civil practice, and in order to
obtain information wherewith to meet new experiences in war surgery, as
these arose, a laboratory for surgical research was established at Dijon.
This organization was established on the initiative of the chief surgical con-
sultant and connected with the central Medical Department laboratory. Plans
for carrying on the research work were perfected in January, 1918, but it was
not until May 1 of that year that active work was begun. Two divisions
of the unit were established, physiological and surgical, the former being
staffed by 4 officers and 3 enlisted men and the latter by 6 officers, 2 nurses,
and 2 enlisted men. Investigations of problems connected with shock and
hemorrhage and the development of a satisfactory technique in the treatment
of chest wounds were the first studies undertaken.^'' Studies concerning
shock and hemorrhage progressed in such a favorable manner that late in May
instruction was begun of classes in resuscitation, and thereafter teaching and
investigation were closely associated in this service. With a few interrup-
tions, classes of from 6 to 21 officers were instructed each week until November
1, 1918, the successive courses of lectures and demonstrations being gradually
amplified and improved. Members of the classes draw^n from the surgical
staffs of base hospitals, were organized in resuscitation teams, and when needed
they were to be ordered to hospitals at or near the front. This plan was not
altogether satisfactory. In many cases the personnel in question could not be
released from their units for this purpose and as a result some of the resusci-
tation teams in forward hospitals had not received the instruction referred to.^'
The teaching staff of the surgical research laboratory also gave instruction
monthly to the classes in the sanitary school at Langres.'"
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 227
Meanwhile surgical research was prosecuted, some studies of this char-
acter being conducted in British hospitals. Research in the treatment of
chest wounds was conducted by a team of 6 officers, 2 nurses, and 2 enlisted
men.'^ These studies were not completed but certain principles apparently
were established and surgical operations simplified accordingly.^^ A project
to establish an advance surgical research laboratorj'^ where observations could
be made on recently wounded men was contemplated but never materialized.^^
REFERENCES
(1) Report of the activities of the water analysis laboratories, to January, 1919, by Lieut.
Col. Edward Bartow, S. C. On file. Historical Division, S. G. O.
(2) Report of water analysis work at the central Medical Department laboratory, Dijon,
France, January 25, 1919, by Captain H. B. Hommon, S. C. On file. Historical
Division, S. G. O.
(3) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file,
Historical Division, S. G. O.
(4) Letter from the chief surgeon, A. E. F., to the Surgeon General, January 18, 1918.
Subject: Recommendation for food division. On file, A. G. O., World War Division,
chief surgeon's files (720.1).
(5) Cablegram No. 614, par. A, from General Pershing to The Adjutant General, February
18, 1918.
(6) Memorandum from the Surgeon General to the chief surgeon, A. E. F., March 1, 1918.
Subject: Officers reporting for duty. On file, A. G. O., World War Division, chief
surgeon's files (720.1).
v7) Letter from Maj. P. A. Shaffer, San. Corps, December 6, 1918, to the director of labora-
tories, A. E. F. Subject: General report from the food and nutrition section, from
its establishment to December 1, 1918. On file, Historical Division, S. G. O.
(8) Report on the section of food and nutrition, personnel, August 8, 1919, by Maj. Walter
H. Eddy, S. C. On file, Historical Division, S. G. O.
(9) Letter from the chief surgeon, A. E. F., to chief surgeons of sections concerned, April 12,
1918. Subject: Duties and cooperation of food and nutritional officers. On file,
A. G. O., World War Division, chief surgeon's files (720.1).
(10) Report on the section of food and nutrition, food problems with combat troops in France,
August 8, 1919, by Capt. C. C. Mason, S. C, and Lieut. A. T. Shohl, M. C. On file,
Historical Division, S. G. O.
(11) Letter from the adjutant general, A. E. F., to commanding officer of the organization
concerned, September 20, 1918. Subject: Assignment of field party, food and nutri-
tion section. Copj' on file. Historical Division, S. G. O.
(12) Report on the museum and art service of the American Expeditionary Forces (undated),
by Col. Louis B. Wilson, M. C. On file, Historical Division, S. G. O.
(13) Letter from Lieut. Col. J. F. Siler, M. C, director of laboratories, A. E. F., to the chief
surgeon, A. E. F., May 3, 1918. Subject: Photographic work in laboratory service.
On file, A. G. O., World War Division, chief surgeon's files (321.630).
(14) Letter from Lieut. Col. J. F. Siler, M. C, director of laboratories, A. E. F., to the chief
quartermaster, A. E. F., September 15, 1918. Subject: Transfer of certain material
to the Medical Department. On file, A. G. O., World War Division, chief surgeon's
files (700.6).
(15) Fourth indorsement from director of laboratories, A. E. F., to the Surgeon General,
U. S. Army, December 26, 1918, on letter from Major M. C. Winternitz, M. C, to
director of Chemical Warfare Service, November 7, 1918. Subject: Study of human
pathology of poison war gases. On file. World War Division, chief surgeon's files
(321.630).
228
ADMINISTRATION, AJklEKICAN EXPEDITIONARY FORCES
(16) Letter from commander in chief, A. E. F., to army commanders and all technical and
supply divisions, January 13, 1919. SuV)ject: Collections of materials of historic
value. Copy on file, Historical Division, S. G. O.
(17) Report on the services of the laboratory of surgical research, American Expeditionary
Forces, at Dijon, December 7, 1918, by Lieut. Col. W. B. Cannon, M. C, and Lieut.
Col. J. L. Yates, M. C. On file. Historical Division, S. G. O.
CHAPTER XIV
THE DIVISION OF HOSPITALIZATION
GENERAL OUTLINE OF DEVELOPMENT AND ACTIVITIES
The broader activities of the hospitalization division, especially in so far
as they pertained to projects, procurement, and organization of hospitals,
general control of the professional services. Medical Department transportation,
and evacuation of patients, are described in other chapters of this volume.
This chapter has to do only with a general outline of this division's develop-
ment and activities.
Securing adequate hospital beds was one of the earliest tasks, and con-
tinued to be one of the greatest and most difficult of the Medical Department
of the American Expeditionary Forces until after the armistice had been signed.^
That the needs as to hospital beds were met, generally speaking, and that there
was always a surplus of several thousand hospital beds, were the results of
great effort and the use of all possible expendients to utilize available resources
to the utmost.^
The necessity for close cooperation between the Medical Department of
the American Expeditionary Forces and the medical services of our Allies, espe-
cially France, in the provision of hospital facilities was apparent from the outset.'
Prior to the arrival of headquarters, A. E. F., the question of hospitals had been
taken up with the French Minister of War, and a Medical Department mem-
ber of the American mission with a medical officer of the French Army had made
an extensive inspection trip with a view of determining what French military
hospitals might be available and suitable for the American Expeditionary
Forces.' All Atlantic ports in France were visited and their hospital facilities
investigated,' so that even before the arrival of our first contingent of troops it
was possible for the French to begin work for us on a camp hospital at St.
Nazaire, and for the existing French hospitals in the vicinity of that port to be
evacuated and prepared for transfer to the American Expeditionary Forces as
soon as American personnel became available.'
After the arrival in France of the chief surgeon, A. E. F., he and the Amer-
ican medical officer above referred to covered almost the same itinerary as that
followed in the inspection trip which the latter already had conducted, with a
view of locating hospitals and Medical Department supply depots and of pro-
curing immediate facilities for the medical service of the troops then expected.'
When organization of the chief surgeon's office was amplified, July 28, 1917,
the hospital division of that office was charged with all questions that concerned
the Medical Department pertaining to the location, procurement, construction,
and repair of hospitals, the care and evacuation of sick and wounded, the pro-
vision and control of hospital trains, ambulances and barges, and the training of
Medical Department personnel.^ The chief of this division was also designated
liaison officer between the American and French medical services. The great
229
230
AD.MIXISTKATIOX, AMKKICAN EXPEDITK ).\ A K V FORCES
majority of Medical Department questions which required negotiation during
the early formative period of the American Expeditionary Forces pertained to
the procurement of hospitals and the determination of general policies.^
When the chief surgeon for the line of communications was assigned,
July 18, 1917, he was charged with certain duties then carried out by the office
of the chief surgeon, A. E. F/ These were to include control of base hospitals,
medical supplies and personnel in the line of communications. However,
until headquarters, A. E. F., moved, September 1, 1917, from Paris to Chau-
mont, there was very close contact between the chief surgeons of the American
Expeditionary Forces and of the line of communications in matters pertaining
to hospitalization as well as other affairs.^ Thereafter, in so far as hospitals
were concerned, the office of the chief surgeon, A. E. F., while located at Chau-
mont, was more particularly concerned with procurement of facilities and gene-
ral policies concerning hospitals. Very important parts of this service per-
tained to the fixation of the bed capacity of base, camp and evacuation hospitals*
the determination of the duty personnel required to serve units of each class'
the provision of convalescent camps and depots, and the preparation of the
plans and specifications for hospital construction.^ On the other hand, the
office of the chief surgeon, line of communications, was concerned with estab-
lishment of fixed hospitals throughout the expanding territory of the lines of
communications, the provision for their supply and the control of their adminis-
tration. When headquarters and the supply and administrative services of
the American Expeditionary Forces were reorganized by General Orders,
No. 31, G. H. Q., A. E. F., February 16, 1918, the chief surgeon moved with
the chiefs of most other administrative staffs to Tours, where his office absorbed
that of the chief surgeon, line of communications.^ Two of the officers who
had been identified with the hospitalization division of the chief surgeon's
office, A. E. F., remained at Chaumont, one of them being detailed to serve
as representative of the chief surgeon with the general staff, the other with the
fourth section of that body (with which the representative of the chief surgeon,
at G. H. Q., soon identified himself). Another officer was now placed at the
head of the hospital division.^ This division was now charged with genera^
matters pertaining to hospitalization, administration and evacuation, while
the medical officers attached to G-4 were charged with the hospitalization of
the armies in the field, the location and procurement of sites of fixed hospitals,
negotiations with the French Mission, and broad questions of general policy
which required action by the general staff. ^ Their activities in these matters
conformed to the plans of the hospitalization division of the chief surgeon's
office at Tours. ^ This division, as ultimately organized, administered the
duties outlined above in the manner shown in in the following schedule:^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 231
HOSPITALIZATION AND EVACUATION DIVISION
(Corrected to November 1, 1918)
A. General administration (one officer).
B. Procurement and construction section (five officers).
Hospital projects.
Transfer of hospital and property from French central authorities.
Off"ers of land and buildings for hospital purposes.
Leasing of land, buildings; etates des Heux.
Hospital plans and construction.
Repairs to hospitals.
Sanitary appliances, plumbing, water, sewerage, fight.
Procurement and distribution of tentage.
Coordination with engineers, railroad and construction, and quartermaster.
Inspection and reports on all included in above items.
Reference maps and graphic charts.
C. Administration and poficj^ section (six officers).
Hospitals:
Centers.
Base.
Camp.
Convalescent (hospitals and camps).
Special.
Red Cross (military and homes).
Boards :
Disability.
Classification.
General.
Inspections:
Action on reports.
Authorization of.
Action on complaints.
Instruction:
Officers.
Enlisted men.
Personnel requirements:
Medical.
Quartermaster.
Engineers.
Etc.
Regulations: General pohcy of.
War diary hospitalization section.
Historical record of hospitalization.
Coordination of administration with other departments and professional section.
D. Personnel and equipment; statistical and liaison section (two officers).
(1) Daily bed report of base hospitals and convalescent camps.
Weekly bed report of all hospitals.
Monthly bed and authorization report of all hospitals.
Statistical tables.
(2) Liaison, chief quartermaster's office reference:
(a) Laundries.
(b) Bakeries.
(c) Fuel.
(d) Subsistence.
(e) Ranges, stoves, etc., for hospitals.
(3) Care of and location of Medical Department units arriving from United States.
(4) Installation of new hospitals, initial equipment and supplies.
(5) Assembh- and shipment of mobile hospitals and mobile surgical units.
232
ADMINISTRATION, AMERICAN EXPEDITIONAKY FORCES
E. Evacuation and transportation section (six officers).
Primary, secondarj', and special evacuation of sick and wounded.
Collection of evacuables of class D and their asseml)ly at base ports for transfer
to the United States.
Transfer and assembly of special classes of patients at special hospitals.
Liaison with Navy Department representatives reference to transfer jjatients to
home ports by Navy transports.
Liaison with French mission reference to disposition American patients in Frendi
hospitals.
Liaison with British mission reference to disposition American patients in liritisli
hospitals.
Liaison with troop movement bureau reference to routing evacuables from hospi-
tals to casual depots, depot divisions, and regulating stations.
Liaison with armies and general headquarters through rei)resentatives at regulating
stations.
Records and statistics of evacuations.
Hospitals trains, personnel, supply, inspections and regulations, requirements and
specifications, auditing of accounts for purchases and rental.
Motor transportation. Shipments from United States, arrivals and shortages in
France, losses, furnishing of transportation and equipment by other agencies.
Records of transportation for identification; registration cards; assignment of
motor transportation in Services of Supply and to arriving sanitary trains.
Records of assembling, repairs, maintenance, and storage of equipment. Person-
nel, supply, inspections and regulations for evacuation ambulance companies.
Service of light, railway, and canal. Construction of cars and appliances for sup-
porting litters. Records of transportation. Obtaining sanitary personnel for this
service.
Liaison with railway transport service and Motor Transport Corps and light rail-
way and canal service.
Under the immediate jurisdiction of the hospitalization division, but not
actually pertaining to it, was the group of professional consultants at Neuf-
chateau. These consultants supplemented the purely official activities of the
hospitalization division by their supervision and direction of the technical,
medical, and surgical services rendered the patients in hospital.^
Instructions concerning the partitioning of military hospitals into two
classes, and the determination of the field of Medical Department responsi-
bility in the control of hospitals under the jurisdiction of the Services of Supply
were published, as follows:
Bulletin No. 29.
American Expeditionary Forces,
Headquarters, Services of Supply,
France, August 30, 1918.
1. All hospitals, e.xcept evacuation and field hospitals, are hereby designated as S. 0. S.
(Services of Supply) formations. These hospitals are divided into two classes. The first
class includes hospital centers and base or special hospitals disconnected from hospital
centers. The second class includes camp or other hospitals serving purely local purposes.
2. Hospitals of the first class have the status of general hospitals and are under the
control of the commanding generals of the sections in which they are located only in the
matter of discipline, guard, inspection, construction, supply, and fire protection. The\' are
under the direct control of chief surgeon, A. E. F., in all other matters, including general
administration, control of personnel, care and evacuation of the sick and wounded, etc.
3. Com manding officers of hospitals of the first class have the responsibility and author-
ity of post commanders in addition to their duty in connection with the general management
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 233
of the hospitals. They are authorized to appoint disability boards for the service of their
hospitals, as provided in section 1, G. O. 41, G. H. Q., A. E. F., 1918. They are authorized
to communicate direct with the American Red Cross convalescent homes and to issue the
necessary orders to send cases to such homes, where accommodations are available.
4. They will apply to section commanders for necessary guards. The commander of
such guard, if a commissioned officer, will report to the medical officer commanding for instruc-
tions as to the character of the guard duty to be preformed and he will exercise no control
over the sanitary formation. If the guard be reported by a noncommissioned officer, it will
be under the immediate control of the medical officer of the day.
5. Hospitals of the second class, including those serving school areas, are under the
control of the commanding generals of the sections in which they are located. This control
will be exercised through the surgeon on the staff of the section commander.
6. Supplies for hospitals, except medical supplies, and allotments for repairs will be
obtained from headquarters of the section in which the hospital is located. Medical supplies
will be obtained by requisition on depots in the manner specified from time to time by the
chief surgeon.
By command of Major General Harbord:
Johnson Hagood, Chiej of Staff.
Official:
L. H. Bash, Adjutant General.
Such of the activities of the American National Red Cross as were con-
ducted in the American Expeditionary Forces and as pertained to mihtary
hospitihzation and supphes were under the control of In the zone of the
armies, the hospitals of this society were under the control of G-4-B; i. e., the
Medical Department element of the fourth section of the general staff.^ When
American Red Cross hospitals were taken over by the Army they became part
of its effective hospitalization service, and as such were under the supervision of
the hospitalization division of the chief surgeon's office.^
Though a large number of possible locations for hospitals had been selected
prior to the transfer of the chief surgeon's office from Chaumont, the need-for
others steadily progressed. When the hospitalization division desired further
procurement it so notified the chief surgeon's representative at general head-
quarters.^ In discharging this duty, the group with G-4 would learn whether
the site proposed had a prior claim upon it either by the French or by another
branch of our service; whether railway facilities (e. g., strength of bridges) were
such that it was readily accessible by trains carrying patients from the front and
by others bringing supplies from the rear; whether the terrain was suitable, if
new construction was planned, or whether available buildings were approxi-
mately satisfactory if use of such structures was contemplated; whether the
water supply was adequate, etc.^ Suitability of the terrain had been a factor
in the early tentative selection of each site, but this was reexamined when
information was received designating definitely the number of buildings that
would be necessary for a specific project.^
Efforts w^ere made in advance to prepare hospital facilities for arriving
troops. To this end surgeons of base sections were directed to make prelimi-
nary arrangements for the care of the sick of incoming troops, and to notify
surgeons of the same concerning the hospitalization and transportation of their
sick pending the establishment of their own infirmaries and camp hospitals.*
In order that hospitals might be established and equipped before the arrival
of troops, the chief surgeon, A. E. F., notified the assistant chief of staff, G-4,
234
ADMIXISTKATIOX, A.MEKK'AX KXPKDITIONAHV FORCES
general headquarters, that he would have to be informed sufficiently in advance
as to the training areas to which the troops concerned would go.* He also noti-
fied the assistant chief of staff, G-3, that each division surgeon should come
to France with the advance party of the division to make the necessary hos-
pital preparation."*
On request of the hospitalization division to the supply division of the chief
surgeon's office, property was shipped to different hospitals without requisition
by the commanding officer of the hospital concerned. Such property included
equipment for base hospitals, complete, crisis expansion equipment,'^ dis-
infectors,'^ and a w^de range of other supphes and material including tentage."
Similarly, the hospitalization division made application upon the American Red
Cross for a variety of supplies and installations (e. g., portable ice machines)'^ and
upon the chief quartermaster for equipment of incoming hospitals w^th such items
as heating stoves,'^ ranges, marmites, hot water reservoirs, cooking utensils,
and messing equipment.'^ Its activities extended into great detail for it formu-
lated lists of the quota of heating stoves and cooking ranges necessary for each
type of unit, itemized the utensils which should accompany each range,
and detailed the equipment of W' ard diet kitchens, of American Red Cross diet
kitchens'^ and specified articles comprising a surgical ward dressing unit,'^
the equipment for a 1,000-bed tent crisis expansion,^** the furniture unit for a
tent ward,^' the furniture unit for a ward containing normal beds,^^ and pre-
scribed in explicit detail the character and quantity of all supplies authorized for
each of the different types of hospitals and for each department of a hospital.
It supervised the organization, selection and provision of equipment for mobile
hospitals, mobile surgical units and other newly created and speciahzed
hospital agencies, as well as of the base or camp hospitals discharging their usual
service, procured authorization for convalescent camps and prescribed their
organization, equipment and operation. It notified the division of labora-
tories of the arrival and assignment of base hospitals in order that the division
of laboratories might make appropriate contact with the respective laboratory
services.^* Some hospitals were assigned to the service of particular classes of
cases, such as cases of psychoneurosis, tuberculosis, bone and joint, cranial and
maxillofacial injuries. The proper selection of specialist personnel for assign-
ment, their supervision and the procurement and distribution of technical
equipment were essential in order that satisfactory results might be attained in
the treatment of patients. That part of the Medical Department which was
charged with the professional care of patients w^as under control of the hos-
pitalization division. It was also necessary that special foodstuffs be provided
and that personnel and equipment suitable for their preparation be furnished."
The provision of labor, fuel, pure water, illumination, and transportation were a
few of the other interests of the hospital service throughout the American
Expeditionary Forces. The hospitalization division was thus charged with the
provision of hospital needs, for their satisfaction, the utilization of resources to
the best advantage, and general administration of the service of hospitalization
and evacuation.^" The fact that over three thousand items were listed among
the supplies required by the Medical Department (most of these pertaining to
its hospital service) illustrated the highly technical character of the professional
services rendered."
ORGANIZATION' AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 235
The hospital division of the chief surgeon's office, A. E. F., conducted its
general administration by means of instructions which were incorporated in
circulars, circular letters and memoranda from the chief surgeon's office, and by
telegrams, letters or telephone conversations with the parties interested. In-
spections were conducted by general inspectors, by members of the hospital-
ization and finance divisions of the chief surgeon's office and by the professional
consultants.^^ Information was also disseminated by the WeeMy Bulletin
published by the chief surgeon's office. Special inspectors constantly visited
the hospitals to instruct the inexperienced in military methods of administration,
to secure the formulation of more accurate reports, and to improve all elements
of the service discharged by those units.
The gravest difficulty which the hospitahzation division experienced arose
from the lack of adequate personnel for fixed hospitals. As stated in Chapter V
of this section, base hospitals were stripped of all available officers, nurses, and
men to form operating and other teams for service in the zone of the armies and
to staff the camp hospitals. Provision of personnel for the last mentioned units,
the chief surgeon declared, was the most difficult problem of the Medical
Department in the American Expeditionary Forces.^"
The hospitalization division compiled two consolidated bed reports, a weekly
report'*^ and a daily report. Both of these were based upon telegraphic
reports of bed status (number of designated beds, both normal and crisis expan-
sion, and occupied and vacant) received from the various stationary hospitals in
the Services of Supply. The purpose of the weekly consolidated report was to
have at hand, not only for the chief surgeon but also for headquarters, Services
of Supply, and headquarters, general headquarters, a complete statement of the
hospital bed situation, in order that the necessity for the additional provision
of hospital beds could be foreseen.
The hospitalization division did not require at first that bed reports of field
hospitals when operating as purely divisional units be submitted to the chief
surgeon's office direct. Later it was required that weekly bed reports be tele-
graphed by field and evacuation hospitals, direct to the chief surgeon's office,
and a form for this was prescribed. Weekly telegraphic bed reports were
required of the chief surgeons of the several armies.^* Considerable difficulty
was experienced in the effort to keep a correct, consolidated report of the hos-
pitals attached to combat units; consequently, on September 21, 1918, the chief
surgeon requested his representative with the general staff to notify him of
changes of status of all hospitals attached to combat units.^^ Frequently units,
such as field, evacuation, and mobile hospitals, arrived in France, opened, closed,
and combined, etc., without word being received by the chief surgeon's office.
The chief surgeon's representative at general headquarters replied to the effect
that in time of active operations compliance with the above instructions would
be very difficult largely because of the difficulties of communication between
the division and corps surgeons and the latter officers and the army surgeon.
Positive orders of general headquarters prohibited telephoning or telegraphing
any information concerning a military location except in code, and code books
were not supplied to any unit smaller than a regiment. The chief surgeon's
representative stated further that this information would undoubtedly be
236
ADMINISTRATION, AMERICAN EXPEDITIONARY' FORCES
furnished when the organization became a smoother working machine, but that
it would have to be suppHed by mail, which was a very uncertain method of
communication.^^
In the late spring of 1918, when our Medical Department took over from
the French the medical service to the rear of our combat divisions,'^ the necessity
arose for having at hand a constantly corrected record of the hospital bed situa-
tion. The hospitalization division of the chief surgeon's office not only had to
assign to a regulating station a definite number of beds for casualties being
evacuated from the front, but also must know to w^hich hospitals farther to the
rear patients in hospitals nearer the front could be cleared. Obviously weekly
telegraphic reports from hospitals would be totally inadequate for the purpose;
consequently, daily bed reports now were required from all stationary hospitals
in a manner similar to that in which the weekly reports were made.^^ It was
this daily report of the bed situation in the hospitals of the Services of Supply,
with which the evacuation section of the hospitalization division was most
concerned.
On the date the armistice was signed the hospitalization division included
41 per cent of the 61 officers then on duty in the chief surgeon's office, a fact
which illustrates the relative extent of its activities.
After the signing of the armistice the hospitalization division was concerned
chiefly with the cancellation of projects, the transfer of patients to base ports
for evacuation to the United States, the closure of hospitals, and the storage of
hospital equipment and supplies.^^
The hospitalization activities of the chief surgeon's office, A. E. F., were con-
tinued along the lines outlined above until the American Expeditionary Forces
were succeeded first by the American forces in France and then by the American
forces in Germany
PERSONNEL
(July 28, 1917, to July 15, 1919)
Brig. Gen. James D. Glennan, M. C, chief.
Col. John L. Shepard, M. C, chief.
Col. Sanford W. Wadhams, M. C, chief.
PROCUREMENT AND CONSTRUCTION SECTION
Col. James D. Fife, M. C, chief.
Col. Arnold D. Tuttle, M. C, chief.
Lieut. Col. Rolf Floyd, M. C.
Capt. John A. P. Millett, M. C.
Capt. Martin D. Mims, San. Corps.
Capt. Harold Rich, San. Corps.
Capt. Donald V. Trueblood, M. C.
First Lieut. Garrett S. De Grange, jr., San. Corps.
First Lieut. Peter A. Lelong, San. Corps.
First Lieut. George E. Russell, San. Corps.
" In this list have been included the names. of those who at one time or another were assigned to the division during
the period July 28, 191", to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names have
been arranged alphabetically, by grades, irrespective of chronological sequence of service.
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 237
ADMINISTRATION AND POLICY SECTION
Col. Frederick P. Reynolds, M. C, chief.
Col. John L. Shepard, M. C, chief.
Lieut. Col. Leartus J. Owen, M. C, chief.
Col. Shelley V. Marietta, M. C.
Maj. Earnest L. Scott, San. Corps.
PERSONNEL AND EQUIPMENT; STATISTICAL AND LIAISON SECTION
Col. Thomas H. Johnson, M. C, chief.
Lieut. Col. Lucius L. Hopwood, M. C, chief.
EVACUATION AND TRANSPORTATION SECTION
Col. Robert M. Culler, M. C, chief.
Col. George P. Peed, M. C, chief.
Col. Frank W. Weed, M. C, chief.
Lieut. Col. Howard Clarke, M. C.
Capt. James E. Barney, San. Corps.
Capt. Joseph E. Murray, San. Corps.
REFERENCES
(1) Wadhams, S. H., Col., M. C, and Tattle, A. D., Col M. C: Some of the early prob-
lems of the Medical Department, A. E. F. The Militanj Surgeon, Washington^ D. C.
December, 1919, xlv, No. 6, 636. '
(2) Final report of Gen. John J. Pershing, September 1, 1919, 77.
(3) War diary, chief surgeon's office, A. E. F., Julv 28, 1917. On file, Historical Division
S. G. O.
(4) War diary, chief surgeon's office, A. E. F., Julv 21, 1917. On file. Historical Division
S. G. O.
(5) Report from the chief of the medical group, G-4 section of the general staff, G. H. Q.,
A. E. F., to the chief of G-4, general staff, G. H. Q., A. E. F., December 31, 1918.
Subject: Activities of G-4-B, for the period embracing the beginning and end of
American participation in hostihties. Copy on file, Historical Division, S. G. O.
(6) Schedule of organization of hospitalization and evacuation division (corrected to
November 1, 1918). On file, A. G. O., World War Division, chief surgeon's files
(322.32911).
(7) Report from Col. W. L. Keller, M. C, director of professional services, A. E. F., to the
chief surgeon, A. E. F., December 31, 1918. Subject: Brief outline of the organi-
zation and activities of the professional services between April, 1918, and December, 31,
1918. On file, Historical Division, S. G. O.
(8) Letter from the chief surgeon, A. E. F., to surgeon, Base Section No. 2, October 14,
1918. Subject: Hospitalization of incoming troops. On file, A. G. O., World War
Division, chief surgeon's files (322.32911).
(9) Memorandum from the chief surgeon, A. E. F., to assistant chief of staff, G-4, G. H. Q.,
A. E. F., October 13, 1918. Subject: Notification of incoming divisions. On file,
A. G. O., World War Division, chief surgeon's files (322.32911).
(10) Memorandum from the chief surgeon, A. E. F., to the assistant chief of staff, G-3,
October 21, 1918. Subject: Division surgeon with advance party. On file, A. G. O.,
World War Division, chief surgeon's files (322.32911).
238 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(11) Letter from the chief surgeon, A. E. F., to the commanding officer, Base Hospital \o. 14,
A, E. F., July 28, 1918. Subject: Equipment. On file, World War Division,
A. G. O., chief surgeon's files (322.32911.)
(12) Memorandum from the chief of hospitalization division to the chief of the supply
division, July 11, 1918. Subject: Crisis expansion equipment. On file, A. G. O.
World War Division, chief surgeon's files (322.32911).
(13) Letter from the chief surgeon, A. E. F., to commanding officer. Camp Hospital No. 27,
August 5, 1918. Subject: Replacement of Quartermaster Department disinfectors,
On file. World War Division, A. G. O., chief surgeon's files (322.32911).
(14) Letter from the chief surgeon, A. E. F., to the chief of Army Transport Service, June 8,
1919. Subject: Request shipment of portable ice machines. On file, A. G. O.,
World War Division, chief surgeon's files (322.32911).
(15) Letter from the chief surgeon, A. E. F., to the chief quartermaster, A. E. F., July 5,
1918. Subject: Heating stoves. On file, A. G. O., World War Division, chief
surgeon's files (414.2).
(16) Letter from the chief surgeon, A. E. F., to the chief quartermaster, A. E. F., May 31,
1918. Subject: Equipment. On file, A. G. O., World War Division, chief sur-
geon's files (414.2).
(17) Equipment of ward unit, diet kitchens (undated). On file, A. G. O., World War
Division, chief surgeon's files (414.2).
(18) Red Cross diet kitchen equipment list (undated). On file, A. G. O., World War Divi-
sion, chief surgeon's files (414.2).
(19) Memorandum from chief of hospitalization division, chief surgeon's office, A. E. F.,
to chief of supply division, June 19, 1918. Subject: List of articles comprising a
surgical ward dressing unit. On file, A. G. O., World War Division, chief surgeon's
files (442).
(20) List showing " Equipment to be ordered for 1,000 beds-tent crisis expansion, 24 wards."
On file, A. G. O., World War Division, chief surgeon's files (440.1).
(21) "Furniture unit for a tent ward." On file, A. G. O., World War Division, chief sur-
geon's files (440.1)1.
(22) "Furniture unit — ward." On file, A. G. O., World War Division, chief surgeon's
files (440.1).
(23) Statement based on general correspondence concerning hospitalization. On file,
A. G. O., World War Division, chief surgeon's files (322.32911).
(24) Report from Col. J. F. Siler, M. C, director of laboratories and infectious diseases,
to the chief surgeon, A. E. F. (undated). Subject: Activities of the division of
laboratories and infectious diseases, from August, 1917, to July, 1919. On file.
Historical Division, S. G. O.
(25) Report of the activities, hospital center, Vichy; also, report of the activities of Base
Hospital No. 117, prepared under the direction of the respective commanding offi-
cers (undated). On file. Historical Division, S. G. O.
(26) Schematic chart of Medical Department organization, A. E. F. Approved by the
commander in chief, A. E. F., March 6, 1918. On file. Historical Division, S. G. 0.
(27) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April
17, 1919. Subject: The Medical Department, A. E. F., to November 11, 1918.
On file. Historical Division, S. G. O.
(28) Statement based on circulars, circular letters, and weekly bulletins, published by the
chief surgeon's office, A. E. F. On file. Historical Division, S. G. O.
(29) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F. (undated),
Subject: Outline report of chief surgeon, A. E. F. Copy on file. Historical Divi-
sion, S. G. 0.
(30) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file. Historical Division, S. G. O.
(31) Letter from the chief surgeon, A. E. F., to the commanding officers of base, camp,
and Red Cross hospitals, May 17, 1918. Subject: Weekly bed reports. On file,
A. G. O., World War Division, chief surgeon's files (632.1).
ORGANIZATIOX AND ADMINISTRATIOX OF CHIEF SURGEON'S OFFICE 239
(32) First indorsement, from the chief surgeon, A. E. F., to commanding officer, 164th
Field Hospital Co., June 20, 1918; on letter from the commanding officer, 164th
Field Hospital Co. to the chief surgeon, A. E. F., June 16, 1918. Subject: Daih-
report of patients in hospital. On file, A. G. O., World War Division, chief surgeon's
files (632.1).
(33) Letter from the chief surgeon, A. E. F., to the chief surgeon. Third Army, January 17,
1919. Siajject: Weekly telegraphic bed reports. On file, A. G. O., World War
Division, chief surgeon's files (632.1).
(34) Letter from the chief surgeon, A. E. F., to chief surgeon. First Army, January 17, 1918.
Subject: Weekly telegraphic bed reports. On file, A. G. O., World War Division,
chief surgeon's files (632.1).
(35) Memorandum from the chief surgeon, A. E. F., to Col. S. H. Wadhams, M. C, G-4,
G. H. Q., A. E. F., September 21, 1918. Subject: Information regarding change
of status of hospitals. On file, A. G. O., World War Division, chief surgeon's files
(320.23).
(36) Memorandum from Col. S. H. Wadhams, M. C, to the chief surgeon, A. E. F., Septem-
ber 30, 1918. Subject: Information regarding change of status of hospitals. On
file, A. G. O., World War Division, chief surgeon's files (320.23).
(37) War diaries, chief surgeon's office, November 16, 1918, to June 30, 1919.
(38) Report of the Medical Department activities of the Third Army (undated), by Col.
J. C. Grissinger, M. C; also, letter from the chief surgeon, A. F. in F., to the com-
manding general, A. F. in F., December 30, 1919. Subject: Report from July 1
to December 31, 1919. Both on file. Historical Division, S. G. O.
13901—27 16
CHAPTER XV
THE DIVISION OF HOSPITALIZATION (Continued)
HOSPITAL CONSTRUCTION; PROCUREMENT
CONSTRUCTION
Despite the possibility of procuring from the French certain buildings
that could be adapted to hospital purposes, it was apparent to the Medical
Department, A. E. F., from the outset that these would have to be supple-
mented by new construction.^ Even before the arrival of headquarters,
A. E. F., the erection of a barrack hospital was commenced in the debarkation
camp at St. Nazaire.^
An important factor in expediting the development of our needs in this
matter was the fact that the French did not have in the training areas which
they were to turn over to our troops sufficient hospitalization to meet our
needs, and it quickly became essential that we then construct buildings of
our own.^ A set of plans for a large hospital of barrack type had been sent
to France when the staff of the American Expeditionary Forces went over-
seas, but these were found to be wholly impracticable.^ The ground plan
of the unit as defined by the War Department called for three times as large
an area as did the plans eventually adopted for a unit with the same number
of beds in the American Expeditionary Forces. Also, it prescribed porches,
a sewerage system, extensive plumbing and heating appliances and other
features which could not have been realized with the limited resources avail-
able in France. Neither lumber nor the labor necessary for their construction
were procurable overseas.^ Accordingly, as soon as it was ascertained that
the plans prepared by the War Department could not be utilized, an assist-
ant to the chief surgeon, A. E. F., after collecting suggestions from various
medical officers commanding base hospitals of the American Expeditionary
Forces, formulated plans for construction and layout which were more com-
patible with our resources.^ Many of the good features that had been de-
veloped by our Allies were incorporated in the plans which he developed, but
he also considered in their formulation the general layout of the Letterman
General Hospital in San Francisco. The plans now formulated were made
the basis of hospital construction in the American Expeditionary Forces.
PLANS FOR A BASE HOSPITAL, TYPE A
The plan for the layout and for the buildings to be erected for each base
hospital, whether located separately or in conjunction with others, was desig-
nated that of a type A unit.^
To conserve wear and tear on personnel and to facilitate administrative
control, the area to be covered by these hospital units was reduced to a mini-
mum, consistent with safety from fire.- To economize in heating, lighting,
structural material, etc., and to centralize and standardize the units, only 20
241
242
ADMINISTRATION, AMERICAN EXPEDITIONAR V FORCES
feet of space was allowed between most of the buildings. From an adminis-
trative and clinical standpoint this concentration proved preferable, and,
though it increased the fire risk, not a single serious fire occurred in any of
these units. ^
The type A unit required a frontage of 850 feet and a similar depth, its
normal layout comprising 3 rows of buildings, divided by suitable intercom-
LMRINE.
ABLUTION BLDQ.
IBftRRACKSl I I
|e>^RRACKS[
PEKSONNEL DINING HALL
WlClS DESTRUC-g
TOR SHED J
INCINERATOR^
Imeoical stores I
y c — '
LATRINE
□
ELECTRIC L1G,HT PLANT
iDISINftCTOIll
ir> o
5 O
(_» "0
u. Z
^^
uJ
uJ —
UJ ^
I WARP I
WARD
|_ ^ j [OFFICERS WARP |
OFFICERS
LATRINE I— J
AHO bathLj=[
OFFICERS QUAR-
I I TERS
I Q.M^STORES I
IPATIENTS Dm. RIC
Ol
iPATIENTil
KITCHEN I
PATIENTS DIN. KM.
DISPENSARY AND CLINIC
ol
lOPERATINQ
[and xray
laboratory AND MOR(<UE
RECREATION HALL
I PATIENTS I
RtCEIVlN&A
(~EVAC. [=L
ADMINISTRATION*
OFFICERS QTR5. & DINING HAU
WA R D
WAR D
1
in uJ
« o
UJ >
WARD
<
I
NUR5E5 DIN-
ING ROOM AND
=i KITCHEN~|=^NUR$FS QTftS^j-
rilNURiES ()TRT^j=(HUR«S QTKS.I
PNUB5C5 R
=fno^rT
NUR2E3
LATRINE
& BATH
H]
850
Fig. 21.— General layout of hospital unit, type A (base hospital), with wards 20 feet wide. Demountable buildings. In
a hospital center one recreation hall and one disinfector were provided for each two hospital units; the nurses' recreation
club was omitted when a central nurses' recreation club was provided
municating roadways and walks. ^ The central row of buildings included
those pertaining to general service such as administration, reception of patients,
baths, operating and X-ray section, clinic, and dining room. On each side of
this central row of buildings was a block of 5 or 10 wards, dependent upon
their size, and in rear of these sufficient space for the erection of tents, the
crisis expansion, which in prolongation of the several wards would provide
additional bed capacity in emergencies.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 243
In the type A unit the ward buildings were of two sizes; * the scarcity of
building material, and the different contracts made it necessary to have in one
part of France buildings entirely different from those in another part.^ Thus
the dimensions of one ward used was 20 by 164 feet; of another, 36 by 156 feet.
The number of patients per ward varied, of course, with its size, normally
being about 50 for the narrower ward and double that number for the wider
one. In addition, the wards provided space for the necessary administrative,
ABLUTION bLO^.
I 6ARRACK5~1 | |
PER50NN£L
Idininq hall] I barracks"!
-FECES DE5TRUC- O-^
TOR SHED J
INCINERATOR^
LATRINE
djELtCTRlC LIQHT PLANT
jDISINFLCTOR]
I 1 c
Z
< lO
X uJ
UJ lO
<r, O
2§
u. Mi
\-
a
u r
> t-
oc —
UJ J
UJ
cc r
o
WARD
WARD
WARD
I I [OFFICERS WARD
H L-l ,
OFFICERS
LATRI
& &AT
OFFICERS QUARTERS
().M.& MEDICAL 5T0RES
— 1 KITCHEN I—,
I— DININQ HALL —
OPERATING, X-RAV
AND CL1N\C
LABORATORY AND MORQUE
RECREATION HALL
L!: REC* EVAC
OFFICERS QUARTERS AND OINIHQ HALL
ADMINISTRATION
WARD
WARD
WARD
Z
<
0-
X »0
uJ o
UJ
"5 O
^ z
O
uJ —
I I
NURSES mm
ROOM* KITCHEN
j=^URSE5 QTrT^ j::|NUR5ES QTRS|
LATRINE
& BATH
==i NURSES QTRS[=1^"
NURSES RECREATION CLUB
850
Fig. 22.— General layout of hospital unit, type A, with wards 20 feet wide. Permanent buildings. In a hospital center
one recreation hall and one disinfector were provided for each two hospital units; the nurses' recreation club was
omitted when a central nurses' recreation club was provided
culinary and toilet facilities. Twenty of these buildings (10 when the wider
wards were used), half being on each side of the central administrative or
chnical group, provided accommodations for 1,000 patients, the normal capac-
ity of these units. Extension of each ward by tentage, the crisis expansion,
doubled this capacity, and gave accommodations for 1,000 emergency beds.
In the corners of the general plan were located the quarters of the officers,
nurses, enlisted men and accommodations for the isolated or psychiatric cases. ^
244
ADMINISTRATION-, AMERICAN EXPEDITIONARY FORCES
Originally the plans for type A units provided for a recreation hall in the
central row of buildings, and a space had been designed for such a structure.
The American Red Cross imdertook to install, equip, and operate these build-
ings, and in the fall of 1917 sent to France 5,000,000 feet of lumber for this
and other purposes.^ Building material, however, was so scarce that the general
staff, A. E. F., requested the American Red Cross to transfer this material to
FtCE5 DE5TRUCT0R
5HED-2_
LATRINE.
ABLUTION BLDG
I6ARRACK5I
PERSONNEL DINING
HAUl
LATRINE
□ electric light PLANT
INCINERATOR
DI5INFECT0R
I I
(ft
o
^ o
Of o
Of z
o
< z
lO ft.
K
0FFICERS|—|_
LATRINtIF
AND BATH
WARD
WARD
WARD
WARD
OFFICER'5
WARD
OFFICERS
QUARTERS
Q.M.Y MEDlCXU
STORES
J~L
= KITCHEN AND =
=1 DINING HALL =
OPERATING X
AND CLINIC
LAB.rh AND
MORGUE
RECREATION HALL
PAT BATM =
It RtCJtVACriJ
1 1 / aoministratiohX
WARD
WARD
WARD
WARD
WARD
r
2 O
ac o
(J
o z
ec t
UJ >
«o >
-r
* O
lU
o. <
lO a
I I
NURSES DINING
RM. 8i KITCHEN
Nil
NURSES
LATRINl
NUR5ES RECREATION
CLUft
850
Fig. 23.— General layout of hospital unit, type A, with wards 36 feet wide, 156 feet long. In a hospital center one recrea-
tion hall and one disinfector were provided for each two hospital units; the nurses' recreation club was omitted when
a central nurses' recreation club was provided
the American Expeditionary Forces, engaging itself to construct these buildings
from material that would be obtained later. ^ This created a regretable situa-
tion, because at no time did sufficient material become available for the Amer-
ican Expeditionary Forces to fulfill this obligation.^ Accordingly w^hen the
American Red Cross realized that fact, it again undertook the provision of
recreation buildings, construction being effected by the engineers, but, when
hostilities ceased many hospital units lacked their authorized recreation huts.^
ORGAXIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 245
AD:\riXI8TKATI0X, AMERICAN EXPEDITIONARY FORCES
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 247
O X
■(N
uj O
ol
III
O
u.
u.
o
O
u.
"o
>
O
y-
a;
o
o
■0-O3-
248
AD.MIXISTKATIOX.
A^r?:RI('A^■ expkditioxaky forces
J I
O- c
Si
o
O
Is
f40UiJ.'iivd iHbi3H nnj.
2
o
H
2
o
o
llJ
u
4^
V
UJ
5
: ^ - -
1 ^ ^
i> — —
5 Z
-4 O
V
II <
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 249
This was a graver matter than might at first appear, for, in the absence of
legitimate diversions otherwise obtainable, the facilities of the recreation
buildings had a noteworthy influence in promoting the morale of the hospital.
&0-0-
A
RACKS
V
OFFlCtR OF Day
(>'-(>"x ll'
R.ECEIVIN(i AND EVACUATlNC^ HALL
69-0" X 20'- 0"
NOrCi- ALL PAR.TIT1ONJ a HiqH
NO FLOOKy
OUILOIHtf "OT LINtD
Fig. 31.— Receiving and evacuating hall, hospital unit, type A; for use with demountable buildings
J4'- o"
-WOOD OR COMCHlTt FLOOH,-!
-COMCRETt FLOOR -
-WOOD OR CONCRETE FLOOR.-
UNOREiiinq ROOM /C^^^^ fU5S 3 WASHmq ''v ) ORESSINq KOOM i
r\, 24'-o"x i8'-o- r\\ ^ 2v-o"xi8'-o"
MOTeS- ALL rARTITIOMS 8-0 UIQH
MO Lmm(j- OB. ceiLmq
Fig. 32.— Receiving and evacuating hall and patients' bath, hospital unit, type A. Permanent type
note: ALL PARTITIOMS O'-O Hlt^H
Fig. 33.— Patients' bath, hospital unit, type A; for use with demountable buildings. Permanent type is shown in
Figure 32
In order to standardize and simplify construction, each hospital w^as
designed on the principle of using only portable wooden huts with floor dimen-
sions of 20 by 100 feet, or any huts built of other materials but approximating
these dimensions and obtainable in Europe.^ These standard units as designed
were complete in every particular.^ Most of the type A hospitals w^ere built
of wood. Some, where local resources permitted, were superior, and, especially
ADMIXISTRATIOX, AMEHTCAX E:XPEDITI0X AR V FORCKS
A
5
o
O 'sO
HI
I !
I i I
I :3 I
If I
I ^ I
! NC
si
if
in those units constructed by English
or French contractors, tile, brick, sheet
steel, and concrete were frequently
used.^ The buildings that were made
of wood or sheet steel (Adrian barracks)
were composed of unit mill-fabricated
sections 10 feet high and 83^ feet wide,
each side of the average buildings which
had a length of 100 feet comprising 12
sections. These sections consisted of
side frames and roof trusses to which,
when set up, the walls and roof panels
were bolted. They were bolted together
while flat on the ground, then raised
to a vertical position and temporarily
secured until the side and roof panels had
been bolted. The wall panels, 10 feet
long and 4K feet wide, were provided
with exterior and interior board walls,
the latter having a smooth finish.
Roofs consisted of boards covered with
tar paper; floors and ceilings, of planks.
The windows, though adecjuate, were
comparatively small, for glass was scarce
and substitutes frequently were neces-
sary. Among these substitutes for glass
were plain or oiled cotton fabrics, and
an isinglass preparation on thin wire
mesh. The isinglass preparation proved
unsatisfactory in the damp climate of
France.^ The first type A hospital,
which was at Bazoilles, was reported
as one-third completed in December,
1917.2
The component parts of the huts were
interchangeable and were so divided that
it was possible by adding sections to erect
a building of any length desired; for ex-
ample, ward buildings in the type A unit
measuring 20 by 164 feet.^-^ Changes in
width were made with more difficulty
but could be effected by an adjustment
of paneling or by doubling up buildings.
Considerable latitude was thus possible
in the dimensions of buildings.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 251
Erection of these huts was relatively simple and, if the military situation
so required, they could be taken down (no nails having been used in the assem-
blage of the component parts), shipped and reerected on another site in a mini-
mum space of time.- They left much to be desired, when compared with
permanent structures, but met requirements, though the great scarcity of lumber
frequently necessitated the use of green timber which resulted in some warping
of the walls. ^ The great advantages which structures of this type presented
were availability, mobility, quickness of erecting, and low initial cost. The
/V foTol
y
Kic. 3').— Nurses' recreation club, hospital unit, type A; demountable
average price paid for them was $2,000. These huts, frequently called barracks,
had been in use among the armies in France and had proven satisfactory.^
They became the backbone of our hospitalization program.
In order to preserve symmetry and to facilitate assembly it was prescribed
that as far as possible huts should all be of similar design and of the same dimen-
sions in any one unit. The demand for these structures gradually became so
great that it was necessary to comb every available European market for build-
ing materials for them, and, as a result, a half dozen different materials for hos-
pital huts eventually came into use.^
BIMCH- 6H£LveS
I P CLINICAL LA
\y i5'x2o'
3
Of whatever material they were built
the huts had the same design and .
dimensions as those prescribed for the
portable wooden huts.
Soon after the Medical Depart-
ment began its construction program
general headquarters, A. E. F., was
confronted by a severe shortage in
the building material necessary for its
many construction projects.^ Accord-
ingly, in an effort to retrench, it
reexamined the plans for hospitals and other buildings and ordered a re-
duction in the space allowed for living quarters of officers, nurses, and
enlisted men.^ The chief surgeon's office acceded to this reduction except
in so far as it affected nurses.^ Though it strenuously opposed diminution
of the modest allowance that had been made for them, this reduction in
their quarters was enforced until April, 1918,^ when one room, 10 by 14 feet,
was allowed for each 2 nurses. Covered passageways connecting wards,
clinical buildings and dining rooms were eliminated as mentioned above, but
n07£ :- WINDOWS AHD DOORS OF MOKijtJE. AUTOPSr
JfOOM 70 0£ JCR££N£D.
COI^CRtTC FLOOHi THUOiKjHOUT.
-Laboratory and morgue, hospital unit, type A;
for use with demountable buildings
252
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the plans successfully resisted further pruning except where the units were
grouped in centers. Certain further reduction was then possible; for example,
some of the psychiatric or isolation buildings were eliminated and the general
staff strongly advocated elimination also of unit administration buildings and
storehouses.^ Fortunately it receded from this position, otherwise it would
have been impossible promptly to equip the frequent drafts of outgoing
patients.^
As discussed below, under procurement, the French were primarily charged
with coordination of construction, several agencies often seeking the same
site.^ After the approval of the French had been received for the construction
of a project, the chief surgeon recommended to the assistant chief of staffs
note: DAR.K. ROOM TO S£ LlflCD TWO S/P£S WITH LEAP OK IKON TO A HSIQHT OF T FT. INTER.IOR. OF ROOlyl TO BE
PAINTED BLACK. IfVALLi AND CEILIN<f OF OPEHATINCf AND FLUOROSCOPIC ROOMi TO BE PAINTED WHITE-
Fig. 37.— Operating and X-ray building, hospital unit, type A. This plan was adopted December 15, 1917, and waste be
used only when demountable buildings were to be used. The permanent type is shown in Figure 38
G-4, general headquarters that such construction be effected. The latter
then directed the commanding general, Services of Supply, to proceed with
construction of a designated number of hospital units at a certain place. The
Engineer Corps then proceeded with the construction, much of this being
effected, under engineer control by civilian contractors. Even when buildings
were taken over from the French it was almost always necessary to have exten-
sive additions, repairs or alterations made before they were suitable for our
hospital use.^
During the early period of our hospital construction it was necessary to
secure from the French a promise that their Engineer Corps would construct
the necessary railroad sidings and loading quais.^ In view of their shortage
of man power and materiel, such promises were difl&cult to obtain. On the
whole, however, without the assistance at this time of the French, who took
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 253
PLANS FOR HOSPITAL CENTERS
The necessity for doubling, or in
emergencies quadrupling, the size of a
base hospital with relatively small in-
crease in the number of the per-
sonnel serving the unit, suggested
that further economies might be made
by grouping these organizations into
hospital centers.^ Though the expedient
c a
immediate and actively helpful interest in the prosecution of our program, we
would have experienced great difficulty
in having ready sufficient hospitals to
shelter the large number of wounded
of the following summer and fall.^ As
it was, very few of our barrack hos-
pitals were ever entirely finished.^ It
was necessary to occupy them long
before the construction work was com-
pleted and wounded were moved into
the wards when these furnished little
more than protection from the ele-
ments.^ During the warm weather this
situation was not serious, but after cold
weather came on it was only the early
termination of hostilities that pre-
vented very great suffering: Thousands
of casualties were sheltered in unfloored
and unheated tents.' The personnel
of base and camp hospitals frequently
assisted in the building or modification
of the structures which their respective
units utilized and continued to perform
this work even after patients were ad-
mitted. Convalescent patients and,
later, labor troops also assisted and
were an important factor in the efforts
to overcome the shortage of civilian
labor.^ The situation was fraught with
great anxiety to those charged with the
provision of hospital accommodations
for the rapidly increasing numbers of
casualties, but in view of the difficulties
encountered it was not surprising that
the construction program was never
fully realized.'
offered many advantages
254
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
HALL
a' % zo'
OI5PEN5A(l.Y
zV-d' X 20- o"
a'x lo'
0B.E.5SINq ROOM
zo' X 20'
trt, tAt.NOSt A THROAT
CLINIC
20' X,
DtNTAL
LABORAT0R.Y
I0'-o"xi2'-o" DENTAL
OPERATING ROOM
lb' X zo"
WAITING ROOM
32 X 10'
ALL FAKJITlONi 6 fT. MI<iH tXCSPT AS NOTED
Fig. 39. — Dispensary and clinic building, hospital unit, type A; to be used for demountable building only
96'- 0"
DENTAL LABORATORY
AND OPERATINq
20' X 24'
la
0ISPEN5ARY
is'xzV
fLAP COUNT
MEDICAL STORAGE,
le' X 36'
[(RESSINqS
16' X 12'
CLINIC
EYE, EAR, HOSE, THROAT
20' X 12'
WAITING ROOM
le' X za'
efT AS ftCTCC
ROOM FOR.
5URQICAL DRES5INQS
is' X 46*
V
Fig. 40.— Clinic and surgical dressings building, hospital unit, type A. This building was to alternate with the operating
X-ray, and clinic building shown in Figure 38; that is, when there were more than one type A unit in a hospital center,
half were to have buildings according to this plan, and half according to the plan shown in Figure 38
CANNED Q00D5
z'xiz'
meat room
12' me'
VEQETABLES
7'xIE' /
BREAD ROOM
tz'% \z'
uJ
88' ±
KITCHEN
43' X 40'
BRAIN BOARP I "I I 1^ I I
<e
0. o
PAY COOKS
16' X 26'
MIQHT COOK
i6'x 13'
Fig. 41.— Patients' kitchen, hospital unit, type A. Temporary type
ORGAXIZATIOX AND ADMIXISTEATIOX OF CHIEF SCRGEOX'S OFFICE 255
liJ t X
CZ2
MbtH ^ 9
1\
z.
-1 X I 9>^ — iVo
■o - u I
3: ^ Lii_ J
3^
13901—27
17
256 AD^riXTSTRATIOX, AMERICAN EXPEnTTIOXA H V FORCES
ORGANIZATION ANT) A I):MINISTRATI0N OF CHIEF SURGEON'S OFFICE 257
dominant consideration causing its adoption was
as far as possible for the shortage
in personnel, h}^ reducing staff and over-
head demands to a niininium. It was
jjlanned as early as September, 1917, to
group from 2 to 20 hospitals and a con-
valescent camp at each of these formations
and that the largest of them should have
from 30,000 to 36,000 beds.^
The geometrical layout of the indi-
vidual unit admirably fitted in with any
grouping scheme. When a site capable of
acconnnodating a number of the type A
units was selected, an initial survey, with
particular reference to contours, was made
by the Engineer Corps, A. E. F., and the
grouping eventually adopted with reference
to the most adaptable conformation to these
contour lines. ^ By doing this and by bear-
ing in mind that the majority of the build-
ings were but 20 feet wide, a considerable
saving in piering materiel or excavation
work was effected. The location of the
units, moreover, was made with a view of har-
monizing the administration of the center.
In consultation with those in charge
of construction, representatives of the chief
surg(>on's ofHce worked out and adopted an
appropriate layout for each center.- The
primary requisite was the decision as to the
location and adequacy of railroad sidings,
all of which had to be newly installed, and
the frontage of units on these sidings. The
requirements for the administration and
supply of these centers were made b}^ pro-
viding suitable extra buildings for that
purpose. Central water, sewerage and
lighting systems, garages, storehouses, etc.,
also had to be installed. In fact, the larger
centers, in some of which we had projected
a capacity of 20,000 beds, approximated
the creation of a veritable city with all its
a (• c ess o ry re q u i r e ni e n t s .
PLAXS FOR CAMP HOSPITALS, TYPE B UNITS
The layouts of the type A and type B
units were highly similar, differences
hetween the two consisting chiefly in
the size and completeness of the buildings employed.
the need to compensate
Z Z (D oi
< uJ - O
S Z X o
A
Kl\ O ^ °
§5. -
< § S o2
uJ oc ^ 0
o . , o
s: o J
V
V
258
ADMIXISTHATIOX, AMKHKAX EXPHDniOXAin' FOHCKS
Typo B hospitals wore niucli loss olahorato than thoso of typo A, for it
was iiitondod that they would provide only the barest hospital noeessities.-
Though each of these was a fairly complete working plant with operating room,
X-ray laboratory, etc., they wore not designed to give definitive treatment.
Each type B unit required an area 600 feet square and consisted of a central
block of service buildings and two lateral rows of five wards each.^ Each of
the wards was 100 feet long by 20 feet broad and accommodated 30 patients. In
each of these units also, space was reserved, in prolongation of the wards, for
crisis expansion by tentago, or w^iere permanent expansion was desired, by
huts.^ The normal capacity of the units was 300 beds but with the crisis
expansion a total capacity of 1,000 beds was provided.
T3'-pe B hospitals were never grouped, but were scattered througiioiit
France, to moot needs arising in isolated commands and in training aroas.-
ROOM FOR NIQHT MEN
30'-0" X 20'-0"
TWO BARRACKS RtqUIRED , ONE TO HAVE. ROOM FOR MiqHT MEN.
NO FLQOR.S. aviLP/Nq NOT LINED.
Fio. 40.— Barrack building, hospital unit, type A. Demountable
DININQ
7a'- a" X
HALL
19'-8''
AO FLOOIZ,
STOfllS
KITCHEN
13'-E"xt9'-8"
C<WC«£T£ fLOOK.
bUILPI*fq HOT LIHtP
Fk;. 47.— Personnel dining hall, hospital unit, type A. Demountable
They were a very important element of American Expeditionary Forces hos-
pitalization and proved to be quite indispensable. On the day the armistice
was signed 66 of these units were in operation.^
QUALITY OF CONSTRUCTION WORK
The quality of the construction w^ork performed in our various individual
hospitals and hospital centers varied from good to bad, seemingly conforming
to the individual experience and efforts of the officer locally in charge of con-
struction.^ Many of the projects were turned over to French or English
contractors who secured the best results. The work performed on some of the
hospital projects, particularly those in the advance section, was highly unsatis-
factory, being of a makeshift character with apparently no attention to detail
or desire to make the best of the material at hand.- It was early pointed out
and particularly emphasized by the chief surgeon's office that the first requisite
OKGAXIZATIOX AND ADMIXISTRATIOX OF CHIEF SUEGEOX'S OFFICE 259
mi
2
?\ i
7^ t
COXVALESCEXT CAMPS
in any construction program was the building of good roads, and the develop-
ment of the water and sewer systems. In many of the
projects these desiderata were overlooked, construction
of buildings being started before any work had been
done upon roads. Hospital sites, when this procedure
was followed, soon became small seas of mud, and
])rogress was materially handicapped. As late as Dec-
ember, 1918, many of the essential roadways in these
units were in inexcusably bad condition.^
In those parts of France where our base hospitals
wore erected, cloudy days prevailed for the major part
of the year and for this reason north-south orientation
with east-west exposure to sunlight was not as impor-
tant a factor as it would have been in more sunny
localities, nevertheless, wherever practicable, this or-
ientation was practiced.
To avoid excessive piering, all buildings were
arranged on parallel lines with the general layout con-
forming as far as possible to contour lines.
Recognizing the shortage in material, and the great
difficulty of obtaining in adequate quantities many of
the essential articles required in a great construction
project of this nature, every conceivable refinement
was eliminated from these type X and type B hospital
units. ^ For example, porches were not included. Be-
cause of the prevalence of inclement weather in
France, particularly in the territory in which we were
recpiired to hospitalize, it was believed that overhead
l)rot(M'tion in the form of covered passageways along
the front of the ward entrance and connecting up the
central group of clinical and mess buildings should be
])rovided. These were prescribed in the plans as
finally adopted, but were never installed in any of
the units, owing to scarcity of lumber. Because of
the fact that plumbing material could be procured in
very limited amounts only, plumbing fixtures were
reduced to a minimum. Buildings were heated by
stoves; fecal matter was disposed of by the pail
method and incineration.
V
With the speeding up of troop movements early _i
in the summer of 1918, it was soon realized that fixed
iiospitalization, as its acquisition was then progress-
imr, could not keep pace witii the arrival of troops. To meet this situation it was
decided to provide convalescent camps in the vicinity of and as part of large
260
ADMINISTKATIOX, AMERICAN KXI'KDITIOXA m' KOKCES
hospital centers to which men not yet lit for duty, but w ho no \ouv:v\- re(|iiire(l
careful hospital treatment, could be sent pending their fitness lor return to duty.'
In these camps the men were provided with shelter. The bed space was limited
but the food was good, and the men were given a certain amount of work and
exercise to fit them for their forthcoming duty. The assistant chief of staff, G-4,
general headquarters, on June 1, 1918, authorized the construction oi- establisli-
ment by tentage of these convalescent camps, on the ratio of 20 per cent of our
total bed capacity.'" Many of these camps were in operation upon the conclu-
sion of hostilities on November 11, 1918, and it was through their operation
-91 - 10 ±-
■« /f^SORTINq ROOM^
/H 19-0" X l9'-8" f\
DRYiNq ROOM
19'- 8" X 40'-0"
M0T£3: COnCHETL FLOOK. THUOUCHOUT
ALL PAK.riTtONS FULL HtlOHT
MoT TO »£ if<£D
19-B X 0-0
SOILED CLOT
19'-8"x
Fig. 49. — Disinfector building, hospital unit, type A, for use only when demountable barracks were used
only that we were able to provide accommodations for the battle casualties
occurring during; the summer and fall of 1918.-
TENTAGE
The intended use of tents in connection with fixed hospitals in the American
Expeditionary Forces w^as to permit a rapid expansion of the bed capacity of a
hospital during stress ^ and to shelter patients in convalescent camps.^ As
stated above, in the plans of both type A and type B hospitals the permanent
wards were so situated as to leave space
JJ DRtSSmQ
Xl ROOM
Fio. 50.— Ablution building, hospital unit, type A.
moun table
Be-
at their outer ends for ward tents.
Thus patients in the permanent wards
so far improved as to be no longer in
need of close supervision by ward sur-
geons and nurses could with safety be
removed to the contiguous tent wards,
leaving space for the more seriously
sick or wounded.
The kinds of tents used were two European models, the marquee and the
Bessonneau and our own Medical Department w^ard tent." Contracts were
made with three companies in France for 10,000 Bessonneau tents." This is a
double-wall tent, capacity 26 beds normal, 30 beds emergency. It is well lighted
with windows, and since stoves may easily be installed, this tent is quite warm.
If supplied with electricity, suitable walks and roads, this tent makes an admir-
able ward as it is warmer than the barrack ward. The Bessonneau tents did
not begin to arrive until about the 1st of October, and there were only 800 of
them in use on November 11." Three thousand marquee tents had been deliv-
ered by the British, and deliveries were coming in at the rate of 50 per day at
the time of the signing of the armistice."
ORGAN l/.ATIOX AN J) ADMINISTRATION OF CHIEF SURGEON'S OFFICE 261
262 ADMINISTHATIOX, AMKHK AX EXPEDlTroXAHV FORCES
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 263
Because of the inability to obtain an adequate number of either the marquee
or Ikvssonneau tents, practically all hospil als with crisis expansion made use of all
three of the kinds of tents referred to. However, the greatest use was made of
the United States Army ward tent in connection with the convalescent camps,
since the patients therein had convalesced to a point where they needed little or
no strict hospital treatment.'^
It was necessary to employ approximately 2,500 American ward tents in
convalescent camps in the fall of 1918, and when the armistice was signed the
chief surgeon's office had placed in use practically all its resources in tentage.^^
The question might logically be asked why type A units were not constructed
on a 2,000-bed capacity basis from the start, and thus eliminate the necessity
for tentage. The reasons for this were obvious. There was not sufficient
[jj FECES DESTRUCTOR
EXPANSION AREA
FOR,
HUTS OR TENTS
350 BEOS
WARD Z=
PATHS 4 WIDE
OPERATING
AND CLINIC
11 ir— ir
BATM HOUSE.
AND DISINFECTQR
PATIENTS MESS —
II ilLJ
□
ADMINISTRATION AND
OFFICERS^UAHnWS | — |
EXPANSION AREA
FOR.
HUTS OR TENTS
350 BEOS
DINING HALL
HOSPITAL PEHSOWHEL
Fig. 53. — General layout, hcspital unit, type B (camp hospital)
building material on hand in France to permit of this action; and even had
there been, it would have been unnecessary and expensive installation.- In
l)i'oviding for this expansion by the use of tentage we divided our sources of
supply and retained a mobility in crisis materiel that w^as essential in expanding
at places requiring it, and, as the name implies, these crises occurred only in
certain phases of our cambat acitvities. By expanding only during them, over-
head and upkeep expenses were reduced materially.
In this connection, the chief surgeon, A. E. F., expressed the opinion
in March, 1919, that a crisis expansion of 1,000 beds made a hospital too un-
wieldy, and that it should be no greater than 500 beds.^
264
ADMINISTEATIOX, AMERICAN EXPEDITIONARY FORCES
I o — ' o
U. M
uj UJ O
-J B J<
_I ,
3 o 9
-_9X,.0-,1'
0-0?-
O
O
> 9
1 N
(rj.H!>i3H nnj HOii
O K
a;
5>
2Ht>i3H nnj rnoiiiinvd'
"■-4 u.-'
O i o S
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 265
UJ (SI
« JX
°'?
«o'2
z o
2 o
3 O
Z 2
f^iivM xHt>u t>na
+1
_1
8
ce.
i
a: o
uJ M
J X
5-
o o
O.'
Z 0-0?-
AD.MIXISTKATIOX, AM?:RICAX KXI'EDITIONAHV FOHCES
J^rior to the api)r(>val, on J
PROCUREMKXT
\iigust 13, 1917, of a program authoiiziiii;
73,000 beds,'2 the chief surgeons' office, A.
E. F., had steadil}' been ac{[iiirinfr existin<r
hospitals from the French, for it was impos-
sible to construct buildings in time to meet
the immediate needs of our troops wlio had
begun to arrive in June, 1917.^ But when
the program authorized June 1 became effec-
tive a progressive system of hospital pro-
curement was adopted.^ As it was evident
that any attempt to administer our base hos-
pitals under canvas would prove impracti-
cable, it was essential that the chief sur-
geon find buildings in which base hospital
units could operate, and during many months
he took over the most suitabh' available
structures that could be foimd. These ac-
commodations could be provided by (1) tak-
ing over military hospitals from the Frencii
Army; (2) leasing the most suitable buildings
available. Buildings in the first category
were transferred by the French to the limit of
their capacity. No reasonable request was
ever refused, and among the hospitals thus
transferred were some of the very best in
France, but evidently it was neither expe-
dient nor possible that that country deplete
its own resources of this character unduly
in order to meet our needs. ^ From our own
point of view, too, there were definite objec-
tions to taking over French military hospi-
tals, despite the willingness of France to help
us to the utmost. One objection was the
fact that most of these hospitals w^ere small
institutions of from 25 to 300 beds, and that
the limited personnel authorized for our serv-
ice could be used much more economically
in operating much larger units. Moreover,
these hospitals, w'idely scattered, were
served largely by French residents of the com-
munities where they were located. When we
took over such a formation it was necessary
either to lease neighboring quarters for our
personnel or to diminish its bed capacity by
quartering them in a part of the hospital
itself. As explained more fully in Chapter
XVI, the bed capacity of our base hospital
ORGAXIZATIOX AND AI)^[IXISTRATI()X OF CHIEF SURGEOX'S OFFICE 267
in order to compensate to a degree for the low percentage of Medical Depart-
ment personnel authorized on the priority schedule by the general staff,
had been increased to 1,000 and made capable of expansion in emergencies
to double that size.'^ It was recognized from the outset that only under
unusual circumstances could French hospitals be used to advantage, except
FECES DBSTRUCTOR. P
□ HQ
LATRINE CiROUP „ „
INCINERATOR
JMM cimic
bHOn AND
0FECES DESTRUCTOR
D BD
X J; LATRINE QROUP
|piwiN<j H*TH ipmiNq HAU^ — ^ — p~
Idininq HAiil Ipwrnq hail| — | — p"
IPATH HOUStl |8ATH HOUsT^ -| — ^
OFFICERS LATRINE -T
AND 6ATH
I I I I □
140
PARADE. QROUND
APPROXIMATELY I060' X 50o'
NOTSS:- LOCATIONS OF ADMIN 1ST RATIOfI BUILOIN<i, OFFICtKS QUARTERS, OFflCtRS MESS,
TRtATMENT BARRACK AND OFFICERS' LATRINE * OATH TO Ot DETERMINCP IH EACH
SPtCIFIC CASE. ,11
THIS LAYOUT CONTEMPLATES THE USE OF MARQUEE UNITS (l7 K 3S - S TO A IVAXo) ^
BUT EITHER BESSONNEAU TENTS ( lO' X 56- 2 To A WARD) OR U.S. HOSPITAL TENTS (ik' X 50-
l TO A ward) may be used WHERE THEY ARE MORE ACCESSIBLE.
THREE INCH CONCRETE FLOORS TO BE USED IN ALL BUILDINqS SHOWN WITH FLOORS
WHIH CONCHETE MATERIAL IS AVAILABLE LOCALLY.
LEGEND
URINALS '
f~~l WOODEN HUT5
I I TEMT5
Pir,. 59.— General layout, hospital unit, type C (convalescent camp), 2,000 beds
to meet transient needs or to form a nucleus around which barrack extensions
could be constructed. Practically all of those which were transferred to our
service w^ere much increased shortly after they came under our control.'*
Therefore, in attempting to meet hospitalization requirements, medical
officers charged with the procurement of buildings quickly turned to the adap-
268
ADMINISTRATION, AMERICAN EXPEDITIONA H V FORCES
11^
^ o X
2.
O-'
X
? o
ILl
<o r J.
^ 111 o ^
_ uJ —
SOS
*- 2 « -
S 3 I--?
V
I- 5 X
z h; =
lU < O
CL —
O
IC
>- uJ X
Z Of:
< o
5 0^ o
2 UJ <^
<yx
3°-^
uls
oo
iZ'O
u. CM
tation of suitable buildings. These, however,
were comparatively few , most of them having
been preempted by the French or by her
allies, Belgium, Italy, and Portugal, and were
being utilized either for hospital purposes or
as habitations for French and Belgian refu-
gees. Many were occupied by Red Cross
and other volunteer aid societies from all
parts of the world. Under these circum-
stances, when the United States entered the
field it was found that the majority of possi-
ble hospitals discovered or offered were lack-
ing essential and rudimentary hospital facili-
ties or potentialities.^^ Common defects were
inaccessibility, poor state of repair, lack of
sanitary plumbing, small size and wide dis-
persion of buildings. Nevertheless, anticipa-
ting the arrival of large bodies of troops from
the United States necessitated the procure-
ment of existing buildings. This was pushed
to the utmost, though most buildings taken
over required alterations, additions, and re-
pairs in order to make them suitable for ho.s-
pital use.'^ On September 27, 1917, the chief
surgeon, A. E. F., reported in some detail the
difficulties which would be encountered in
adapting existing buildings to hospital needs.
On the 17th of the following month he wrote
the Chief of Staff as follows
It is recognized that in the present emergency
anything that offers shelter for patients must be used.
However, the use of such buildings as the French have
offered can be considered only as an emergency meas-
ure and in no wise meets, from our point of view, the
demands for adequate hospital facilities.
Among the buildings taken over were
school buildings, hotels, chateaux, barracks,
factories, and even stables. School buildings,
as a rule, were among the earliest buildings
utilized. Almost invariably they were
unsatisfactory; few had running water, sewer
connections, or toilet facilities. Under the
French law, when schools were requisitioned
for militaiy purposes the teaching person-
nel, which were furnished living quar-
ters in the building, had to })e allowed to
ORGANIZATIOX AND ADMINISTEATIOX OF CHIEF SURGEON'S OFFICE 269
X
I-
i
o
Do
ROOM
X 14-'
S'o
CO
8:
270
ADMlXrSTRATIOX, AMERICAN EXPKDITK )X A K V KOIUKS
lotaiii them.
The result was that in the same buildin^js there would he wards
for patients, quarters for personnel, and livinf;
:/ I ' =^ quarters for French civilians — arrangements
that were inevitabh^ unsatisfactory to all
concerned.
Objections to the use of hotels as iios-
pitals rested on other grounds.'^ As prac-
tically all the best and most suitably located
buildings of this class had been taken over
by the allied governments, those available
were very lai'gely summer hotels without
heating facilities. Usually, they had insuffi-
cient water and very limited plumbing, and
they required many alterations before they
were suitable for hospital purposes. Also the
rate of rentals was very high. In addition,
when a private })uilding was taken over for
military purposes the owner was allowed by
law to reserve certain parts of the building;
also the law required that a building should
be returned to the owner in the same condi-
tion as when taken out of his control.^ The
latter provision necessitated refurnishing
these structures at high cost and removing
all improvements or additions which might
have been installed. Furthermore, they were
difficult to administer and extravagant in
their requirement of personnel.
With many differences in detail, the diffi-
culties incident to the use of other buildings
were comparable to those pertaining to hotels.
Barracks, because of their large ward space,
were more easily administered, generally
speaking, than the hospital established in
other preexisting structures.''^
When we desired an existing French hospi-
tal, or buildings being utilized by the French
as a hospital, a representative of the chief sur-
geon inspected it and if it was deemed suit-
able, a request by letter was made upon the
French for its transfer to the American Ex-
peditionary Forces, through the chief of the
mission attached to headquarters of the
' y* I '-^ American Expeditionary Forces.^ The date
— of transfer was decided upon and the
French thereupon notified us when we could
take control. As a rule, the Medical Department of the American Expeditionary
OROAXIZATIOX AND ADMIXISTKATIOX OF CHIEF SURGEOX'S OFFICE 271
Forces usually took over in these buildings all the hospital property that was
still serviceable.^
Careful inventories, which included the conditions of buildings and lists of
the property contained therein, were prepared by representatives of the American
and French Armies, acting jointly.- These inventories were prepared in quad-
ruplicate and each interested party was furnished a copy. Record of these
transactions was maintained in the chief surgeon's office, A. E. F. From this
beginning gradually developed the service later known as "rents, requisitions,
and claims," which later took charge of all such transactions and became the
custodian of these records.- The personnel of the chief surgeon's office which
had been gathered together for this purpose was transferred to that service when
it was officially put into operation.
i ^
ij s I
1
11
JJ*— FlOOIl PKAin
KITCHEN
40-o"x 5o'-o"
COMCHtTC FLOOK,
tut- rioOK DKAin
ItOQF Of into
1
ill
Fig. 6.3.— Kitchen, liospital unit, type C
The acquisition of schools, hotels, and other buildings not previously
occupied as hospitals was accomplished through leases obtained generally
through a local representative of the French Army.- Rarely was it necessary
to resort to military requisition, although in a few isolated cases this proved
nocessar}'.-
Securing private buildings was not unattended with great difficulty; on the
contrary, much opposition was encountered even after they became available to
us. Endless bickerings with proprietors and directors led to almost endless
coirespondence w^hich could result only in the greatest amount of delay in
making the buildings over into hospitals.'^
In July, 1918, when our hospitals in France provided beds for but 5.7 per
cent of our troops there, the French were asked for buildings sufficient for 45,000
beds, because of the difficulties in the way of construction.^*' The beds requested
were to be in buildings located either on our line of communications or, if not
there obtainable, then in the more remote parts of France. The central bureau,
Franco-American relations, w^hich controlled all such requests, unofficially
13901—27 IS
272
ADMINISTRATION, AMERICAN KXFKDITIONAH V FORCES
-5°
-Ox
"^IHOIIH IWJ NOIlllWd
5 o
cr o ><
uJ
V
V
+1
'o
uJ
»- 0. O o
O aJ f\l ^
r o vo ^
uJ r — §
Z
o o
o: 2
111 5 K
^HOIH ,P MOIlllVirif
V
OROAXIZATIOX AXD ADZMIXISTRATIOX OF CHIEF SUEGEOX'S OFFICE 273
1 .
o O
O .1
a o
> X
or .
o "o
r
o o
V
0-02
0- 02-
274
ADMINISTHATIOX, AMERK'AX KXPKDITION A 1{ V lOlU K:
+1
V
«0
V
c
+ ^p-02 -
ORGANTZATIOX ANB ADTkllXTSTRATTOX OF CHIEF SL'RGEOX'S OFFICE 275
70. — Perspective of n Bessomunm lent in a two-tent unit
PLAN OF A TWO TLNT WAR.D
44- BLDJ
acALt OfitLT
» • i> to » 4a St
Fig. 72. — Plan of a two-tent (Bessonneau) ward
Fig. 73.— Showing heating arrangements in a Bessonneau tent
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 277
278
AD.MIXISTKATIOX, A:\IKKltAX KX I'EDn lONAHV FOMCKS
t I— 1 1—1 t— J tr,
inopn
n n n i
DDDnil
f" f 1 n
Uuui
n n n !
liDODi
nnnni
DDDg
innn
n n n
mnn
1 iJ^
i
1
i
LX
i«N
iX
UT
ANN
<xa
154-'' 4^-
f± .js-4:
PLAN OF WAR.D OF THILLL TLNT5
4a BE.D5
Fic. T.T. — Plan of a inarciuoe tent ward of three tents
Fic. 76. — Showing heating arrangements in a marquee tent ward
OKGAXIZATIOX AND AD:MTXTPTRATI0X OF CHIEF SUEGEOX'S OFFICE 279
Fig. 77. — Perspective of closet in a marquee tent ward, showing construction
D
U
n
J
~'n~
ji
u
9tov«
a
n
D
•PLAN OF TWO TENT WARD'
40 5EPJ5-
jj/ca-le of feet-
Fig. 78.— Plan of a two-tent ward, United States hospital ward tent
280
ADMIXISTHATIOX, AMEKICAX EXPEDITION A UV FORCES
answered all the requests made by furnishino; lists of buildings that were quite
different from those desired, thus necessitating our rejecting many buildings as
being unpractical for our purposes.'^ Because of the urgency of the situation,
Genei-al Pershing addressed the Premier of France as follows:
General Headquarters,
American Expeditionary Forces,
France, August 16, 191 S.
Monsieur Georges Clemenceau,
President du Conseil, Paris.
My Dkak Mk. President: General Ireland, the chief of our Army Aledical Service,
has brought to my attention the vital need of extra hospital facilities, which we must liave
as soon as possible. At present we have at the most but 6 per cent of beds for our troops
in France, and it is agreed that 10 per cent is the lowest safe margin. In view of the
increased program of troop arrivals, it will be impossible for our hospital construction to
keep pace with the influx of troops, so that it is necessary to call on your people for an
increasingly large amount of hospital space in buildings already constructed. On July 13
a request was made for 45,000 beds in buildings either on our line of communications or,
if this were impossible, in the more remote parts of France, and a specific request has been
made for various hotels, schools, and military barracks which have been inspected by our
medical officers. A copy of this list is herewith attached, with the addition that we have
made a request for and need the Ecole de Legion d'Honneur at St. Denis.
In accordance with instructions No. 9 of February 12, from the office of the Under-
secretary of State, these questions have been handled entirely with the central office of the
Franco-American relations in Paris. General Ireland informs me, however, that he fears
that it will be impossible to get the quick action needed. Experience has shown that any
specific request for buildings which have been inspected by our medical officers are usually
met by a counterproposition which, after a certain length of time, has been made to the
American officers in charge of this work. May I not suggest that the central bureau of
Franco-American relations hasten to make inspections of a number of buildings suitable
for hospitals with a view of meeting, without delay, the increasing necessity for largely
increased accommodations for our sick and wounded? Just now, time is the all-important
factor, and anything you may be able to do to enable us to meet our early requirements
will be most highly appreciated.
I regret having to bother you with this matter, but in view of its importance I bring
it to your attention, knowing well that with your powerful assistance we will achieve the
results that we desire in the quickest possible time.
Permit me to express my thanks for the splendid efforts made by your officials to aid
us in every way.
With highest personal and official regards, believe me,
Very sincerely yours,
(Signed) Johx J. Pershing.
At the instance of the Premier, the French mission now submitted a list
of public buildings which, it w^as stated, had been reserved for the American
Medical Service.^* The French Government wished to divide equally the
burden of hospitalization among the territorial departments and among the
different classes of buildings in the departments. Long lists of buildings were
sent at intervals to the chief surgeon through the French mission, but for
various reasons (such as the delapidated condition of some of the buildings,
their small size, their remote location) many buildings included in these lists
had to be rejected.'^ Buildings thus offered fell, in the main, into four classes:
Military casernes, public or private hotels, schools, and miscellaneous buildings
which comprised factories, storehouses, etc. The amount of buildings thus
OKGANIZATIOX AND ADIMINI^TRATIOX OF CHIEF SURGEON'S OFFICE 281
offered potentially i-epresented beds to the number of 155,422.'^ Possible
accommodations for many more had been taken over by us, but these were
found unnecessary after the armistice had been signed.
After the signing of the armistice the buildings which had been accepted
from the French on November 11 were returned with the exception of one at
Lucon,"^ but procurement of buildings continued for several weeks in order to
provide hospital facilities in new locations conformable to the new conditions
which arose by the armistice/^
On November 27, in reply to a request for a conference concerning relin-
quishment of buildings used for hospital purposes, the commanding general.
Services of Supply, wrote the commissioner general for Franco-American war
affairs as follows:
2. Owing to the indefinite information regarding the military situation at present, it
is not believed that a conference on this subject should be undertaken at this time, but this
can be undertaken as soon as a definite plan of demobilization of the American Expe'ditionarv
Forces has been made.
3. Although a reduction of the necessity for hospitalization has been made from 15 per
cent to per cent, since November 11, yet this reduction comes at a time when there are
approximately 190,000 patients in hospitals, and we can not operate upon the lesser figure
until these cases are returned to duty with their units or evacuated to States.
4. All offers of buildings made on the various lists have been definitely accepted or
rejected. Since August 1 these have amounted to approximately 125,000 beds, of which
approximately 51,000 have been accepted and approximately 74,000 rejected. Since this
time many buildings that have been accepted have been returned through the French mission
as being necessary for hospitalization, and from time to time many others will l)e returned
when it is definitely ascertained that they will not be needed and that no troops will be located
ill the localities concerned.
5. Your attention is called to the fact that every consideration has been given to dis-
lurl)ing schools as little as possible, that wherever possible schools have been evacuated
and returned, and this plan will be continued. Attention is also called to the fact that it
will be only necessary to requisition buildings in those localities where troops may hereafter
be stationed and where no buildings exist. This number will be reduced to a minimum.
6. Regarding the matter of deoccupation of the older establishments obtained during
the early part of the American occupation, attention is called to the fact that considerable
construction in barracks, or water supply, electric lighting, sewers, roads, drainage, etc. has
been done, and it is believed that on this account these should be retained until the last
to be evacuated.
7. It will not be necessary to requisition buildings not already in process of organization,
l)ut it is desired to occupy many hotels on the Mediterranean and in the Pyrenees, in which
it is expected to treat convalescents. These properties were obtained through amicable
lease in the main. But few requisitions were made, and their retention is in the main
agreeable to the owners. In other localities no buildings have been taken or will Ijc taken
where hospitals have not been organized and operated.
REFERENCES '
(1) Wadhams, S. H., Col., M. C, and Tuttle, A. D., Col., M. C: Some of the early problems
of the Medical Dei)artmcnt, A. E. F. The Military Surgeon, 1919, Washington D C
xlv, No. 6, 636. ' '
(2) Report of activities of G-4-B, medical group, general staff, G. H. Q., A. E. F., Decem-
ber 31, 1918, by Wadhams, S. H., Col., M. C. On file. Historical Division, S. G. O.
282 ADMIXJSTHATION, AMKHICAX KXPKDITIOXAHV lOHCES
(3) Letter from the chief surgeon, A. E. F., to tlie cliief engineer, A. E. F., September 17,
1917. Subject: Design for a l,()00-bed crisis expansion, A. E. F., Army Hosi)ital,
Type A. Copy on file, A. G. O., World War Division, chief surgeon's files (322.3291 1 1
(4) Plans on file, Record Room, S. G. O. 632 (A. E. F., France).
(5) Letter from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, March 2S,
1919. Subject: Plans for hospitalization. On file. Record Room, S. G. O., 632
(A. E. F., France).
(6) G. O. No. 46, H. A. E. F., October 10, 1917.
(7) G. O. No. 58, G. H. Q., A. E. F., April 18, 1918.
(8) Letter from the chief surgeon, A. E. F., to the chief engineer, A. E. F., September 30, 1918.
Subject : Plan of type B (300-bed) camp hospital unit. Copy on file, A. G. O., World
War Division, chief surgeon's files (329.32914).
(9) Memorandum for the assistant chief of staff, G-4, G. H. Q., A. E. F., from Col. S. H.
Wadhams, G. S., May 24, 1918. Subject: Hospitalization. Copy on file. Historical
Division, S. G. O.
(10) Memorandum for the commanding general. Services of Supj)ly, A. E. F., from the
assistant chief of staff, G-4, G. H. Q., A. E. F., June 1, 1918. Coi)y on file. Historical
Division, S. G. O.
(11) Report on hospitalization and evacuation of sick and wounded, for the military l)oard of
Allied supply, April 10, 1919, by Brig. Gen. J. R. Kean, M. D. Cojiy on file, A. G. 0.
World War Division, chief surgeon's files (314.7).
(12) Memorandum for the chief of staff from the chief of operations section. General Staff,
G. H. Q., A. E. F., August 11, 1917. Subject: Hospitahzation. On file, A. G. 0.,
World War Division (632) .
(13) Report of the activities of the chief surgeon's office, A. E. F., from llic arrival of the
American Expeditionary Forces in Europe to the armistice, )>y the chief surgeon,
A. E. F., March 20, 1919. On file. Historical Division, S. G. O.
(14) Memorandum for the chief engineer, A. E. F., from the chief surgeon, A. E. F., Septcml)('r
20, 1917. Copy on file. Historical Division, S. G. O.
(15) War diar}-, chief surgeon, A. E. F.
(16) Letter from the commander in chief, A. E. F., to the chief of French Mission, Tours,
Juh' 13, 1918. Subject: Hospitalization. On file, A. G. O., World War Division,
chief surgeon's files (322.32911).
(17) Letter to M. Georges Clemenceau, President du Conseil, Paris, from General Pershing,
August 16, 1918. Subject: Hospitalization. On file, A. G. O., World War Division,
chief surgeon's files (322.3291).
(18) Memorandum for the as.sistant chief of staff, G-4, S. O. S., from the chief surgeon,
A. E. F., August, 13, 1918. Subject: Hospital program, A. E. F. On file, A. G. 0.,
World War Division, chief surgeon's files (322.32911).
(19) Letter from the chief surgeon, A. E. F., to the chief, French Military mis.sion, S. 0. S.,
November 23, 1918. Subject: Hospitalization. Copy on file, A. G. O., World War
Division, chief surgeon's files (329.32911).
(20) Letter from the commanding general, S. O. S., A. E. F., to the commissioner general,
Franco-American war affairs, Noveml)er 27, 1918. Subject: Hospitalization. Copy
on file, A. G. O., World War Division, chief stirgeon's files (329.32911).
CHAPTER XVT
THE DIVISION OF HOSPITALIZATION (Continued)
HOSPITALIZATION OF SICK AND WOUNDED
Though the hospitalization division of the chief surgeon's ofhce, A. E. F.,
was charged with the supervision of all hospitals of the American Expeditionary
Forces, this volume gives but brief consideration to the mobile hospitals which
served armies, corps, or divisions in battle or in training areas. These mobile
hospitals are discussed in Volume VIII of this history, which considers field
operations of the Medical Department. Though they were a part of the
entire hospital provision of the American Expeditionary Forces, their procure-
ment did not form a part of the hospitalization program as that term was
t(>clinically understood. The hospitalization program referred essentially to
the provision of fixed formations — i. e., base and camp hospitals and convales-
cent camps — and only when qualified by some explanatory phrase was the term
"hospital program" made to include the field hospitalization of the American
Expeditionary Forces. One reason for this was the fact that most of these
Held units were authorized by Tables of Organization in certain numbers for
each body of troops and were supposed to accompany them automatically
except as this provision was modified by priority of the shipping schedule.
Certain units — e. g., mobile hospitals and mobile surgical units — were not
originally prescribed by organization tables but were authorized by general
orders and were provided according to tactical needs and resources. Thus,
mobile hospitals were authorized ' but not supplied ^ in the proportion of one
per division. But the prime reason why the field units were not included in
the hospitalization program proper was the fact that they were expected to
give only very temporary accommodation to casualties. They had to clear
as rapidly as possible in order to receive new arrivals from the fi'ont and to
be prepared to clear and move on very short notice in order to accompany
the troops they served. Therefore their bed capacity could not be considered
a part of the total that should be available at a given moment. Nor did this
program technically include infirmaries established by the American Red
Cross along the line of communications, nor the infirmaries with capacities of
from 10 to 50 beds which the military forces established and staffed with
local personnel for care of the slightly sick and injured belonging to regiments
in camps, small groups serving in towns, or other detached commands. These
latter infirmaries were established where neither the number nor the severity
of the cases required the establishment of a camp hospital and were under
the administrative control of the local commander. All of these services
though not included in the hospitalization program proper were nevertheless
under the general supervision of the hospitalization division of the chief
surgeon's office.
283
284
ADMTXISTRATIOX, AMERICAN EXPKDITION'AH V FOHCER
Therefore, though the term "hospitalization," as technically understood
and as utilized in the following text, was applied to onl}^ fixed formations,
and among these essentially to base and camp hospitals, including militarized
American Red Cross hospitals and naval base hospitals receiving Army casual-
ties, and to convalescent camps, it was used also in another and more general
sense, being applied to the entire hospital system of the American Expedi-
tionary Forces from the battle areas to the sea. This general system is here
briefly described, before a discussion of hospitalization in its more technical
sense is undertaken, in prder that there may be given a coherent view of the
subject in its entirety, and that the position therein of the fixed hospitalization
may be defined.
HOSPITAL FACILITIES AT THE FRONT
The following units, which are discussed at some length in Volume VIII,
comprised, during the World War, the sanitary train of divisions, corps, and
armies:^ 3 field hospitals, motorized; 1 field hospital, animal-draw^n; 3 ambu-
lance companies, motorized; 1 ambulance company, animal-drawn; 8 camp
infirmaries; 1 medical supply unit; 1 mobile laboratory (added later). The
normal capacity of the field hospital was 216 patients.^
When we entered the World War field hospitals were equipped similarly
throughout and in accordance with existent tables of organization, but the
unlooked for conditions it was necessary for them to meet in France necessi-
tated additions to this equipment.^ Thus to one of the four divisional field
hospitals additional surgical equipment w^as issued in order that it might func-
tion on a larger scale as a surgical hospital. To one of the other hospitals was
added the equipment for the treatment of gassed patients.
Field hospitals were utilized according to current needs, their service and
disposition differing considerably^ in the several divisions under changin<r
circumstances. Often two hospitals were combined and here patients were
sorted, distributed if need be to the other field hospitals with the division, or sent
to the rear.
Usually one of the divisional field hospitals was used to sort patients and
to care for the wounded, one received sick, and another gassed, while the fourth
hospital was held in reserve or was used to supplement one of the others.'
Sometimes one of these hospitals was used for the nontransportable surgical
cases only. When facilities permitted, this last-mentioned unit was reenforced
by a mobile surgical unit, extra bedding and equipment and, rarely, by surgical
teams. The hospitals carried their own tentage, but when opportunity offered
occupied buildings in suitable locations.
As stated above, mobile hospitals were authorized in the proportion of
one per division in action ^ but were not provided in that number.^ Only
12 were actually utilized.^ These units were devised to care for the serious
surgical cases and therefore were provided with appropriate equipment and
with 120 beds for nontransportable wounded. The equipment to a large degree
was surgical, and included X-ray apparatus, sterilizing apparatus, operating
room supplies, electric lighting plant and mobile laundry. The}' cared for the
seriously wounded who could not be transported to the rear without grave
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 285
danger. They were distributed b}^ the army surgeon to augment the service
of field or evacuation hospitals. One was used for a time for the treatment,
in the army zone, of cranial cases only.^ These units, though small, were
complete, required but a few hours for their establishment or packing, were
readily transportable.
Mobile surgical units were smaller organizations transportable on three
trucks each provided with an operating room, sterilizing, X-ray and electric
light equipment. They also were assigned by the army surgeon to supplement
the hospitals of division, corps, or army.^
The sanitary train of a corps consisted of four field hospitals, four ambu-
lance companies (all motorized) withdrawn from the replacement divisions.''
These units cared for and evacuated patients from the divisional hospitals in
front of them to the army units in their rear and cared for the disabled while
en route.
The sanitary train prescribed for an army was the same as that of an
Infantry division.^ It was supplemented by the mobile hospitals and mobile
surgical units above mentioned, and by evacuation hospitals which were
authorized in the proportion of the two per division.^ However, that number
of evacuation hospitals was never reached, though equipment for 16 of them
was sent overseas early in the war.^ Each evacuation hospital originally
provided for 432 patients but in the summer of 1918 their capacity was increased
to 1,000 beds and the equipment of these units already in France expanded
accordingly.^ In emergencies their capacity was further increased. These
units under control of the army surgeon were located at railheads, where they
received from the front all patients that were to be sent to base hospitals on
the line of communications. They were supplemented by other army hospi-
tals which cared for gassed patients by three neuropsychiatric hospitals and
by certain militarized units furnished by the American Red Cross. ^
HOSPITAL FACILITIES IN THE SERVICES OF SUPPLY
The hospital facilities provided in the interior, in France, England and
Italy, but b}^ far to the greatest degree in France, were base hospitals (including
one pertaining to the Navy), hospital centers, convalescent camps, camp hos-
pitals, American Red Cross military hospitals, American Red Cross hospitals,
and American Red Cross convalescent homes
BASE HOSPITALS
Prior to the World War, base hospitals were the Medical Department
units of the line of communications designed to receive patients from field and
evacuation hospitals, as well as cases originating on the fine of communications,
and to give them definitive treatment.^" It was intended that base hospitals
would be well equipped for such treatment and that there would be sent to
the home territory only patients requiring special treatment or whose condition
might be such as to warrant the opinion that they were either disabled per-
manently or not likely to recover within a reasonable length of time.
Base hospitals had been organized originally with a staff of 20 officers,
46 nurses, and 153 enlisted men.'" This staff was increased in the latter part
286
AD.MINI.STKATIOX, A.MKHKAX KXl'KDniOXAin" lOMCKS
of 1917, then consisting of 35 officers, 100 nurses, 200 enlisted men and a valuable
but limited number of civilian eniplo^^ees, viz, dietitians, technicians, and
stenographers."
Base hospital units were allowed in the shipping schedule in the proportion
of four to a division, but were displaced to a considerable degree by combat
troops, with the result that from the time our forces began to conduct operations
on a large scale, in the summer of 1918, their number was inadequate and
remained so until after the armistice was signed.- In many instances their
equipment was not received for many months after having arriving overseas.
HOSPITAL CENTERS
In the American Expeditionary Forces the controlling factor in the prepa-
ration of plans for base hospitals was economy in personnel and material. But
there was every necessity for further economy in personnel, administration,
and supply; consequently, these hospitals were grouped, in so far as local
conditions permitted, into "centers of hospitalization," or hospital centers,
as they came to be called.
CONVALESCENT CAMPS
Before headquarters, A. E. F., authorized the establishment of convales-
cent camps, on June 1, 1918,'^ there were in nearly all our military hospitals
in France many patients whose medical or surgical treatment had been com-
pleted, but whose physical condition was such that their attending surgeons could
not return them to their commands for full duty.*^ Since there was every
necessity for keeping as many base hospital beds as possible ready for the
reception of patients from the front, the substandard men referred to above
frequently had to be evacuated long distances to other hospitals where the
demand for beds was not so insistent. Particularly was this necessity for a
clearance true of the base hospitals located nearer to the front. To relieve
this condition and, at the same time, to increase hospital facilities generally,
the chief surgeon, A. E. F., recommended on May 17, 1918,'^ that convalescent
camps be authorized and constructed, one in the vicinity of each hospital
group. Its size in point of bed capacity was to be rated at one-fifth that of the
hospital group it was to serve.
The cases to be sent to a convalescent camp were those for whom medical
and surgical treatment, beyond dispensary care was no longer necessary, but
who needed a more or less brief period of graded physical training and rehabili-
tation suited to their condition. This physical rehabilitation was to be under
an experienced medical officer; but line officers assisted by noncommissioned
officers, temporarily or permanently disabled for further duty, were to be used
for commanding and drilling provisional companies. Thus over-hospitiliza-
tion and loss of discipline would tend to be obviated.
Though it was proposed to use barracks for convalescent camps, no objec-
tion was held to the use of tents, the stipulation being, however, that there
should be an increase in floor space over that for ordinary barracks and that
there should be no double bunks.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 287
As mentioned above, this proposal of the chief surgeon was approved by
headquarters, A. E. F., June 1, 1918. The bed capacity of convalescent camps
was included in the normal capacity of the hospitals with which they were
connected.
CAMP HOSPITALS
It is neither necessary nor advisable to place all cases originating on the
lines of communications in base hospitals; all such cases do not require the more
extensive or definitive treatment for which base hospitals are intended; further-
more, it is axiomatic that sick and injured soldiers should receive hospital care
just as near their commands as is compatible with the condition of the patients
and with the exigencies of the military situation. Therefore, in the American
Expeditionary Forces for each divisional training area and camp, a camp hos-
pital was provided, where all local cases could be admitted, only the severely
sick and injured requiring a better quality of treatment being transferred to
base hospitals.
As early as July, 1917, the chief surgeon, A. E. F., attempted to secure
authorization for personnel for these important units but his recommendation
was disapproved, on the ground that personnel from the divisional sanitary
trains would be available to fill this need.^ Experience proved that such a view
is based on a misconception of the problem presented. To employ the sanitary
train personnel in this way prevents the training in preparation for combat,
which is just as essential for sanitary units as for those of the line. Moreover,
divisions were constantly changing from one area to another and to have followed
the plan proposed by the general staff, A. E. F., would have resulted in aban-
doning these excellently-equipped sanitary formations until the next division
chanced into the same area.^ The necessity for providing and authorizing
sanitary personnel for the camp hospitals is one of the outstanding lessons of
the experience gained in this war.^
CAPACITY OF HOSPITALS
BASE HOSPITALS
The pre-war bed capacity of a base hospital was 500.^*^ This was based upon
the fact that in a war of motion it frequently would become necessary with the
progression or recession of the battle front to change the locations of base hospi-
tals along lines of communications. Thus mobility was a factor which had to be
borne in mind in connection with the equipment of a base hospital. However,
in France, there was every indication that the location of a given base hospital
would be relatively fixed; consequently, in his study of hospitalization for the
American Expeditionary Forces, the chief surgeon, A. E. F., on August 2, 1917,
stated that the personnel of a base hospital, with proper material, could reason-
ably well care for 1,000 patients, and that it was his intention to increase the
equipment of these units and to operate them with a capacity of 1,000 beds
each."* This increased capacity was effected in General Pershing's project of
the rear which he sent by cable to the War Department during the following
month.
13901—27 19
288
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
In addition to the increase in capacity of base hospitals from 500 to 1,000
beds, a crisis expansion of 1,000 beds was provided for by the use of tents. ^' Thus
there came to be two kinds of bed capacity: normal and crisis expansion. It
was only upon the normal bed capacity, however, that the ratio of hospital beds
to troops was based.
HOSPITAL CENTERS
Since hospital centers comprised an aggregation of base hospitals, their
separate bed capacities w^ere not fixed. They possessed an elasticity, in so far
as hospital beds were concerned, that was limited, on the one hand, by available
ground where buiklings constructed in situ were to be used, and, on the other
hand, by available buildings where these were to be used, for example, at Vichy.
At a number of points several— i. e., from 2 to 11— base hospitals were
grouped physically in hospital centers, and accommodations for much larger
formations were under construction when the armistice was signed.
The largest of these hospital centers were at Mesves, Mars, Savenay,
Bordeaux, Bazoilles, Rimaucourt, Beaune, Allerey, Nantes, Brest, and Limoges,
whereas in Paris the hospitals were grouped administratively as one center.
The principal hospital centers in existing buildings were Vichy (hotels), Toul
(casernes), Clermont-Ferrand, Vittel-Contrexeville, and Cannes.
CAMP HOSPITALS
Camp hospitals had an authorized capacity of 300 beds and crisis capacity
in emergencies,'^ but some were much larger; e. g.. No. 26, which served the
first replacement depot at St. Aignan, and had a capacity of 2,200 beds, and
Camp Hospital No. 52 at Le Mans, which had a capacity of 2,300.^*^
AMERICAN RED CROSS HOSPITALS
American Red Cross military hospitals and convalescent homes were a
valuable asset to the American Expeditionary Forces, particularly in Paris,
where up to the time of the Chateau-Thierry operation the Medical Department
was not allowed to establish hospitals.^ Their bed capacity was variable.
After July 1 the Medical Department did establish many hospitals in and
around Paris and on November 1 1 arrangements were under way by which we
would have had 20,000 beds in that city.^' Other notable Red Cross hospitals
were at Beauvais, Juilly, Jouy-sur-Marne, Toul, Froidos, and Glorieux, as well
as convalescent homes for officers, nurses, and men.
RATIO OF BEDS
In the early summer of 1917 the hospitalization question concerning the
American Expeditionary Forces naturally divided itself into two distinct prob-
lems: Hospital accommodations to meet the immediate needs of the sick of the
American troops in France; the provision of hospitals for the care of the wounded
to be expected when our troops became actively engaged in the front line.
As it obviously was impossible for us to construct hospitals in time to meet
our immediate needs, the French were asked to relinquish to us accommodations
of this character wherever they were needed.^ To these requests they willingly
acceded.
OUTLmL MAP OF f 2.A/iCE:
OHOWINQ HO^ITAL CLmi:Il&
OmC£ Ot- TriI.C«ltt SUROLCWi .
A t ^■
SiCALfc- 1 : 1,250.000
SO U. <54-5& -27
Fig. 79. — Outline map of France, showing the location of the rarious fixed hospitals of tlie American Expeditionary Forc(<s
13901—27. (Face p. 288.;
ORGAXIZATIOX AND ADMINISTEATIOX OF CHIEF SURGEON'S OFFICE 289
Alter the French had met the initial needs of our service in the transfer of
hospital facilities, they urged that we prepare a hospitalization program in
w hich we would outline what we considered necessary to meet both present and
future needs." They did not seek to influence the terms of the program, but
sought chiefly to learn the number of beds that the American Army would
require as well as their geographical distribution in order that they might pro-
mote our projects and coordinate a similar plan of their own with ours. Accord-
ingly, on July 8, 1917, representatives of the chief surgeon's office, A. E. F., and
of the French Medical Service held a conference whose purpose was the study
Fig. 80.— American Red Cross Military Hospital No. 21, Paignton, Devon, England
of a project to provide 50,000 beds, which it was the intention of headquarters,
A. E. F., to locate in France during 1917.^^
This number of beds was considered by the chief surgeon as being too small
to use in connection with a project, in view of the inevitable delay in securing
sites and completing necessary construction work; therefore on August 2 he
reconnnended in its stead that not less than 100,000 beds be provided, using
500,000 troops as a basis for his estimates. At this time the general staff
was willing to agree to the chief surgeon's estimate in part only; that is to say,
no fault was found with the proportion of the number of beds to be supplied,
but, since it was believed that there had been an inadequate time for mutual
research and study, there was a possibility of error which would be minimized
290
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
in a basic number smaller than 500,000 troops. Therefore, the ai)pli('ation of
the chief surgeon's percentages was made to a force of 300,()()() men, thus
viding for 73,000 beds.
Since there must be a correlation of the provision of beds and personnel
with which to operate them, and further, since the bringing of personnel to
France had been placed on a phase basis, it is not surprising that headquarters,
A. E. F., should adopt a similar basis for hospitals. This was done in mid-
October, 1917.^ Hospital beds were now allowed on the basis of 10 per cent of
Fig. 81.— American Red Cross Coiu ali bcriit Hospital No. 101, Lingficld, Surrey, England. (For officers)
our total forces in Europe for a given phase, with an additional 10 per cent for
troops in combat. It was anticipated by the general staff that not more than
four of the five corps concerned would be engaged simultaneously, consequently
the above allowance would approximate 15 per cent hospital beds for ordinary
needs and 25 per cent for maximum needs, in addition to the beds of the divi-
sional field hospitals.
The provision of base hospitals according to the successive increment of
forces was tabulated as follows:
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 291
American Expeditionary Forces hospitalization program — estimated beds required
Phase
Second .
Third..
Fourth .
Fifth..
Sixth...
Troops
Line of communication troops..
Army troops and aviation
First Corps..
Army troops and aviation
83.000 8.300
"22,0001 2.200
174,000 17, 400
25.0001 2, .500
Total __ 304, OOOlSO, 400
Line of communication troops.. 73, OOOj 7,300
Second Corps j 178, 000 17, 800
.\rmy troops and aviation ["SUOOOj 3, 100
liinc of communication troops.. _ I .52, OOOi .5,200
Third Corps .1177,000 17,700
"32,000 3,200
41,000 4,100
177,000 17,700
"29,000 2,900
27,000 2,700
177,000 17, 700
"21,000 2,100
16,000 1,600
Army troops and aviation.
Line of communication troops.
Fourth Corps
Army troops and aviation
Line of communication troops.
Fifth Corps..
Army troops and aviation
Line of communication troops.
Total
Convalescent camps and depots.
Grand total.
Total hospi-
talization
e.s-
8, 300
2,200
17, 400
2,500
17,400
17,800
17,700
17, 700
17,700
8, 300
10, .500
27,900
30, 400
Hospi-
tals
200 119,
100 124,
1221.800
138
7,000
12, om
19,000
8,000
31,000
7,000
31,000
6,000
31,000
5,000
31,000
14,000
183,000
17,000
200,000
13,000
24,000
37,000
14,000
55,000
12,000
55,000
10.000
55,000
8,000
55,000
20,000
321,000
17,000
338, 000
7,000
19,000
13.000
37,000
000 50,000
000 51,000
000 106,000
,000 118,000
,000 173,000
000 183,000
000,238, 000
000 246, 000
000 301,000
14,000 20.000
183.000 321,000
17,000l 17,000
200, 000 338, 000
" 15,000 aviation.
In forwarding this program to the chief surgeon, the adjutant general,
A. E. F., stated that since the whole question of the strength of the American
Expeditionary Forces was dependent upon the amount of tonnage that might
be placed by our Government in the trans-Atlantic transport service, and that
accurate information on this particular subject would not be available for some
time, the commander in chief, A. E. F., was not prepared to take any definite
action beyond such authorization for providing hospitals as had already been
given. The study was believed to be complete enough to warrant consideration
by the chief surgeon with a view of making such recommendations as he desired.
In his analysis of this program, the chief surgeon pointed out that there
were two factors which must be taken into consideration as having a possible
modifying influence on the result arrived at: ^'^ First, the basic principle on
which the program was founded was that the personnel of each base hospital
unit could care for 1,000 patients; second that a base hospital unit in an emer-
gency, could increase its capacity from 1,000 beds to 2,000 beds by the use of
tentage. As to the first, the base hospital unit obviously could not care for 1,000
l)atients if it became necessary to divide the units into small detachments in order
to fit them into small existing buildings which might be taken over from the
French. As to the second factor, the emergency expansion could not be consid-
ered as being possible were existing buildings such as schools and hotels to be taken
over and used as hospitals, in view of the fact that in connection wdth most of
these buildings there was inadequate ground space for expansion. Even if there
were the necessary ground space, the lack of usual hospital facilities, by addi-
tionally burdening the personnel, would almost make expansion out of the
question.
292
ADMINISTRATION, AIVIERICAN EXPEDITIONARY FORCES
On December 15, 1917, the chief surgeon reported to the commander in
chief, A. E. F., that in so far as the Medical Department was concerned, the
project of 73,000 hospital beds along the line of communications iiad been
accomplished. In this accomplishment, he had found that adherence to a
fixed numerical fractional program had caused much confusion and debiy in the
acquisition of sites and labor and in the placing of material. It was thus obvious
that hospital construction on a definitely prescribed percentage basis could not
keep pace with the arrival of troops. In the absence of authorization to perfect
plans for a progressive hospitalization program looking far into the future, it was
impossible to provide in time the necessary hospital facilities eventually required.
For this reason the chief surgeon recommended that hospital construction he
authorized on the basis of the strength of an army rather than in proportion
to increments of troops. Such authorization, he pointed out, would permit the
development of a much more comprehensive plan of hospitalization than the
phase or progressive fractional plan. This program was to contemplate the
ultimate provision of a total of 200,000 hospital beds, ordinary capacity.
Pursuing this question further, a medical representative of the chief surgeon,
G-4, G. H. Q., A. E. F., made an analytical study of the resources and limitations
of hospitalization. The result of this study was submitted to the general staff
on March 31, 1918, together with a recommendation that there be authorized
an automatic bed allowance which would recognize that six months would be
necessary to complete a project. It was also recommended that the Medical
Department be authorized to arrange for new hospital accommodations on the
basis of 12,000 beds a month, which would be acquired either through acquisi-
tion of existing buildings or by new construction. These recommendations
were not approved at the time, and until a new policy was announced it was
necessary for the Medical Department to take up direct with the general staff
any new project for which new construction was necessary.
At this time 45,300 beds were allowed on the strength of the troops pres-
ent, 1 corps— i. e., 300,000 men — but of these beds there were actually avail-
able in the hospitals of the American Expeditionary Forces only 21,340, leaving
a shortage of 23,960.^ Projects then under way to meet the needs of present
and prospective strength would provide for a total of 118,930 beds when
completed.^
On June 1, 1918, headquarters, A. E. F., authorized the Medical Depart-
ment to maintain an actual current bed status aggregating 15 per cent of the
total strength of the American Expeditionary Forces.^'' In effect, this was
approximately the same percentage that previously had obtained — that is,
10 per cent for total forces and 10 per cent additional for combat forces—
however, in reaHty, the establishment of the flat rate tended to avoid future
conflict of opinion as to the ratio of combat and other troops. This latest numer-
ical allowance was to include the accommodations in all fixed hospitals, irre-
spective of type, as well as in convalescent camps, and the computation was
to be made on the basis of ordinary capacity.
Since it now w^as well recognized that projects involving new construction
could not ordinarily be available for occupancy before the lapse of at least six
months, and that the provision of adequate hospital accommodations must
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 293
keep pace with the arrival of troops, headquarters authorized the Medical
Department an additional credit of 90,000 beds over the 15 per cent referred
to, in order that it could make timely anticipation of its future needs. In
utilizing this credit the Medical Department was to write off approximately
one-sixth of it monthly/'^
LOCATION OF HOSPITALS; PROGRESS IN HOSPITALIZATION
The first program for the location of hospitals of the American Expedi-
tionary Forces, formulated by the chief surgeon, A. E. F., in the summer of
1917, was, of necessity, tentative for the reason that before it could be adopted
certain factors must definitely be decided upon, especially the sector of the
front which the American forces would occupy, and the main railway lines
and ports which would afford means of communication.^ Up to the fall of
1917, the chief surgeon had not received any definite information concerning
the sector our troops eventually would occupy at the front; ^ however, as
delay could not be countenanced, he proceeded on the assumption that our
principal bases must be St. Nazaire and Bordeaux, and that our sector would
be in Lorraine, in the vicinity of the training areas (Gondrecourt, Neufchateau,
Mirecourt, and Le Valdahon) in which they were placing our troops.^ This
assumption indicated, in turn, what probably would be our lines of communi-
cations, and events proved that these early conjectures generally were correct.
The American sector eventually occupied extended from west of Verdun to
east of Belfort,^" and the base ports most utilized were Bordeaux, La Rochelle,
St. Nazaire, and Brest.
While estimates of the number of troops that would be used in the Ameri-
can Expeditionary Forces were being formulated by general headquarters,
A. E. F., the hospital program was being furthered, inspections for possible
hospitals were continued and arrangements made for obtaining buildings
which were suitable for hospital purposes, and, so far as could be estimated,
properly located near St. Nazaire, Bordeaux, the training areas mentioned
above and along the railway lines between them and the ports. ^ In carrying
out this project studies were made of prospective hospital sites in or near the
following^ places : Nantes, Angers, Tours, Romorantin, Bourges, Gievres,
Nevers, Beaune, Dijon, Langres, Chaumont, Martigny, Neufchateau, Vittel,
Contrexeville, Bordeaux, Perigueux, Limoges, Chateauroux, St. Nazaire,
Savenay, La Rochelle, Cercy-la-Tour, Le Valdahon, Besangon, Rigny-les-
Salles, Cosne, Ourches, Epinal, and Sens.^^ The Engineer and the Medical
Departments concurred in the behef that Bordeaux and St. Nazaire were the
most desirable ports, since in both places there were good facilities for docks,
large base hospitals, camps, and water supply.
As stated above, the first allowance for hospital beds made by general
headquarters, A. E. F., was 73,000.^^ As to the location of these, headquarters
directed that a joint study be made by the chief quartermaster, the chief
surgeon, and the chief of engineers, A. E. F., which resulted in the geographical
distribution of hospital beds as follows: 14,000 beds in the advance section,
21,000 beds between Tours and the French zone of the armies, 38,000 beds from
Tours westward.
294
ADMINISTRATION, A:MERICAN EXPEDITION AHY FORCES
The chief surgeon, A. E. F., now proposed that such construction for
hospitals be located as follows, the several establishments in each section
being entered on this list, in order of their preferability : ^
Advance section (14,000 beds)
1. Bazoillcs-sur-Meuse
2. Bazoillcs-sur-Meuse
3. Bazoilles-sur-Meuse
4. Chaumont
5. Bologne
Intermediate section (21,000 beds):
1. Dijon
2. Dijon
3. Beaune
4. Moulins ---
5. Vichy _ _
6. Chateauroux
7. Limoges _
Base section (38,000 beds):
1. Tours
2. Perigueux
3. Vauclaiie.-
4. Tale nee —
5. Angers
6. Nantes
7. Savenay
8. St. Nazaire -
9. La Boule
10. La Rochelle
11. Bordeaux
12. Poitiers
13. Angouleme
To be
con-
structed
(beds)
2,000
5,000
0
400
700
2, fXW
700
■MM.)
5, (KK)
5,000
3,000
1,000
1,000
On October 6, the commander in chief, A. E. F., wrote the French mili-
tary mission in part as follows
The attached letter shows in detail the program that is now being carried out by the
Medical Corps, American Expeditionary Forces. It shows the immediate necessity of
providing hospital facilities for 73,000 beds in the zone of the line of commnnications. It
shows also the general areas in which it is desired to locate the various hospitals with the
desired bed capacity of each.
It is believed, however, that during the preliminary phases of our operations here we
will be forced to use existing buildings, hotels, etc., as hospitals pending the construction
of new hospitals, notwithstanding their disadvantages. This is on account of the shortage
of construction material.
The most practical plan for us to follow, it is believed, is to make use temporarily of
the existing facilities and at the same time push new construction as fast as possible. The
sites for construction of hospitals must be at points where the available ground will permit
of large expansion and where the railroad evacuations will be best met.
It is therefore requested that we be given the benefit of the opinion of the French au-
thorities on this entire question at as early a date as practicable. Please include lists of
available buildings in the zone of the line of communications of these forces, not including
those listed in the attached letter, suitable and available for hospitalization. At the same
time, please give your recommendations as to location of definite sites for coi|^truction of
hospital centers.
From the attached letter the difficulties that the Medical Corps, American Expedi-
tionary Forces, have had in their endeavor to procure hospital accommodations and sites
are clearly presented. It is requested that this matter be immediately taken up and that
these headquarters be informed as to what steps it should take with reference to placing
the proper representatives of the Medical Corps in relation to representatives of the French
Government, to the end that any further delay in providing hospitals for these forces be
prevented.
On October 8, 1917, the chief surgeon informed the chief of staff, A. E. F.,
that the commander in chief of the French Armies had stated that it would
be necessary to hold a conference to establish a program of hospitalization.^^
He added that a working basis concerning this subject in the French zone
of the interior had been reached between his office and that of the French
Medical Service, but that until a similar arrangement could be made for hos-
pitalization in the zone of the armies, but little progress could be made in
ORGANIZATION AND AD:MINISTRATI0N OF CHIEF SURGEON'S OFFICE 295
providing the absolutely necessary hospital facilities in that jurisdiction. He
therefore recommended that the proposed conference between representatives
of the French and American services for the consideration of hospitalization
be held at the earliest practical moment.
On October 11, the commander in chief wrot(5 to the chief of the French
military mission calling attention to the need of hospitalization in the Amer-
can Expeditionary Forces and to the necessity for immediate steps to provide
adequate hospital facilities. He recommended that a conference be called
at the earliest possible moment.^* Accordingly a conference was held at
Chaumont, October 17, between representatives of the American and French
Armies, when the following conclusions were reached :
Seventy-three thousand beds should be provided for a force of 300,000 men. In order
to shorten the journey for wounded and to effect economies in transportation, equipment,
personnel, the general distribution of beds proposed by the general staff (13,000 in the ad-
vance zone, 21,000 in the intermediate, and 39,000 in the bases) should be modified, so
that 40,000 beds would be located in the intermediate zone and 20,000 in the zone of the
bases. The intermediate zone would be included (roughly) in the area bounded by Sens
(exclusive), Orleans, Tours, Dijon, Lyon. Sanitary installations would not be restricted
to the lines of communication only, but might also be developed on subsidiarj^ branches
of these lines. This arrangement would secure treatment of slight cases in the zone of
the advance, of more serious cases in the intermediate zone and of the very serious cases,
inchiding those returnable to the United States, in the zone of the bases. Inspections
with a view of locating suitable hospital sites would be undertaken jointly, hy the Americans
and French without delay and installations would be sought not only on the direct lines
of communication but in subsidiary lines as well. In the zone of the armies, formations
then held by the French would be turned over with their equipment to the American service
as soon as its troops entered the sectors these formations served, while regional installations
would be, in principle, retained under the general jurisdication of the territory they served,
the transfer being decided according to circumstances in each case.
The report of the conference further reads as follows:
Hospitals in the zone of the armies: In regard to the 10 division camp hospitals which
the American staff proposed to establish as hospitals of 300 beds apiece with extension pos-
sibilities to 1,000 beds, the French staff thinks that it would be advisable, in order to obtain
immediately and at the lowest cost the necessary buildings for the hospitalization of the
sick, to provide each zone with places for cantonment infirmaries in each of the existing
cantonments, and to use, for supplementary needs, the French hospitals which would be
handed over to the Americans in the zones in question and to which evacuations could be
made by motor ambulances. In this connection a list of hospitals containing from 7,000
to 8,000 beds was handed the representative of the chief surgeon. These hospitals will
be handed over progressively to the American Medical Service concurrently with the arrival
of 300,000 men.
Beds ; Beds
Vaucouleurs 50 LifTol 100
Mandres 220 Martigny 850
Ourches - 500 Contrexeville 1,080
Rigny 600 Vittell 1,820
Chalaines 220 Bazoilles (already turned over) 1,040
Mirecourt 240
Xeufchateau (300 beds having already
been handed over) 900
It is also considered expedient to utilize as far as possible at the present time all avail-
able structures, such as chateaux and large buildings. In regard to the hospitals which
are to be built, sites are to be searched for on the lines, Bricon-Chatillon, Chatillon-Troyes,
Chalindroy, Boulogne- Rimaucourt.
296
ADMINISTEATION, AMERICAN EXPEDITIONARY FORCES
4. Hospitals in the zone of the interior. — After the examination made of the projects
entertained by the American staff in regard to the French hospitals which are to be taken
over and hospitals to be built, the conclusion is reached that in dealing with numbers of beds
as detailed in page 1 it is advisable only to use, in selecting important hospital centers, such
plants or places that can be cleared by railroad service. In this respect sites for large hospitals
will be suggested and searched for (subject to the approval of the coniinandor in cliicf,
A. E. F.).
(1) In the intermediate zone, sites will be located in the district of Cercy-la-Tour, of
Clamecy, of Autun, of Avallon, etc.
(2) In the zone of the bases, sites will be located in the district of Rcdon and Auray
in the northern area and in the district of Bordeaux and Arcachon in the southern area.
The sites to be utilized and the hospitals in the interior which are to be taken over will l)e
made the subject of studies and agreements, to be concluded, in each case, between the
luidersecretary of state of the service de sante and the general staff of the Army (fourth
bureau, on the one hand, and the American staff, on the other).
5. It is agreed that this study is based on the requirements of 300,000 men and that
a new conference will be held in due course for a discussion of the needs of larger numl)ers
of effectives.
With this report was inchided a statement of the hospitals which had been
and which would be turned over to the American Expeditionary Forces and
the bed capacity of each. These were as follows:
1. INSTRUCTION CAMPS
Gondrecourt (turned over August, 1917): Beds
Wooden barrack hospital capacity 180
Can be increased by additional 70
250
Bazoilles-sur-Meuse (turned over July 4, 1917), formerly the Bazoilles Hospital (direc-
tion Etapes group of the Armies of the East) : Wooden barrack hospital 1, 000
2. ZONE OF THE BASES
St. Nazaire (turned over July 6, 1917) :
Boys' school (formerly Surgical Hospital 59) 292
Eleventh region, possible extension of 208
500
Camp infirmary, eleventh region 100
Savenay (turned over Aug. 8, 1917):
Normal school for teachers (formerly Surgical Hospital 14) 300
Possible extension 700
1, 000
Brest (placed at the disposal, on June 17, 1917, of American patrol crews.
Bordeaux (turned over Aug. 8, 1917): Small school of Talence (formerly Surgical
Hospital 25) 1, 083
Eighteenth region — 40 Adrian barracks have been asked for the personnel.
3. INTERMEDIATE ZONE
Angers (turned over Sept. 3, 1917):
Small girls' school (formerly Surgical Hospital 58) 470
Ninth region, possible extension 530
1,000
ORGANIZATION AND ADMINISTEATION OF CHIEF SUEGEON'S OFFICE 297
Chateauroux (turned over Aug. 22, 1917) : Beds
Retreat for mental affected (Surgical Hospital 23) 810
Ninth region, possible extension 190
1, 000
Dijon (turned over Aug. 8, 1917):
Theological school (formerh' Surgical Hospital 77) 546
Eighth region, possible extension 455
1,000 '
Limoges (turned over Sept. 3, 1917):
Haviland factory (formerly Hospital du Mas Loubier — Surgical Hospital 49) 510
Possible extension 490
1, 000
Paris (in process of being turned over) : Formerly Red Cross Hospital, 6 Rue Piccini. 300
5. ZONE OF THE ARMIES
Chaumont (in process of being turned over) : Artillery barracks (Surgical Hospital 28)
twenty-first region 2, 800
Two Adrian barracks have been requested for operating rooms.
Neufchateau (Rebeval Barracks) 300
HOSPITALS THAT WILL EVENTUALLY BE TURNED OVER TO AMERICAN EXPEDITIONARY FORCES
Nantes, Grand Lycee de Nance (schoolhouse) : Eleventh Region Complementary
Hospital No. 21 500
Perigueux, Vauclaire Abbey: Twelfth region departmental establishment, not occupied
by the service de sante, which should be turned over to American Expeditionary
Forces.
Limoges: Seminary.
Tours: Chateau St. Victor (to build), ninth region.
Perigueux: Mallet property (to build), twelfth region.
Bordeaux: Chateau Raoul et Chateau des Iris, eighteenth region.
Dijon: Porte Neuve station, eighth region.
Nantes: Grand Blottreau, eleventh region.
La Rochelle: Land between Lallen and La Pallice, thirteenth region.
Beaune: Eighth region.
Peppignan: Hospital (part finished) 600
The report of this conference was accepted by the administrative section,
general staff." Concerning this program the chief surgeon wrote as follows
on October 19, 1917.^«
October 19, 1917.
Memorandum for the C. of S.
Subject: Hospitalization.
1. The conference of October 17, 1917, referred to in attached memorandum brings
up tliree points for consideration:
(a) The acceptance of certain French hospitals located to the north and east of Neuf-
chateau.
(fe) Changing the figures accepted by the general staff, from 38,000 beds in the base
section and 21,000 beds in the intermediate section, to read 21,000 beds in the base section
and 38,000 beds in the intermediate section.
(c) The enlargement of the intermediate section to take in the territory shown on the
attached map.
298
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
2. All of these propositions meet with my approval. The acceptance of the hospitals
offered by the French appears at this time to be a matter of necessity. The enlargement
of the intermediate zone opens a considerable field where existing French hospitals suitable
for our purposes may be found.
3. The accompanying map shows very clearly the lack of existing French liospitals in
the southwestern part of the divisional training areas, consequently as stated in the attached
memorandum hospital facilities can be provided only by construction.
4. In paragraph 1-A of the attached memorandum the statement is made that 7,000
beds now existing in the French hospitals are available to the American Expeditionary
Forces. Attention is invited to the fact that while the French hospitals shown on the map
attached total, according to the figures, 7,233 beds, 1,510 beds have already been turned
over to the American Expeditionary Forces and are not to be counted. This leaves 5,700
beds which it is stated are available. From information now at hand it appears that one of
these proffered hospitals belongs to the civil community and can not be disposed of by the
G. Q. G.
5. This number will be further reduced through the fact that it appears probable from
information now at hand that some of these smaller hospitals can not be used by the American
Expeditionary Forces. In addition, the capacity of the hotels at Contrexeville, Martigny,
and Vittel is listed differently by the French for summer and winter; i. e., certain of the
hotels were built for summer use only and it has been possible to occupy only a part of the
buildings in winter time. The figures given above are the summer capacity.
6. It is recognized that in the present emergency anything that offers shelter for patients
must be used. However, in concurring in this memorandum it is with the reservation
that the use of such buildings as the French have offered can be considered only as an
emergency measure and in no wise meets, from our point of view, the demands for adequate
hospital facilities. The very serious obstacles to the use of buildings now employed by the
French as emergency hospitals was indicated in detail in my letter of September 27, 1917,
on the general subject of hospitalization.
A. E. Bradley,
Brigadier General, Chief Surgeon.
On October 23 the following hospitals were under the control of the chief
surgeon, A. E. F. : "
American Red Cross Military Hospital No. 1, Neuilly.
Base Hospital No. 6, A. E. F., Bordeaux.
Base Hospital No. 8, A. E. F., Savenay.
Base Hospital No. 9, A. E. F., Chateauroux.
Base Hospital No. 15, A. E. F., Chaumont.
Base Hospital No. 17, A. E. F., Dijon.
Base Hospital No. 18, A. E. F., Bazoilles.
Base Hospital No. 101, A. E. F., St. Nazaire.
Base Hospital No. 27, A. E. F., Angers.
Base Hospital No. 39, A. E. F., Limoges.
Base Hospital No. 2, care of General Hospital No. 1, British Expeditionarv Force,
Etretat.
Base Hospital No. 4, care of General Hospital No. 9, British Expeditionary Force,
Rouen.
Base Hospital No. 5, care of General Hospital No. 13, British Expeditionary Force,
Camiers.
Base Hospital No. 10, care of General Hospital No. 16, British Expeditionary Force,
Treport.
Base Hospital No. 12, care of General Hospital No. 18, British Expeditionary Force,
Camiers.
Base Hospital No. 21, care of General Hospital No. 12, British Expeditionarv Force,
Rouen.
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 299
CAMP HOSPITALS ESTABLISHED OR TO BE ESTABLISHED
First divisional training area, Camp Hospital No. 1, A. E. F.
Second divisional training area, Camp Hospital No. 2, A. E. F.
Third divisional training area, Camp Hospital No. 3, A. E. F.
Fourth divisional training area, Camp Hospital No. 4, A. E. F.
Fifth divisional training area, Camp Hospital No. 5, A. E. F.
Sixth divisional training area. Camp Hospital No. 6, A. E. F.
Seventh divisional training area. Camp Hospital No. 7, A. E. F.
Eighth divisional training area. Camp Hospital No. 8, A. E. F.
Ninth divisional training area, Camp Hospital No. 9, A. E. F.
Tenth divisional training area. Camp Hospital No 10, A. E. F.
Camp hospital established at St. Nazaire, Camp Hospital No. 11, A. E. F.
Camp hospital established at Le Valdahon, Camp Hospital No. 12, A. E. F.
Camp hospital to be estabUshed at Mailly, Camp Hospital No. 13, A. E. F.
Camp hospital to be estabUshed at Issoudun, Camp Hospital No. 14, A. E. F.
Not until October 31 did the chief surgeon receive the approval of the chief
of staff of the conclusion reached at the conference of October 17.^^ In the
meantime very little could be accomplished in the prosecution of the hospitali-
zation program because of the fact that it was necessary to have the approval of
the commander in chief, A. E. F., before hospitals offered by the French could
be accepted. These hospitals were particularly those in the region of Vittel,
Contrexeville, and Martigny. Previously the general staff, A. E. F., had
notified the chief surgeon that hospitalization projects should keep to the west
of the general area in which these places were located.^''
On October 31, 1917, the chief of staff telegraphed the approval of the
commander in chief concerning the hospitalization project of October 17.^^
The chief of staff drew especial attention to that portion of his approval which
pertained to the utilization of existing buildings. The next day the commander
in chief approved this project in the following terms :^
A. S., G. S., November 1, 1917.
¥vom: Commander in Chief.
To: Chief, French Mihtary Mission.
Subject: Hospitalization.
1. I have the honor to inform you that the hospitalization project contemplated in the
conference held at the French mission October 17, 1917, meets with the approval of the
commander and chief as follows :
(a) Acceptance of existing hospitals offered in the zone of the armies, to be taken over
as required.
{h) Acceptance of the area Sens (exclusive)— Orleans— Tours— Dijon— Lyon for hos-
i)italization in the intermediate area, subject to remarks given below.
(c) Acceptance of the altered distribution of the 73,000 beds in the first program so as
to give about 40,000 in the intermediate section and about 20,000 in the base sections.
(d) Acceptance of the plan to seek sites for construction of hospital centers in the
general areas indicated in the conference; i. e., for the advance section in the vicinity of
Is-sur-Tille Champlitte, AndiUy, Boulogne, ChatiUon, etc., for the intermediate section in
the vicinity of Cercy-la-Tour, Autun, Avallon, and Clamecy, and for the base sections in
the vicinitv of Bordeaux, Redon, and Auray.
2 With reference to (c) above, and in view of the necessity of utilizing existing buildings
to the maximum, it is considered advisable that the areas in which such buildings may be
ocated include also the vicinity of the American line of communications from Tours to St.
Nazaire and Chateauroux to Bordeaux.
300
ADMINISTRATION, AMERICAN EXPEDITIONAHY FORCES
3. The commander in chief in giving his approval of the project for hospitaUzation lays
special emphasis on the fact that, on account of the scarcity of shipping and difficulty of
obtaining material, every effort should be made to obtain existing buildings and that where
construction is necessary it must be of the simplest character possible consistent with neces-
sities. It is, therefore, requested that the facilities in existing hospitals or l)uildings which
can be offered be made the maximum possible.
4. It is the understanding that, as soon as possible, the French authorities will furnish
preliminary studies of the question of existing hospitals and other buildings in the interior
and of sites for hospital construction in the three sections, as indicated under ((/) above,
which can be utilized by the American Army.
5. With regard to areas for construction of hospitals, it will be necessary to consider
carefully the location of such hospital centers in order to avoid interference with storage
depots, training areas, etc., and in order to permit this study to be made it is desirable to have
the suggestions of the French authorities as early as practicable. As soon as the French
authorities are read}^ I shall take pleasure in having the American representatives confer
with their representatives to fix definite locations for these hospitals.
By direction:
W. D. Connor, Acting Chief of Staff.
As of December 15 the following reports were submitted to the general
staff concerning hospital status :
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 301
Jit.........
■^66666666666666 H Sec do odd odds H
d d
z; z
II
?5 S g
302
ADMINISTRATION,
AMERICAN EXPEDITIONARY
FORCES
& c.
E-i a;
>:^.9'o ^ o i>
w o
.E o
2;o::Z M
0.0
a c3 o 1-
O) (N 00
^ 'O T3
0^ ^ 0^ o) a; a;
ii
ji: ^ x3 j3 ^ ^ P ji: O
3 Sdas 3 3
33 3
800QQCJS000C
ooooooooo<
0000000000c
^^lOC^fM^^i-HOOOOfO
tt> 1-1 lO CS C^l .
I r-< O O O o «■
0000000^0
•3 " R a
S ^.2.2
M §00
° ^ m
.5 « a 0
w 2 o o
g 3-e
- «J3 o
E3 M S
O C3 o 3 2C2 »
3?o
3 ^ E
0 S O Sii m =3 « 9
§1
^ bo
Oi e
§■0
o .
"t" d c 6 6 6 6 6 6 6
CC *0 CC 1^ X
f-l ^ ^ ^ r-l .-^ r- 1 ^ -H (M !N
ORGANIZATION- AND AMINISTRATION OF CHIEF SURGEON'S OFFICE 303
Additional hospitalization projects at the following-named places were
also tentatively proposed at this time in order to meet fm'ther prospective
needs.^^
Location
I Ordinary
bed
capacity
j to be
provided
Remarks
[{iniiiiicourt
Laiit'res,
Contrexeville
Vittel
Veuxhaulles _
( ' hatillon-sur-Seine
<"(iublanc
Mircbeau
Martigny
Bordeaux.
Savenay... _
Sevcrac, or Questembert, or Quemene-
Penfao.
Limoges
I'erigueux
Tours
\'ichy
Other sites not yet selected but to be
chiefly in the intermediate zone..
3,000
3,000
1,000
1,000
5,000
5,000
5,000
5,000
1,000
15,000
4,000
5,000
3,000
5,000
2,000
5,000
59,000
Tentatively authorized bv adjutant general, A. E. F., Nov. 12.
Do.
Additional hotels to be acquired.
Do.
Site proposed by French general headquarters.
Do.
Do.
Do.
Hotels to be acquired.
Tentatively authorized by adjutant general, A. E. F., Nov. 8.
Sites proposed by French fourth bureau.
Hotels to be acquired.
Total I 127,000
It was believed now that a proper regional distribution of hospital facili-
ties would be approximately as follows: Advance section, 15 per cent;
intermediate section, 60 per cent; base sections, 25 per cent.
The chief surgeon's office also reported that, as had been planned, hospi-
tals were located in general in the training areas centered around Neufchateau,
along the lines of communications, and at Bordeaux, St. Nazaire, and Brest.^^
Considerable hospitalization was necessary at base ports for the permanently
disabled. In selecting sites, consideration had to be given also to such ques-
tions as availability of railroad sidings, situation at points where these forma-
tions would not interfere w'ith the movement of troops, or those in training
areas, and accessibility from camps and depots as well as from the front.
Future experience, it w^as added, might show that some readjustments of these
percentages might be necessary, but in any event these would serve as a basis
for present plans and could be changed if the necessity arose.
On February 23 the chief surgeon forwarded to the Surgeon General the
following data concerning the hospitalization facilities of the American Expedi-
tionary Forces
.\LPH.\BETICAL INDEX OF LOCATIONS, FIXED MEDICAL DEPARTMENT UNITS
Allerey: 10 type A, A. E. F. base hospital units under construction. Total ordinary-
capacity of this center to be 10,000 beds. Work in hands of French contractors and will
soon be under way.
Angers: Base Hospital No. 27, with a capacity of 334 beds, in operation in old French
hospital. Construction under way to increase capacity to 2,000 beds, thus providing for
a special clinic for the treatment of "Diseases of the heart."
Bazoilles: Base Hospital No. 18, with a capacity of 740 beds in operation in barrack hos-
|)ital acquired from the French. Si.x type A, A. E. F. base hospital units under construction
by the Engineer Corps. Total ordinary capacity of this center to be 6,740 beds.
13901—27 20
304
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Bcaune: 10 type A, A. E. F. base hospital units under construction. Total ordinary
capacity of this center to be 10,000 beds. Work in hands of French contractors and will
soon be under way.
Blois: Camp Hospitals Nos. 25 and 26, with a total bed capacity of 430, in operation
in old French hospitals.
Bordeaux: Base Hospital No. 6, with a capacity of 900 beds, in operation. Five
type A, A. E. F. base hospital units under construction on Beau Desert site. This site will
be the eventual center for the construction of a total of 20 type A, A. E. F. base hospitals
with an ordinary capacity of 20,000 beds. Receiving and forwarding medical supply base
No. 2. Base medical laboratory, base section No. 2, temporarily housed in Base Hospital
No. 6.
Bourbonne-les-Bains: Camp Hospital No. 21, with a bed capacity of 200, in operation
in hotel leased for hospital purposes.
Bourmont: Camp Hospital No. 3, with a bed capacity of 300 beds, in operation.
Brest: Naval Base Hospital No. 1, with a capacity of 407 beds, in operation in old
French hospital. Camp Hospital No. 33, with a capacity of 500 beds, capable of expansion
to 1,000 beds, in operation at Pontanezen Barracks. Receiving and forwarding medical
supply base No. 5. Base medical laboratory, base section No. 5.
Burey-en-Vaux : Camp Hospital No. 17, with a capacity of 125 beds. Vacated because
of evacuation of training area.
Chateauroux: Base Hospital No. 9, with a capacity of 817 beds, in operation in old
French hospital. Base medical laboratory, base section No. 3 (intermediate section) tem-
porarily housed in Base Hospital No. 9.
Chateau Villain: Base Hospital No. 9, with a capacity of 300 beds, under construction
b\^ Engineer Corps.
Chalaines: Camp Hospital No. 16, with a bed capacity of 220, vacated because of evacu-
ation of training area.
Chaumont: Base Hospital No. 15, with a capacity of 1,414 beds, in operation in old
French hospital.
Coetquidan: Camp Hospital No. 15, with a bed capacity of 525, in operation in an old
French hospital.
Colombey: Camp Hospital No. 6, with a capacity of 150 beds, vacated becau.se of evac-
uation of training area.
Contrexeville: Base Hospitals Nos. 31 and 32, with a capacity of 1,250 beds each, in
operation in hotels, leased for hospital purposes.
Cosne: Intermediate medical supply depot No. 3.
Dijon: Base Hospital No. 17, with a capacity of 833 beds, in operation in an old French
ho.spital. Central medical laboratory, on University of Dijon property.
Gievres: Intermediate medical supply depot No. 2.
Gondrecourt: Camp hospital No. 1, with a capacity of 300 beds, in operation in barrack
hospital acquired from the French.
Humes: Camp Hospital No. 7, with a capacity of 300 beds, under construction by
Engineel" Corps.
Issoudun: Camp Ho.spital No. 14, with a capacity of 300 beds, in operation.
Is-sur-Tille: Advanced medical supply depot No. 1.
La Courcelles: Camp Hospital No. 38, with a capacity of 240 beds, ready for occupancy.
La Courtine: Camp Hospital No. 19, with a capacity of 300 beds, in operation in old
French hospital.
La Fauche: Camp Hospital No. 4, with a capacity of 300 beds, ready for occupancy.
Langres: Five type A, A. E. F. base hospital units approved for this place. Acquisition
of site still under consideration by the French. Camp Hospitals Nos. 22, 23, and 24, with a
total capacity of 520 beds, in operation in old French buildings.
Le Courneau: Camp Hospital No. 29, with a capacity of 1,000 beds, in operation in
old French hospital.
Le Valdahon: Camp Hospital No. 12, with a capacity of 300 beds, in operation in an old
French hospital.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 305
Limoges: Base Hospital No. 38, with a bed capacity of 242, in operation in old French
hospital; two modified type A, A. E. F. base hospital units, with a capacity of 1,500 beds each,
under construction by Engineer Corps. New Grand Seminaire, with alterations and additions
under way to provide a capacity of 1,000 beds, will soon be occupied by a unit.
LifTol-le-Grand : Camp Hospital No. 18, with a capacity of 300 beds temporarily
vacated.
Mailly: Camp Hospital No. 13, with a capacity of 250 beds, in operation in old French
hospital.
Mars: Ten type A, A. E. F. base hospital units under construction. Total ordinary
capacity of this center to be 10,000 beds. Work in hands of French contractors and will soon
be under way.
Mesves: Ten type A, A. E. F. base hospital units under construction. Total ordinary
capacity of this center to be 10,000 beds. Work in hands of French contractors and will soon
be under way.
Meucon: Camp Hospital No. 31, with a capacity of 500 beds, under construction bv
French engineers.
Montigny: Camp Hospital No. 8, with a capacity of 300 beds, under construction by
Engineer Corps.
Nantes: Base Hospital No. 34, occupying Grand Seminary; alterations and additions
under way to increase capacity to 1,000 beds. Three type A, A. E. F. base hospital units under
construction on the Grand Blottereay site. Work in the hands of French contractors.
Neuf chateau: Base Hospital No. 66, with a capacity of 735 beds, in operation in Rebeval
Barracks. Army medical laboratory No. 1.
Nevers: Camp Hospital No. 28, with a capacity of 130 beds, in operation in old French
hospital.
Paris: American Red Cross Mihtary Hospitals, No. 1, with a capacity of 600 beds;
No. 2, with a capacity of 186 beds, and No. 3, with a capacity of 50 beds.
Perigueux: Five type A, A. E. F. base hospital units under construction. Total ordinary
capacity of this center to be 5,000 beds. Work in hands of French contractors and will soon
be under way.
Prauthoy: Camp Hospital No. 10, with a capacity of 300 beds, now under construction
by Engineer Corps.
Rimaucourt: Five type A, A. E. F. base hospital units approved for this place. Work
is to begin immediately upon two of these units by the Engineer Corps.
Savenay: Base Hospital No. 8, with a capacity of 800 beds, which construction, now
under way, will increase to 1,300 beds; will eventually be center for 5,000 beds, the work to
be carried on by Engineer Corps. To become center for psychiatric clinic of 100 beds.
Souge: Camp Hospital No. 20, with a present capacity of 120 beds, which construction
by Eiigineer Corps, now under way, will bring to 500 beds.
St. Maixent: Camp Hospital No. 30, with a capacity of 117 beds, which construction
by Engineer Corps, luider way, will increase to 300 beds.
St. Nazaire: Base Hospital No. 101, with a capacity of 890 beds, in operation. Camp
Hospital No. 11, with a capacity of 350 beds, under construction by Engineer Corps. Receiv-
ing and forwarding medical supply base No. 1. Base medical laboratory, base section No. 1.
Toul: Five hundred beds in wing of French H. O. E. Justice (Field Hospital No. 12 to
operate here); 400 beds in Sebastopol Barracks (Evacuation Hospital No. 1 to operate
here); 400 beds at Menil-la-Tour, evacuation ambulance company to operate at railway
station.
Tours: Camp Hospital No. 27, with a capacity of 300 beds, in operation in old French
hospital.
Vauclaire: Base Hospital No. 25, with a capacity of 1,000 beds, to be located in French
buildings leased for that purpose.
Vaucouleurs: Camp Hospital No. 5, with a capacity of 300 beds, vacated because of
evacuation of training area.
Vichy: Base Hospital center for 3,500 beds, to be acquired by leasing French hotels.
Vittel: Base Hospitals 23 and 36, with a capacity of 1,750 beds each, in operation in
hotels, leased for hospital i)urposes.
306
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Cross reference
BASE HOSPITALS
[Receiving, or ready to receive, patients]
A. E. F.
desig-
nation
15
17
18
23
27
31
32
34
36
39
66
101
Location
Town
Bordeaux
Savcnay
Chateauroux_
Chaumont
Dijon
Bazoilles
Vittel
Angers
Contrexeville _
do
Nantes
Vittel
Limoges
Neufchateau .
St. Nazaire
Naval Brest Finistere
State
Gironde
Loire Inferieure.
Indre-- .-.
Haute Marne . ..
Cote d'Or
Vosges
do
Maine et Loire..
Vosges
do
Loire Inferieure.
Vosges
Haute Vienne...
Vosges
Loire Inferieure .
Region
Wliere organized
18
11
z.
9
A.
z.
8
A.
z.
A.
z.
9
A.
z.
A.
11
z.
A.
12
z.
A.
11
11
Massachusetts General Hospital ,
New York Post-Graduate Hospital - .
New York Hospital
Roosevelt Hospital, New York
Harper Hospital, Detroit
Johns Hopkins, Baltimore
i Buffalo General Hospital..
University of Pittsburgh Med
Youngstown Hospital-
Indianapolis City Hospital
Phihidclphia Episcopal Hospital
Detroit <'(illi>j;t> of Medicine
Massacluisctts Homeopathic Hospital.
United Stales at large
American Expeditionary Forces at
large.
United States at large
Eventual
ordinary
bed ca-
pacity to
be pro-
vided
1,860
2,500
1.500
1,500
1,000
1,000
1,750
2,000
1,275
1,225
1.000
1,750
350
800
1.000
410
A.E. F.
desig-
nation
CAMP HOSPITALS
[Receiving, or ready to receive, patients]
Location
Town
State
Region
Eventual
ordinary
bed ca-
pacity to
be pro-
vided
Gondrecourt
Bourmont
Le Valdahon .
Mailly
Issoudun
Coetquidan..
La Courtine
Souge
Bourbonne les Bains
Langres;
Turrenne Barracks
Physic. Hospital - —
Comp. Hospital No. 3
Blois:
Comp. Hospital No. 13
Comp. Hospital No. 29
Tours, Comp. Hospital No. 3 _..
Nevers, Comp. Hospital No. 14 .
Le Courneau- __
St. Maixent
Meucon
Courcelles
Brest
Meuse
Haute Marne.
Doubs
Auhe
Indre_ -
lUe et Vilaine .
Creuse
Gironde
Haute Marne .
.do.
.do.
.do.
Loire et Cher.
do
Indre et Loire.
Nievre
Gironde
Deux Serves. _
Morbihan
Haute Marne.
Finistere
z.
A.
300
z.
A.
300
7
300
z.
A.
300
9
300
10
500
12
300
18
500
z.
A.
200
z.
A.
120
z.
A.
100
z.
A.
300
5
130
5
300
9
300
8
130
18
1,000
9
300
11
500
z.
A.
240
11
1,000
ORGANIZATION AND ADMINISTEATION OF CHIEF SURGEON'S OFFICE 307
Cross reference — Continued
CONSTRUCTION PROGRAM
Allerey
Mesves
Beaune
Mars
Nantes
Savenay
Perigueux
Vichy
Camp hospitals:
Humes
Montigny
Chat. Villain
Prauthoy
St. Nazaire
Location of site
" Additional contemplated.
' As contemplated by future addition.
Number
of units
author-
Region ized "
6
3
1
5,0 15
2, "3
2,» 3
10
10
10
10
3
1
5
2
How to be acquired
New construction
Two new construction, 1 remodeled
seminary.
Completing existing building
New construction, French contract
New construction
.do_
New construction, French contract
do
New construction
New construction, French contract..
do
New construction
New construction, French contract
Lea.sing hotels from French
New construction.
do
do
do
do
Eventual
ordinary
bed ca-
pacity
to be
provided
as au-
thorized
6,000
4,000
1,000
5.000
^ 20,000
2,000
' 5,000
2,000
' 5, 000
10, 000
10,000
10,000
10,000
3,000
2,500
5,000
3,000
300
300
300
300
300
MISCELLANEOUS MEDICAL DEPARTMENT ACTIVITIES
A. E. F. desig-
nation
1
Central
Base 1
Base 2
Base 5
Intermediate.
1 advance
2 intermediate.
3 intermediate.
Ba.se 1
Base 2
Base 5.
Location
Town and State
AMERICAN RED CROSS MILITARY HOSPITALS
Paris, Seine.
...do
....do
EVACUATION HOSPITALS
Toul, M. et Moselle.
Bazoilles, Vosges
Blois, Loire et Cher.
MEDICAL LABORATORIES
Neufchateau, Vosges
Dijon, Cote d'Or
St. Nazaire, Loire Inferieure.
Bordeaux, Qironde
Brest, Finistere
Chateauroux, Indre
MEDICAL SUPPLY BASES AND DEPOTS
Is-sur-Tille, Cote d'Or
Oievres, Loir et Cher
Cosne, Nievre
St. Nazaire, Loire Inferieure .
Bordeaux, Gironde
Brest, Finistere
Region
C. R.
C. R.
D. R.
Z. A.
Z. A.
5
Z. A.
8
11
18
11
Remarks
650 beds, formerly American ambulance.
300 beds.
50 beds; reserved for officers and Red Cross
personnel.
Supply depot.
Do.
Do.
Receiving and forwarding bases.
Do.
Do.
Note.— The following mobile sanitary units are automatically attached to each division of troops in the field: Four
ambulance companies (3 motor and 1 horse-drawn); 4 field hospital companies (3 motor and 1 horse-drawn); 1 evacuation
ambulance company (motor).
308
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The following memorandum for the chief surgeon, A. E. ¥., from his
deputy at general headquarters, A. E. F., gives a good perspective of the
location of our hospitals necessitated by the acquisition of the fact that our
principal sector of the front was to be from St. Mihiel eastward:
General Headquarters, American Expeditionary Forces,
France, August 9, 1918.
Memorandum for the chief surgeon (attention of hospitalization section) :
1. Recent developments up here show that our principal sector is to be from St. Mihiel
eastward. How far to the east we will go depends upon the number of troops available
for holding the line.
2. The assistant chief of staff, G-4, has given instructions that all projects originally
outlined for the development of railways, regulating stations, hospitals, etc., for the Toul
sector are again in force. I asked the assistant chief of staff, G-4, particularlv about Chat-
illon-sur-Seine. He approves of it as a hospital site; and if the chief surgeon's office desires,
hospital construction can be gone ahead with at that place. A study of the railroad map
will show how very well located this place is for our purpose. Moreover, this is the finest
hospital site I have seen in France. If more hospital facilities are desired in the advance section,
this is undoubtedly the place.
3. We have another approved site at Mirebeau, near Dijon, which as a site is not
as desirable as Chatillon.
4. The assistant chief of staff, G-4, is very anxious that we should have hospital fa-
cilities along the different lines north and south controlled by the different regulating stations.
This in order to prevent the cutting across in the rear of different armies with our hospital
trains. This is the case at the present time when the regulating officer at Le Bourget sends
a train down into the advance section. It can be done, as has been shown, but if railroad
traffic is heavy it becomes practically impossible to cut across from west to east, or vice
versa. The assistant chief of staff, G-4, thinks that we should plan our hospitalization
in the future to permit of evacuation practically from any part of the entire line along the
north and south lines. I was surprised to find that he included in this the English front.
In this connection, I would like to suggest Evreux as a site for hospital development. I am
inclosing a railroad map which my assistant has prepared from one furnished him by the
French G. Q. G. This shows the lines of evacuation from each one of the French regulating
stations, beginning on the west with Sotteville, then to Nantes, Creil, Le Bourget, Connantre,
St. Dizier, Is-sur-Tille, and Gray. These regulating stations are also the stations which
our troops will use. As far as we have gone, we have followed the regulating system from
Is-sur-Tille as far as it was possible to do so and reach our ports. Everything that has
been done in the way of locating hospitals will fit in there nicely with future developments
along the lines indicated.
On August 17 the chief surgeon notified the chief of the French mission
that the offer of the French for accommodation for 3,300 beds in various
localities was accepted.*^ In the Paris district, in addition to what was already
organized, it was desired that facilities for 15,000 beds be provided, and that
extensive hospitalization be provided at Vichy because of its accessibility
by rail from the front, and the suitability of the buildings there."*^
On August 24, 1918, the chief surgeon reported as follows:
[Memorandum]
August 24, 1918.
From: Chief surgeon.
To: Assistant chief of staff, G-4, Services of Supply.
Subject: Hospitalization.
1. There are 75,000 beds at present in base hospitals; 50,000 are occupied. There
are 1,400,000 troops in France, and 15 per cent of hospitalization would give 210,000 beds
that should be available, making a .shortage of 135,000 beds.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 309
2. It is not believed that any construction should be eliminated from this program.
The projects under construction as follows:
Beds
Montoirc 10, 000
La Suze 5, 000
Avoine 5, 000
Savenay 20, 000
Nantes 3, 000
Angers 2, 000
Rochette 5, 000
Perigueux 5, 000
England (by procurement and
construction) 20, 000
Beds
Bazoilles 7, 000
Langres 2, 000
Allcrey 10, 000
Beaune 10, 000
Mars 20, 000
Mesves 20, 000
Tours 10, 000
Rimaucourt 5, 000
Bordeaux 20, 000
Limoges 4, 000
Brest 3, 600
Each to include its proportionate convalescent camp and crisis expansion.
3. It is believed that the following should be given priority for construction: Brest.
Rimaucourt, AUerey, Mars, and Savenay.
By the end of August, 102,144 beds (including emergency beds) were pro-
vided, of which total 54,485 were occupied.^
The selection of sites, procurement of existing buildings, and construction
of new ones progressed steadily, though scarcely keeping pace with the now
rapidly increasing demand for beds, for large numbers of American troops were
now engaged and battle casualties reached the hospitals in considerable num-
bers.One evacuation hospital (No. 7) received 27,000 patients between June
15 and August 11. Also a considerable amount of sickness had developed,
including scattered outbreaks of influenza and quite general epidemics of diar-
rhea and dysentery. Further preparation of hospitals was necessary for the
impending offensive, but no one could foresee that contemporaneously with
this conflict there would occur a great influenza epidemic that would call for
almost as many hospital beds as would the destructive efforts of the enemy.
During September 10, 150 beds were provided at Cannes, Nice, Menton,
and other points on the Mediterranean and a lesser number at Biarritz, near
the Pyrenees.
The French submitted another long list of hotel buildings which might be
used as hospitals, and a list of barracks and school buildings which were made
available by their Government." Of their last mentioned structures certain
were accepted, to a total capacity of 11,550 beds. The director of construction
and forestry, A. E. F., was notified of that fact, given the names and addresses
of medical officers who would be concerned in the operations of the hospitals
located in these public buildings, aud requested that the Engineer Department
consult with them in each case concerning the location of the building, repairs
required, and any information desired in connection with their operation.
By the end of September, 1918, the total fixed hospital capacity, including
emergency beds, was 148,596 beds. Of these, 79,580 were occupied. A hos-
pital center providing 10,240 beds was being established in 25 hotels on the
Riviera. A center had also been established at Clermont-Ferrand.
During October the French furnished a long list of buildings which could
be turned over to the Americans for use as hospitals, the total providing accommo-
dations for more than 30,000 beds.^^ Most of these buildings were schools,
barracks, hotels, chateaux or residences.
310
ADMINISTRATION, AMERICAN EXPEDITION A KV lOHCER
The demands for beds was increased to an unexpected degree at this time
because of the epidemic of influenza which assumed grave proportions sinnil-
taneously with the prosecution of the Meuse-Argonne operation. American
battle casualties during that action included 72,584 wounded and 23,934
gassed.^
This cumulative combination of circumstances subjected the hospitaliza-
tion facilities to a severe test — not so much because of the number of beds
necessary, as because of demands for equipment and especially for personnel.^
The inadequacy of Medical Department personnel to meet the demands now
made upon it, is discussed in another chapter of this volume.
In the procurement of existing buildings for hospital purposes full coopera-
tion had been received from the French with the result that space for thousands
of beds had been secured." Though far from ideal for hospital purposes, these
buildings at least afforded shelter. In spite of all that could be done, however,
with the heavy fighting at the front and a serious influenza epidemic during
the months of September and October, the margin of safety, consisting of unoc-
cupied beds, steadily decreased. On October 10 there were more beds occupied
than were shown by the normal bed capacity, and by October 17 the 166,200
beds occupied included 30,798 for emergency use." The authorized program
at this time provided for approximately 100,000 beds in addition to those
already available. Careful consideration was directed toward the provision of
600,000 beds before July 1, 1919, and all needed aid in the carrying out of the
program was promised. On October 19, the commander in chief wrote to
the commanding general. Services of Supply, as follows:
G. H. Q., A. E. F., 4th Sec, G. S.,
-r, n ■ n October 19, 1918.
From: C. in C '
To: C. G., S. O. S.
Subject: Hospitalization program.
1. The situation of the American Expeditionary Forces, from the point of view of
hospitahzation, has become alarming. The small margin of safety which has existed hereto-
fore has disappeared. The commander in chief is deeply interested in this matter, and has
expressed his concern over the outlook. He directs that immediate steps be taken to remedy
the critical situation with which we are now confronted, and that a hospitalization program,
more comprehensive in scope and sufficient to provide for our future needs, be inaugurated
with the least practicable delay.
2. In this connection, attention is invited to the indorsement from this office of June 1,
1918, a copy of which is herewith attached, which authorizes American Expeditionary Forces
hospitalization requirements on the basis of 15 per cent of hospital beds for all American
Expeditionary Forces troops in Europe. In this indorsement it was specifically stated that
so-called "emergency expansion" was not to be included in computation of beds available.
Based on the estimates as outlined in the indorsement referred to, an analysis of this date
shows a deficit of approximately 100,000 beds therein prescribed, with apparently insufficient
provision for the future. It would appear that a most unsatisfactory situation has been
permitted to develop. It must be rectified at the earliest possible moment.
3. In a recent communication, the War Department commented upon the insufficiency
of the American Expeditionary Forces hospitalization program. It is recognized that the
War Department has been somewhat remiss in that it has failed to ship the necessary and
authorized personnel and equipment for hospitals which are now available for occupancy.
However, as a result of repeated cables and statements of the extreme seriousness of the
existing situation, it is believed that the personnel and equipment phase of our present diffi-
culties will soon be relieved. In any event, this is not a factor which should be taken into
consideration at this time in providing hospitals on the scale which is necessary, if the needs
of the future are to be met.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 311
4. Accordingly, the commander in chief directs that this matter be given careful con-
sideration, and that a hospitalization program aiming at the provision of 600,000 beds for the
American Expeditionary Forces by July 1, 1919, be immediately inaugurated. As the possi-
bilities of ac(iuiring existing buildings or hospitals from the French have been practically
exhausted, the greater part of this program will, of necessity, be possible of fulfillment only
through the means of new construction, chiefly of the hut or portable barrack type.
5. In accomplishing this project, the skilled services of civilian contractors should be uti-
lized to the maximum extent possible, and provision be made to furnish them as much additional
labor and other assistance as may be necessary to expedite construction undertaken by this
means. If necessary, every effort will be made to assign or procure for you such additional
labor or construction troops as will be required to carry out this program.
6. The chief surgeon should make an immediate general survey and submit to you his
recommendations as to where the hospitaUzation herein prescribed can most advantageously
be established. As the changing military situation will probably frequently require the
presence of our troops as far north as the channel ports, the need for new hospitalization north
and west of Paris should be given careful consideration. The evacuation lines from the
regulating station at Creil should be given careful consideration. As a beginning, the French
have already consented to the establishment of an American Expeditionary Force hospital
at Evereux, authority for which has already been transmitted to you.
7. If this headquarters can assist in any way toward furthering the accomplishment of
this hospitalization program, your recommendations thereon are desired, and will be care-
fully considered.
8. A brief report by letter as to the progress made, particularly with reference to new
construction undertaken to meet future needs, will be forwarded to these headquarters at the
end of each month.
By order of the commander in chief.
Geo. Van Horn Moseley,
Brigadier General, G. S., Assistant Chief of Staff, G-4.
In his reply the commanding general, Services of Supply, stated that the
hospitalization program of the American Expeditionary Forces had always
been under the most careful observation and that every efTort possible had been
put forth to carry it out successfully.^^ The reasons why this had not been
actually accomplished were pointed out substantially as outlined above; i. e.,
difficulties incident to procurement of suitable sites and to effecting new con-
struction. Following this correspondence, a telegram was issued by the chief
of staff American Expeditionary Forces, to the commanding general, Services of
Supply, as follows:
G. H. Q., A. E. F., 4th Sec. G. S., October 20, 1918.
Commanding General,
Services of Supply, American Expeditionary Forces:
Because of the critical situation produced by the heavy demands on hospitals, the com-
mander in chief directs as follows: First, the completion of all buildings under construction
for hospital purposes and the necessary alteration in buildings taken over by the Medical
De|)artment from the French must be expedited in every possible manner. Second, command-
ing officers of base hospitals and hospital centers are authorized to retain class B privates
capable of assisting hospital personnel for temporary duty. The number of these men will
be determined by the commanders mentioned above, but will be kept at the minimum neces-
sary to permit hospitals to function under emergency conditions now prevailing. Command-
ing officers will be held responsible for not exceeding the number hereby authorized. Third,
every effort must be made to move Medical Department personnel, units, and hospital
equipment coming into ports, other equipment being shipped from depots to hospitals with
least possible delay. When hospital units arrive at ports with equipment, trains should be
made up and equipment shipped at once with unit.
McAndrew.
Official:
RoBT. C. Davis, Adjutant General.
312 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
On October 28 the bed status of the American Expeditionary Forces was
as follows:
American Expeditionary Forces,
Office of the Chief Surgeon,
October 28, 1918.
Memorandum for the A. C. of S., G-4, Hdqrs. S. O. S., A. E. F.:
1. In reply to your memorandum of October 26, 1918, file No. 010186, submit the follow-
ing information:
(a) Number of beds installed in hospitals ready to receive patients:
Camp hospitals: Beds
Occupied 17, 751
Vacant 7,481
Total 25, 232
Base hospitals (includes normal and crisis expansion beds) :
Occupied 142, 675
Vacant (the vacant beds in base hospitals are all emergency) 50, 289
Total 192, 964
Convalescent camps :
Occupied 15, 995
Vacant 4, 927
Total 20, 721
Total beds in camp hospitals, base hospitals, and convalescent camps 238, 917
Total occupied beds in camp hospitals, base hospitals, and convalescent camps 176, 421
Total vacant beds in camp hospitals, base hospitals, and convalescent camps 62, 496
(6) Number of beds complete now in depots and shipped but not installed and not taken
up on daily bed report, 47,500.
(c) Personnel in Europe not operating hospitals, one base hospital. This personnel can
operate 1,500 beds.
{d) Number of beds complete expected from the United States, to include February, 1919,
as shovi^n on priority schedule, 250,000.
(e) Personnel expected from the United States to include January 31, 1919, as shown on
the priority schedule, officers, 9, 324; nurses, 16,717; enlisted men, 100,748.
February shipment schedule not yet made up. Beds which this personnel can operate:
Normal beds in base hospitals 124, 000
Normal beds in camp hospitals 13, 500
Normal beds in convalescent camps 24, 800
Total normal beds 162, 300
Total normal beds 162, 300
Crisis expansion beds 62, 000
Total normal and crisis expansion beds 224, 300
For the chief surgeon:
J. D. Glennan,
Brigadier General, Medical Corps.
On October 31, of 221,421 beds in camp and base hospitals 163,767 were
occupied. A number of casualties were passing through field, mobile, and
evacuation hospitals, and there were yet others — relatively very few — in allied
and Red Cross hospitals.^ In camp and base hospitals 35,045 normal beds were
vacant, for a number of patients were occupying emergency beds.*^ But for
ORGANIZATION AND ADMINISTEATION OF CHIEF SURGEON'S OFFICE 313
that fact 98.3 per cent of the 166,534 normal beds then provided would have
been occupied by 163,767 patients then in these institutions. In addition to
the 221,421 normal and emergency beds in camp and base hospitals, as noted
above, there were in operation convalescent camps which provided 25,070 beds.
Of these, 19,047 were occupied. The grand total of all vacant beds, normal and
emergency and in hospitals and convalescent camps, was 88,807. On No-
vember 1 the total number on sick report amounted to 9.08 per cent of the
American Expeditionary Forces, i. e., in round numbers, 180,000 patients.^^
The number of vacant beds, normal and emergency, during August and
September had been well above double the number of patients, but during
October, when the number of patients nearly doubled, the factor of safety fell
from 100 to 33 per cent.^^
Shortly before the armistice was signed 115,000 additional beds were
authorized either in existing institutions or in new formations, and buildings
for accommodations to shelter 103,000 of this number of beds were under
construction.23 Also French buildings were secured and structures authorized
in connection therewith for a total of 73,000 other additional beds. Buildings
for 31,000 of the latter number were under preparation. New convalescent
camps were also being constructed and others enlarged, increasing their total
capacity by 15,000 beds. The total of new beds thus contemplated was:^^
Authorized
Under con-
struction
New construction
115,000
73,000
15,000
203,000
103.000
31. 000
15,000
149, 000
In French buildings _
Convalescont camps
Totals
Completion of these projects in addition to the 281,598 beds already pro-
vided would have given a bed capacity of 484,598. This would have been
sufficient for 15 per cent sick and wounded of a force of 3,210,000 men. There
were nearly 2,000,000 men in France at this time, and it was expected that this
number would rapidly be increased so that the entire bed allowance authorized
would be required by the spring of 1919.^^
This project was soon increased so that when the armistice was signed on
November 11 the hospitalization program included construction projects and
leased buildings which together with those already established would be capable
of providing ultimately for 423,722 normal beds and for emergency beds in
addition to these to a grand total of approximately 541,000. These were to be
distributed as follows
Beds nor-
mal
Beds emer-
gency (in-
cluding
normal)
Base hospitals
322, 376
38, 686
62, 660
437, 744
40, 835
62, 660
Camp hospitals . '
Totals - '.
423, 722
541, 239
314
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Among the large projects planned at this time were the following:^' In
Paris, 20,000 beds; Lyons, 15,000 beds; the Riviera, 15,000; Pan and vicinity,
10,000; Clermont and vicinity, 10,000; Vichy, expansion to 30,000; Orleans,
5,000; Blois, 3,000. Smaller projects were to be provided at Poitiers, Bor-
deaux, Angouleme, Rouen, Moulins, Roanne, Caen, and Parthenay. These
plans, however, were changed after the armistice so as to provide hospitalization
for an army of 80 divisions, or about 400,000 men.^'
On November 1 the number of patients on sick report numbered approxi-
mately 182,000 — i. e., 9.08 per cent of the entire force — but a number of these
were under treatment in field formations. The number of patients in fixed
formations reported on November 7 totaled 31,813. They were then distrib-
uted as follows:^**
Recapiiulation
Bed situation
Per cent of beds occupied
Percentage
on sections
Occupied
Vacant
Normal
Emergency
Normal
Emergency
Base
Camp
Base
Camp
Base
Camp
Base
Camp
Base
Camp
Base
Camp
Nor-
mal
emer-
gency
Advance section
Intermediate section
District of Paris
22, 521
69, 802
11,683
17, 992
22, 663
6, 906
7
2, 202
3, 425
6, 226
20, 463
5, 198
677
2, 169
415
197
473
942
1,000
2, 622
2, 360
42, 472
52, 624
8, 306
16,717
16, 283
6, 350
480
3, 144
1,000
5,616
7,527
58, 050
98, 993
12, 498
22, 677
26,641
7, 137
480
3, 280
1,000
6,411
7, 709
53.0
132. 6
140.6
107.6
139.2
108.7
1.4
70.0
61.0
82. 7
38.7
70.6
81. 2
79.3
84.7
96.7
1.4
67. 1
53.4
70.6
.54.0
126. 4
140.6
101.4
125. 5
104.3
1.4
88.7
14.4
90.3
40.3
71.2
81.2
77.4
82.0
94.7
1.4
84.2
14.4
80.6
66.9
Base section No. 1
Base section No. 2 __
Base section No. 3 __.
Base section No. 4.
1,591
1,747
1,200
998
1,420
220
2, 589
3, 167
1,420
2, 629
3, 126
1,420
61.7
55.2
84.5
60.5
.55. 9
84.5
Base section No. 5.._
Base section No. 6.
1,780
187
373
3
113
64
1, 450
300
413
1, 450
300
463
122.7
62.3
90.3
122.7
62.3
80.6
Base section No. 7
Subtotal
153, 776
16, 529
31, 534
7,800
157, 379
22, 482
230, 756
23, 508
97.7
73.5
66.5
70.3
94.7
Summary
Bed situation
Per cent of beds
occupied
Occupied
Vacant
Normal
Emer-
gency
Normal
Emer-
gency
Base hospitals
153, 776
16, 529
31, 534
7, 800
157, 379
22, 482
230, 756
23, 508
97.7
73.5
66.5
70.3
Camp hospitals
Grand total _
170,305
39, 334
179, 861
254, 264
94.7
66.9
Total beds including convalescent camps. 281,598
Total patients including convalescent camps 193,813
Vacant beds 87,785
REFERENCES
(1) G. O. No. 70, G. H. Q., A. E. F., May 6, 1918.
(2) Report of the activities of G-4-B, medical group, fourth section, general staff, G. H. Q.,
A. E. F., by Col. S. H. Wadhams, M. C, chief of section, December 31, 1918. On
file, Historical Division, S. G. O.
(3) Tables of Organization, No. 28, W. D., 1918.
(4) Manual for the Medical Department, U. S. Army, 1916, Art. XIII.
(5) Evacuation system of a field army, by Col. C. R. Reynolds, M. C, undated. On file,
Historical Division, S. G. O.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 315
(6) Report of the activities of the neurological service, A. E. F., by Col. Harvey Cashing,
M. C, December 2, 1918. On file. Historical Division, S. G. O.
(7) Tables of Organization, No. 101, W. D., 1918.
(8) Tables of Organization, No. 201, W. D., 1918.
(9) Manual for tlie Medical Departnaent, U. S. Army, 1918, par. 793.
(10) Manual for the Medical Department, U. S. Army, 1916, Art. XIV.
(11) Tables of Organization (Medical Department). On file. Record Room, S. G. O.,
320.3-1 (Tables Organ.).
(12) Memorandum for the chief engineer, L. O. C, A. E. F., from the chief surgeon, A. E. F.
September 20, 1917. Copy on file, Historical Division, S. G. O.
(13) 1st indorsement from the commander in chief, assistant chief of staff, G-4, general
staff, G. H. Q., A. E. F., June 1, 1918, to the commanding general, S. O. S. Copy
on file, Historical Division, S. G. O.
(14) Memorandum for the assistant chief of staff, G-4, G. H. Q., A. E. F., from Maj. A. D.
Tuttle, M. C, March 31, 1918. Subject: Hospitalization data. Copy on file,
Historical Division, S. G. O.
(15) Memorandum on convalescent camps for the assistant chief of staff, G-4, G. H. Q.,
A. E. F., May 17, 1918. Copy on file, Historical Division, S. G. O.
(16) Letter from the commander in chief, A. E. F., to the chief French military mission,
September 27, 1917. Subject: Program for hospitaHzation, A. E. F. Copy on
file, Historical Division, S. G. O.
(17) Letter from the commander in chief, A. E. F., to Maj. Gen. Omar Bundy, September 18,
1918. Subject: Camp infirmaries (hospitals) in division areas. On file, A. G. O.,
World War Division, chief surgeon's files, 322.32911.
(18) Manual for the Medical Department, U. S. Army, 1916, par. 757.
(19) Report of the activities Camp Hospital No. 26, St. Aignan-Noyers, as of January 1,
1919, by Lieut. Col. Wm. C. Riddell, M. C. On file. Historical Division, S. G. 6.
(20) Report of activities of Camp Hospital No. 52, Le Mans, as of January 1, 1919, by
Maj. Wm. J. Buck, M. C. On file. Historical Division, S. G. O.
(21) War Diary, chief surgeon's office, A. E. F., 1917-18. On file, Hi.storical Division,
S. G. O.
(22) Wadhams, S. H., Col., M. C. and Tuttle, A. D., Col., M. C: Some of the early prob-
lems of the Medical Department, A. E. F. The Military Surgeon, Washington, xlv.
No. 6, 636.
(23) Report of the activities of the chief surgeon's office, A. E. F., from the arrival of the
American Expeditionary Forces in Europe to the armistice, by the chief surgeon,
A. E. F., March 20, 1919. On file. Historical Division, S. G. O.
(24) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., August 2,
1917. Subject: Study of hospitalization. Copy on file. Historical Division, S. G. O.
(25) Memorandum for the chief of staff from the chief of operations section, general staff,
G. H. Q., A. E. F., August 11, 1917. Subject: Hospitalization. On file A. G. O.,
World War Division, 632.
(26) Confidential memorandum for the chief surgeon, A. E. F., from the adjutant general,
A. E. F., November 17, 1917. Subject: Hospitalization program. On file, A. G. O.,
World War Division, chief surgeon's files, 322.32911.
(27) 1st indorsement, chief surgeon's office, A. E. F., November 21, 1917, to the chief of
staff G. H. Q., A. E. F. On file, A. G. O., World War Division, chief surgeon's files,
322.32911.
(28) Report from the chief surgeon, A. E. F., to the commander in chief, A. E. F., December
15, 1917. Subject: Hospital construction, personnel, and equipment, as of Decem-
ber 15, 1917. On file, A. G. O., World War Division, chief surgeon's files, 329.1.
(29) Memorandum on hospitalization for the assistant chief of staff, fourth section, general
staff, prepared by Maj. A. D. Tuttle, M. C. Copy on file. Historical Division, S. G. O.
(30) Final report of General John J. Pershing, September 1, 1919.
(31) Monograph No. 7, prepared in the Hsitorical Branch. War Plans Division, General
Staff, June, 1921.
316 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(32) Letter from the commander in chief, A. E. F., to the chief, French Military Mission,
October 6, 1917. Subject: Program for hospitalization, A. E. F. Copy on file,
A. G. O., World War Division, chief surgeon's files, 322.32911.
(33) Memorandum from the chief surgeon, A. E. F., to the chief of staff, G. H. Q., A. E. F.,
October 8, 1917. Subject: Conference for hospitalization i)rogram. On file, A. G. ().,
World War Division, chief surgeon's files, 322.32911.
(34) Letter from the commander in chief, A. E. F., to the chief, French military mission,
October 11, 1917. Subject: Hospitalization, A. E. F. Copy on file, A. G. O., World
War Division, chief surgeon's files, 322.32911.
(35) Report of conference held October 17, 1917, at Chaumont, on the study of the hospital-
ization program, A. E. F. Translated copy on file, A. G. O., World War Division,
chief surgeon's files, 322.32911.
(36) Memorandum for the chief of staff, from the chief surgeon, A. E. F., October 19, 1917.
Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief sur-
geon's files, 322.32911.
(37) Report of hospitals under control of the chief surgeon, A. E. F., October 23, 1917. Copy
on file, A. G. O., World War Division, chief surgeon's files, 322.329 (Misc.).
(38) Memorandum for file, by Col. S. H. Wadhams, M. C, October 30, 1917. Subject:
Information concerning hospitalization. On file, A. G. O., World War Division,
chief surgeon's files, 322.32911.
(39) Memorandum for the chief surgeon, A. E. F., from the acting chief of staff, October 31,
1917. Subject: Hospitalization. On file, A. G. O., World War Division, chief sur-
geon's files, 322.32911.
(40) Letter from the commander in chief, A. E. F., to the chief, French military mission,
November 1, 1917. Subject: Hospitalization. Copy on file, A. G. O., World War
Division, chief surgeon's files, 322.32911.
(41) Letter from the chief surgeon, A. E. F., to the Surgeon General, February 23, 1918.
Subject: Hospitalization data. On file. Record Room, S. G. O., 322.3 (Med. Dept.
Units, France).
(42) Letter from the chief surgeon, A. E. F., to the chief, French military mission, August 17,
1918. Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief
surgeon's files, 322.32911.
(43) Memorandum for assistant chief of staff, G-4, S. O. S., from the chief surgeon, A. E. F.,
August 24, 1918. Subject: Hospitalization. Copy on file, A. G. O., World War
Division, chief surgeon's files, 322.32911.
(44) Memorandum for the director, construction and forestry, A. E. F., from the chief sur-
geon, A. E. F., September 28, 1918. Subject: Hospitalization. Copy on file,
A. G. O., World War Division, chief surgeon's files, 329.32911.
(45) Weekly bed reports, October 31, 1918, proposed in the office of the chief surgeon, A. E. F.
Copy on file. Historical Division, S. G. O.
(46) Weekly bed report, November 7, 1918, prepared in the office of the chief surgeon, A. E. F.
Copy on file. Historical Division, S. G. O.
CHAPTER XVII
THE DIVISION OF HOSPITALIZATION (Continued)
MEDICAL DEPARTMENT TRANSPORTATION
HOSPITAL TRAINS
Hospital trains of the American Expeditionary Forces, being Medical
Department organizations/ that department administered the personnel
assigned to them and was responsible for the maintenance of train supplies
and equipment.^ As railway units, hospital trains were operated under the
direction of the officer to whom they were assigned, and were repaired by
the transportation service, A. E. F.^
Assignments of hospital trains were made by the fourth section, general
staff, general headquarters, A. E. F., to regulating officers and to the troop
movement bureau, headquarters. Services of Supply.^
An officer of the Medical Department was assigned to each regulating
station as a part of the staff of the regulating officer and as a representative
of the chief surgeon, A. E. F., to whom commanding officers of hospital trains
assigned to that regulating station, were directly answerable in matters per-
taining to Medical Department administration.^ The medical assistant to
the regulating officer was charged with the duty of seeing that trains were at
all times ready to answer calls, and, to this end, that they were kept properly
stocked and provisioned.
Briefly, evacuation of sick and wounded from the zone of the armies by
means of hospital trains was effected by trains assigned to regulating officers.
On the other hand, evacuation from hospitals in the rear of the zone of the
armies was provided for by the troop movement bureau at headquarters.
Services of Supply, in accordance with requests made upon the bureau for this
purpose by the chief surgeon, A. E. F.^
Prior to the signing of the armistice, most of the hospital trains were
assigned to the control of the chief surgeon's representative at general head-
quarters.^ The remainder, which were engaged in secondary evacuations —
i. e., removal of patients from one base hospital to another in the Services of
Supply — were under the immediate control of the transportation section of
the hospitalization division, chief surgeon's office, A. E. F., except that certain
of these secondary evacuations, the purpose of which was to clear base hos-
pitals in the advance section, A. E. F., were conducted for a brief period by
the regulating station at Is-sur-Tille.^
Since the operation of regulating stations, and primary evacuations from
the zone of the armies are discussed in Volume VIII of this history, no further
reference will be made to these subjects herein.
The transport and hospitalization of sick and wounded in the American
Expeditionary Forces after they had left the zone of the armies, presented
317
318
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCP^S
difficulties which differed in many respects from those which had confronted
the French Army during three and a half years of warfare, and also from those
of the British whose system of evacuation was similar to that of French though
modified by geographic conditions.^ The French and British systems involved
no long lines of communication to home ports. France was hospitalized inten-
sively in each of her mihtary regions, so that her disabled could be distributed
among the many military hospitals scattered throughout the country, and,
when hospital bed space was lacking, in private homes. ^ The shortness of the
journey to England made it possible for British wounded to reach home bases
rapidly and in large numbers.
The American Army, on the other hand, was compelled to hospitalize in
France and in England almost all its sick and wounded, during the period of
active warfare, since it was impracticable to return to the United States any
except a relatively small number who were permanently disabled.^ To meet
the needs imposed by this situation and to economize personnel and materiel,
we had recourse to the use of large hospitals and hospital groups into which
patients could be received by the trainload. These organizations necessarily
were situated on supply lines of the American Expeditionary Forces. The
plan involved long hauls when patients were moved from the front into hos-
pital centers in the intermediate or base sections, and early in the organization
of the American Expeditionary Forces it was appreciated that ample hospital
train service was one of the prime elements of a successful evacuation service.
The procurement of such trains was one of the first subjects taken up by the
chief surgeon, A. E. F.^
PROCUREMENT
Pending later arrangements, two hospital trains were rented from the
French Government, the order for them being placed in July, 1917,* delivery
for one being effected in December of that year and for the other in February,
1918.^ Since it was known the French could not furnish more trains, and
as a tentative estimate had been made that 10 trains would be needed for
every 500,000 troops, contracts for others were let in England.'' By August
12, 1917, arrangements had been completed for the procurement of 12 hos-
pital trains from England and the 2 (above mentioned) from France As
the situation developed, an increasing number of these trains was con-
tracted for to a total of 48 hospital trains and 20 corridor trains for sitting
patients only.^ Fifteen of the former had been ordered prior to December
31, 1917, and by the end of August, 1918, 17 hospital trains were in use, and
orders had been placed in England for 23 others.^ The order for the corridor
trains was placed on November 7, 1918.'^ Delivery of trains of both kinds
was stopped when the armistice was signed.^ At that time 19 hospital trains
had been received from the British and 4 more were ready for shipment.^
The cost of each train was approximately $200,000.^ In addition to these
trains others, not especially built for the conveyance of casualties but adapted
as well as might be to that purpose, were rented from the French to meet
emergencies.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 319
Bkitish-made American Hospital Trains
Each of the British-made trains consisted of 16 coaches. With a few-
minor exceptions they were standardized and afforded the following accom-
modations:^ 1 car for infectious cases, 24 beds (one end used for caboose);
1 staff car, 8 beds; 1 kitchen and sick officers' (sitting) car, 3 beds for cooks,'
20 seats; 9 ordinary ward cars, 36 beds each; 1 pharmacy car, 12 beds; 1 per-
sonnel car, 33 beds; 1 train crew and store car, 3 beds; 1 kitchen, men's mess
car, caboose, 2 beds for noncommissioned officers.
The average weight of an empty train, without engine, was about 450
tons, and the average length, less the engine, 920 feet.^ Long coaches, 54
to 56 feet from end to end, were used instead of the short, continental type,
in order to insure more comfortable journeys. These trains were so attractive
in appearance that they were frequently placed on exhibition in England
before being shipped to the Continent.
Each train was provided with 360 beds for patients.^ Not infrequently,
however, in emergencies, the train personnel gave their beds to patients,
thus increasing train capacity to 396 beds. Fittings in all trains (except
the one first rented from the French, which accommodated 306 recumbent
patients) could be so adjusted by folding up the middle tier of beds that the
relative number of recumbent and sitting patients could be varied from 120
of the former and 480 of the latter — the normal arrangement — to 360 of the
former and no sitting patients. The crisis load was 120 beds and 488 sitting
patients.^
Special provisions were made for the badly wounded, the slightly wounded,
infectious and mental cases, respectively, including arrangements for their
medical care and for supplying them with proper food.'' Special cooking
facilities were aft'orded in the two kitchen cars which formed part of these
trains.
The forward kitchen car was divided into three sections — kitchens,
sitting room for disabled officers, and a bedroom for cooks. ^ In the first section
was installed an Army range with equipment, together with an apparatus
providing an adequate supply of water for cooking purposes. This kitchen
was used only when there were patients on board and was supplementary
to the kitchen at the rear of the train. The latter served duty personnel,
whether there were patients on board or not.
The staff car, for medical officers and nurses, was provided with sleeping
compartments and a separate dining room for nurses and officers.^ Also
it was equipped with a shower bath and was made as comfortable as possible.
Each of the 9 ordinary coaches for recumbent patients was fitted with
36 beds, arranged in tiers of 3. Beds were specially designed, were removable,
and in case of necessity could be used as stretchers.^ When the car required
cleaning these beds could be folded against the sides, and by lowering the
middle one flush against the sides of the car the bed nearest the floor was
converted into a comfortable seat or couch, the top one being still available
for a recumbent patient. By thus converting beds into seats the less seriously
wounded could sit up or lie down as desired.
13901—27 21
320
ADMINISTEATIOX, AMERICAN EXPEDITIONARY FORCES
These coaches were considered models of sinipHcity and efHciency." To
expedite loading and unloading double doors were provided on each side of
each ward coach, as near the center as possible. In cases of serious injury where
it was not advisable to remove a patient from the litter, this could be rested
directly on the bed supports, without complicated adjustments. Ash trays and
small racks for holding patients' toilet and other personal articles were j)rovido(l
in convenient places.
The pharmacy car was placed near the center of the nine ward coaches. It
was well equipped with drugs, linen, medical and surgical necessities, and had
an office where records were kept. It also had a room containing a collapsible
operating table for minor operations or for changing dressings, a 12-bed ward,
and a morgue.^
The car for infectious cases was divided into four compartments for patients
and one for attendants.^ Each compartment for patients (used also for mental
cases, as required) accommodated six patients.
The personnel car, provided for the enlisted force, was designed on the same
lines as an ordinary ward coach, so that in emergencies it could be utilized as a
patients' car.'' Accommodation for patients was also increased at such times by
the insertion of litters wherever these could be placed.
The second kitchen car had dining-room accommodations for noncom-
missioned officers and enlisted men and was equipped with facilities for cooking
and for heating water similar to those installed in the forward kitchen car.^
The last coach on the train furnished ample storage space for general sup-
plies such as food and drugs for seven days and, in a section partitioned off from
the rest of the car, afforded additional accommodations for the train crew.^
Trains were electrically lighted throughout and were capable of generating
current when running at any speed. ^ Storage batteries were placed under the
bodies of the cars to furnish current when the train was not in motion, but
orders were enforced that current be economized. Hurricane oil lamps and an
ample supply of candle holders were provided for emergency use in case the
electrical connections became disordered. Material for gas lighting was sup-
plied at some stations, but in times of battle pressure trains were not held to
have this supply.^ If this material was refused at any of these stations, the fact
was reported to the transportation section of the chief surgeon's office.
Our British-made hospital trains were steam heated throughout, the ratio of
heat-radiating surface being higher in them than in any other railway coaches
on the Continent.' Staff and personnel coaches were provided with a special
self-heating equipment for use when detached from the engine. As the person-
nel lived on board, this was a necessary provision. When trains carrying
patients were garaged on sidings and their engines detached, the train commander
was authorized to request French authorities or the railway transportation
officer to have an engine attached if weather conditions were severe.
An ample supply of water for drinking and other purposes was provided
on all coaches, the amount per train being about 2,500 gallons.^ Drinking
water was supplied in 6-gallon tanks throughout the train, and it was ordered
that these tanks be filled as opportunity offered, due notice being given the
railway transportation officer, who was charged with making necessary arrange-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 321
ments. All drinking water was sterilized. Water for washing trains was
obtained from the station supply.
Special attention was given to ventilation of ward and other cars and of
lavatories.^ Trains were equipped with large electric fans, and small portable
ones were used in the treatment of gassed cases. Lavatory accommodations
were ample.
Trains Obtained from the French
The acute need for hospital trains arose first in May, 1918, at Cantigny,
and was intensified during the operations in the Marne area.^ It continued
throughout July and late into August in the last-mentioned sector and in that
of the Champagne. A large number of American wounded were evacuated by
trains procured from the French during operations in front of Paris in July and
August, though we then had 9 trains, from Pantin, in service.^ From 4 to 6
Fig. 82. — Hospital train obtained from the French, at Base Hospital No. 9, Chateauroux
of these were sent daily to entraining points and were routed into Paris or
through it to other destinations. Arrangements had also been made with the
French to furnish us other hospital trains and trains for patients. In the same
way 45 French trains were borrowed for use during the St. Mihiel and Meuse-
Argonne operations.^ These were additional to the 2 specially prepared trains
rented from the French in July and the 19 built in England.
French trains obtained for the Meuse-Argonne operation were of three
main types :^ (1) Permanent trains made up of corridor cars. (2) Permanent
sanitary trains made up of cars specially constructed for the transportation of
bed patients. These were comparable to our hospital trains except that they
were smaller, carrying 120 recumbent patients. Heating, as a rule, was central.
Patients were unloaded through side doors. (3) Improvised hospital trains
322
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
made up of ordinary passenger cars fitted with racks for holding stretchers.
Only recumbent patients were carried in these, 12 to a car. Cars were heated
by a small stove in each, and there was no communication between them. One
enlisted man of the French Medical Department traveled in each car.
In addition to these hospital trains there were the mixed or semipermanent
types, made up of the ordinary French day coaches (second and third class) with
lateral corridors. Certain of them were equipped for carrying recumbent cases.*
Some of these trains were made up of corridor cars only ; others only partially
so. Two stretchers, one above the other, were placed in one-half of each com-
Fig. 83. — French hospital train, with continental type of carriage
partment, leaving room for 3 sitting cases on the opposite seat; that is, each
compartment carried 5 patients, 2 lying and 3 sitting. According to the number
of compartments (6, 7, or 8), cars carried 12, 14, or 16 recumbent cases each, and
18, 21, or 24 seated; a total of 30, 35, or 40.
The method of supporting stretchers varied somewhat, according to the
type of train and also whether it^ belonged to the Midi or Paris-Lyons-Medi-
terranean Co.^ In cars of both these lines the interior handle of the stretcher
rested against an iron frame fixed to the side of the compartment. In the
Paris-Lyons-Mediterranean type of train the external handle of the stretcher
rested on the end of the same frame, while in the Midi type of train it was sus-
pended by a chain from the roof of the car.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 323
Carrying capacities of these French trains varied considerably.^ Some
accommodated an average of 70 recumbent and 300 sitting patients; others
from 70 to 280 recumbent and no sitting patients. Some carried 108 recumbent
and from 230 to 250 sitting patients, and so on.
Toward the end of the Meuse-Argonne operation a few trains of large
capacity, carrying from 1,000 to 1,500 were utilized for the exclusive use of sit-
ting cases.^ It was thought that box-car trains would be used only during periods
of intensive evacuation. In point of fact we employed them frequently during
the Meuse-Argonne operation, because the whole front line from the sea to the
Vosges was continually evacuating, and every available kind of transportation
was needed.
Except the two trains obtained at first, those leased from the French were
operated as arranged for by them, but their destination was controlled by the
American Army.^ They were not used exclusively, however, for American
wounded. French w^ounded carried on these trains were cared for and taken
to American hospitals just as were American patients. Disabled German
prisoners, too, were carried in the same way, no difference being made with them
in accommodations, treatment, or disposition. During the St. Mihiel and
Meuse-Argonne operations, approximately 2,000 wounded German prisoners
were carried on trains belonging to the American evacuation service.^
It had been contemplated that box cars would be fitted up in such a way
that they could be used for transporting patients from the front, and, by the
readjustment of fittings, for transporting supplies from the rear.^ These fittings,
consisting of metal posts supporting tiers of litters, could be screwed in to the
floors and tops of cars and easily removed. Though these fittings arrived in
France, they were never used, for while the idea appeared sound there was delay
in cleaning trains and adjusting fittings. Moreover, cars were not always
available when needed for this purpose. The French and the British Govern-
ments both had attempted to use the plan but soon abandoned it.
SUPPLIES
Initial supplies and equipment for hospital trains w^ere procured from the
American Expeditionary Forces medical supply depot, Cosne, upon which
requisition w^as made direct. After being placed in operation these trains
obtained their supplies from the hospital train store established at the central
depot for hospital trains and from supplementary depots established as neces-
sity arose. In times of pressure, hospital trains disembarking casualties at
base hospitals where there were not hospital train depots, sometimes had to
return direct to railhead areas without stopping for any prolonged period.
Under such circumstances the commanding officers of these trains obtained
supplies, if possible, from these base hospitals or from the quartermaster depots
located there. Notice of stores draw^n under such circumstances was sent to
the central depot against which these supplies were charged, so that this depot
could check the issue.
It was intended that property accountability should be taken care of by
these depots and that hospital trains were to obtain their supplies from them
on memorandum receipt, but uutil such depots were established it was neces-
324
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
sary for the trains to keep a property account."' As soon as depots were estab-
lished, orders were issued for hospital trains to invoice the property to depots
but to retain the same on memorandum receipt. When emergency issues
were necessary, a telegram was sent to the base hospital or quartermaster
storehouse, giving train number, time of arrival, and name and quantity of
articles wanted so that these would be available on arrival. When absolutely
necessary for supplies to be drawn at the railhead, notice of what had been
drawn was sent to the central depot for hospital trains.^"
A list of the standard equipment for each train was furnished the regulating
officer and was kept for his reference." He w^as authorized to check this equip-
ment whenever he deemed this necessary, and the commanding officer of the
train was ordered to check it frequently, verify its condition, and make suitable
provision for its care. Hospital trains were supplied with adequate material
to effect exchange of all property brought by patients from evacuation hos-
pitals, such as pajamas, splints, crutches, litters, air pillows, and dakinization
tubing; when such materiel was delivered with patients at base hospitals it was
similarly replaced. Also, a sufficient supply of litters and blankets was kept
at the hospital centers to permit an exchange, thus avoiding transfer of patients
from one litter to another. When reserve supplies were not sufficient for the
exchange of item for item, either the commanding officer or the supply officer
of the train was given a receipt for materiel not replaced.
Red Cross comforts for patients w^ere obtained at any train depot. ^ Blan-
kets were checked frequently, were obtained from depots when needed, and
were disinfected at the central sterilizing plant.^ Reserve blankets were
turned over to the railhead depot when required, and other medical supplies
carried as reserve when asked for. When the train returned to a depot these
reserve blankets and supplies w^ere replaced. Similarly clothing and shoe
repairs for personnel were obtained at the hospital train depots. Splints and
suspension bars were carried in reserve to replace those brought with patients
from the zone of the advance. Arrangements for dental service of train
personnel were made at the depots.
PERSONNEL
Each American train carried, at first, a personnel of 3 medical officers, 3
nurses, 1 sergeant, first class, or hospital sergeant, 2 sergeants, 2 cooks, and
31 other enlisted men of the Medical Department, including 1 engineer-me-
chanic.^ Later it was found that tw^o medical officers were sufficient, the
third being replaced by an additional nurse. Train personnel was housed and
fed on board whether in transit or in garage.^
ADMINISTRATION
The commanding officer of a train was charged wnth several correlated
duties, exercising military jurisdiction and professional control. '° He was
responsible for discipline, exercising control over personnel and patients, for
which reason he appointed a summary court officer. He was also charged
with the thorough instruction of his personnel. When patients were being
entrained or detrained, the entire train personnel was on duty, and only the
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 325
officer in charge of the movement and the necessary enlisted help were allowed
off the train.'' Furloughs were granted only on approval of the regulating
officer or of the transportation section of the chief surgeon's office if the train
was under the latter's immediate control. Passes to leave a train were granted
with discretion. No such passes were granted in the advance zone, and nurses
were not permitted to be away from a train longer than two hours. Such of
the train personnel as became incapacitated were left at the nearest base hos-
pital. If anyone on duty missed his train he reported at once to the railway
transportation officer of the station it, being forbidden to travel without orders
on any train; all absences were reported to higher authorities. Ward orderlies
were not sent out of the train for any purpose whatever. At night at least one
medical officer, one trained nurse, and one orderly for each ward remained on
duty. Precautions against fire were enjoined, and appropriate orders, includ-
ing assignments in case of such emergency, were issued. The train commander
permitted no one to travel on his train except its authorized personnel, men
whose names appeared on the evacuation lists, and those authorized by the
chief surgeon, A. E. F., or by the regulating officer to whom the train was
assigned.'" '' Armed guards who had accompanied such a train from the zone
of the advance were forbidden to return on it except as so authorized. '°' "
The train commander kept a war diary in which he made note of all matters
of importance to its service." He reported to the regulating officer or to the
chief of the transportation section, chief surgeon's office, all cases of slight
sickness and of the wounded who should have been retained in the advance area,
and all cases of death, giving full particulars. (The regulating officer, in turn,
transmitted this information to G-4, general headquarters, and to the Army
surgeon.)'^ He supervised the treatment of patients and made provision for
their care, kept up the records of sick and wounded, and sent to the chief surgeon
A. E. F., to the commanding officer of the base hospital to which he was taking
patients, and to the regulating officer, telegrams stating the number of recum-
bent and sitting patients in his total trainload, and the same information cover-
ing each class of patients on board: Wounded, sick, and gassed." His telegram
to the regulating officer, confirmed by mail, gave complete detailed information
concerning the trip. To the chief surgeon, A. E. F., and to the regulating
officer he sent copies of his train report and of his "detraining state." A tele-
graphic report of any accidents, confirmed by letter giving full particulars, was
sent to the regulating officer, who was charged with the responsibility of send-
ing immediate relief, with a wrecking crew, and with report of the facts in the
case to the chief surgeon's office."' '^
Accidents causing damage to coaches, or derailments, were reported by
telegraph to the transportation section, chief surgeon's office, A. E. F., and
repeated to the Railway Transport Service, general headquarters.'" Demand
for repairs, was handed to railway transport office representatives at bases where
such repairs were possible and were authorized, but except in cases of great
emergency no such demands were made at a railhead or other unauthorized
station.
Suggestions concerning minor alterations in structure which appeared to
be desirable, or notes on general conditions of trains, were sent by mail to the
transportation section in the chief surgeon's office, A. E. F."
326
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Trains were loaded as nearly as possible according to the instructions of the
regulating officer and were routed as he directed, no trips being made except
upon his authorization.^ Upon completion of evacuation the train was sent
back to the regulating area and garaged there."
If coaches were removed from or added to a train, notification with time,
place, and cause, was telegraphed to the chief surgeon, A. E. F., or to the regu-
lating officer concerned, who altered his record of the carrying capacity of such
train and arranged his load for it accordingly." Changes in the composition
of hospital trains were authorized only by the chief surgeon. If the regulating
officer found that conditions required such changes, he consulted the chief
surgeon's office. If through accident or emergency cars were detached, the
regulating officer endeavored to have them returned as soon as possible if in
his area; if outside it, he made appropriate request upon the transportation
section, chief surgeon's office. Use of cars except for their designated purposes
was forbidden."
Careful classification of evacuable patients before loading was of vital
importance, for the following reasons: " The rate of distribution among hospitals
in the rear was proportionately as rapid as classification at loading points was
correct. Retention of patients of the same classification in the same part of
the train expedited their removal.
Evacuation officers of hospitals where patients were received gave especial
attention to the classification of outgoing patients into such groups as "Seriously
wounded," "Gassed," "Ordinary sick," "Infectious cases," "Mental cases." "
The commanding officer of the train verified this grouping of cases according
to classification. If several places were scheduled for detrainment, the patients
were grouped according to their destination as far as this was possible."
The evacuation officer gave the train commanding officer his evacuation
sheet, on which appeared nominal lists of all cases — classified — to be evacuated,
and the latter prepared his train for the load."
When it was possible to do so the ev^acuation officer inspected each man as
he was placed on board, noting the condition of clothing and dressings, the
patient's field card, record of antitetanic injections given, and saw to it that no
helmets, arms, or packets were carried. Only personal belongings were allowed
to be retained by the patient."
The following reports were rendered for each journey: "
Detraining state: 2 (1 to detraining medical officer at destination; 1 to transportation
section, chief surgeon's office, A. E. F.)
Report of train journey: 1 to transportation section, chief surgeon's office, A. E. F.
List of documents received: 1 to detraining medical officer at destination.
Nominal roll of officer patients: 2 (1 to detraining medical officer at destination; 1 to
transportation section, chief surgeon's office, A. E. F.
Death reports: 2 (1 to adjutant general's office, general headquarters; 1 to transporta-
tion section, chief surgeon's office, A. E. F.)
Nominal Hst of patients detrained en route: 1 to detraining medical officer at detraining
station.
Telegram of French sick and wounded on train: 1 to commandant des Armees Fran-
caises at destination.
Diet accounts: 1 to transportation division, chief surgeon's office, A. E. F.
War diary: 1 monthly to adjutant general's office, through transportation section,
chief surgeon's office, A. E. F.
Return of journeys: 1 monthly to transportation section, chief surgeon's office, A. E. F.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 327
A correspondonce book was kept on each train, and a reserve supply of
official labels in the office of each train, as follows: " (1) Casualty; (2) descrip-
tion; (3) patient's kit; (4) red labels (affixed to patients too sick to be
transported farther and therefore put off at intermediate hospitals); (5) white
or ship labels; (6) specification labels. These were supplied to trains as soon
as obtainable by the depots.
The "detraining state" was a report given by the commanding officer of
a hospital train to the detraining medical officer, and contained the following
items:" (1) Train number; (2) army from which entrained; (3) time and
place of departure; (4) destination; (5) gross number of patients on board;
(6) numbers classified as "lying" and "sitting" in accordance with the follow-
ing category: Infectious cases (disease to be specified); mental cases; Carrel
cases; venereal cases; any other special cases; civilian patients (including
Y. M. C. A. and Red Cross men); labor contingents; French, Belgian, Portu-
guese, etc.; German.
When patients were entrained at base hospitals for ports of evacuation,
the entraining medical officer sent this information by telegram to the detraining
medical officer of the port. When trains were loaded with patients for hos-
pitals located at seaports and not intended for ships, the word "Hospital" was
noted on the telegram to specify destination. Patients carried only between
stations — as, for instance, for dental treatment — were not included in the
telegram to detraining station, as this telegram was intended to notify base
hospital authorities concerning the amount of bed space which would be needed
for patients then en route.'" "
The commanding officer of the train and the evacuation officer checked
the loading of patients and verified the number evacuated.'' When loading
was completed the commanding officer of the train advised the railway trans-
portation officer, who furnished him with an order of transport, showing desti-
nation, stops and load. The commanding officer advised the former of his
readiness to leave, and verified the transmission of his several telegrams.
It was important that advance notice be sent of the expected arrival of a
train, so that the receiving officer could arrange for prompt unloading and for
sufficient transportation for the removal of sick and wounded to hospitals."
In order to expedite matters, announcement of prospective arrival of the train
was made to the commanding officer of the receiving hospital by telegram from
the regulating officer. It was also made by telegram from the commanding
officer of a train as soon as loading was completed.
As promptly as possible after a train was loaded its commanding officer
made inspection, again examinining field cards and clinical records, verifying
information regarding the administration of antitetanic serum and, when
necessary, ordering it to be given." He instructed ward car orderlies how to
care for patients, and the orderlies prepared for him a list of the patients in
their care. These lists formed the basis of the commanding officer's reports
and of his telegrams to the chief surgeon and to the regulating officer making
final records for the train trip.
In so far as the British-built American hospital trains were concerned the
following scheme was adopted for a balanced load when it was desired to carry
328
ADMINISTRATION, AMERICAN EXPEDITIOXAH V FORCES
600 or more patients: Top berths were used for litter eases, the middle berths
being folded, and lower berths for sitting patients, so that each car provided
accommodations for 12 recumbent and 48 sitting patients. Serious cases
requiring much attention were placed in the pharmac}' car in order that their
wounds might be redressed if necessary or the patients be otherwise cared for
on the operating table installed in this car. Unless it was necessary to do so,
wounded men w^ere not removed from one car to another or from one litter to
another. In times of stress the capacity of ward cars was increased by placing
Htters, in tiers of three each, across the car doors. These were secured by
hooks attached to the end rods of the bunks, and by straps.
Fir,. 84. — Intorior of one of our hospital trains (British built i
Bodies of patients who died en route were left at the larger stations where
stops were made, and full details regarding each body were given in an envelope
to the officer taking charge of it, with notice that the commanding officer of the
train had signed the official telegram notifying the central records office, A. E. F.,
of the patient's death. Personal effects of such casualties were disposed
of in accordance with Army Regulations. The transportation section of the
chief surgeon's office, A. E. F., was notified by letter of all deaths occurring oa
trains, with full particulars, and a telegram was sent thereto at the same time
as that sent to the adjutant general's office, A. E. F. Very serious cases were
sometimes detrained en route, at the larger places, but only w^hen this was
absolutely necessary.'^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 329
PROFESSIONAL ACTIVITIES
Serious cases were cared for at once. Orthopedic cases and those that
would recjuire dressing en route, if not placed in the pharmacy car, were placed
in the middle and lower bunks, with injured parts next the aisle." Slightly
wounded, recumbent patients were put in top berths and injured parts immo-
bilized before the train started." Mental cases were searched before being
placed on board (all patients were disarmed before being entrained) and were
taken to a separate compartment the windows and doors of w^hich were
closed, ventilation being provided by electric fans and roof ventilators. These
patients were kept under constant surveillance. Contagious cases also were
carried in special compartments.
Chest cases bore transportation badly. Empyema cases usually drained
freely. When there was danger of secondary hemorrhage, new amputations
were dressed while a stop was being made. A few operations, including ligations
of arteries, were performed on trains, but professeonal activity was limited
usually to redressings — generally performed in the pharmacy car — and symp-
tomatic treatment." Conditions causing the greatest concern were injuries of
head and abdomen, and pneumonia cases. Cases of the first two classes were
prone to secondary hemorrhage; pneumonia patients did not endure well any
movement before convalescents. Gassed cases were carried recumbent when
this was possible, and they were not allowed to smoke. If their eyes were injured
and sensitive to the light, they were placed on the lowest berths if these were not
needed for seriously wounded patients. If a patient's splint was so adjusted
that it obstructed the car aisle, he was placed at the end farthest from the toilet
and a chair put under his splint to remind passers to make a detour around
him. Headboards of berths, especially on train No. 55, were placed at the end
farthest from the car door, and patients were entrained head first and placed in
berths without being turned around.'^ This arrangement facilitated super-
vision by the ward master stationed at the center of the car. Upon com-
pletion of loading, this attendant examined all his patients and their medical
cards, making appropriate entries in a notebook, noting the need of Carrel-Dakin
solution, the administration or nonadministration of tetanus antitoxin and
morphia, the presence of contagious or venereal diseases, abdominal wounds
necessitating liquid diet only, and other items of professional importance.
SUBSISTENCE
Hospital trains drew rations and supplies at base hospitals if this plan was
found to be more convenient." Drawing of commuted rations was found diffi-
cult. Sales commissaries in advance zones were not in convenient locations for
the 30 or 40 stations at which trains were garaged, and even when available
they had not sufficient stock on hand to supply organizations in addition to
those to which they had been assigned." Nor were these sales commissaries
open at all hours of the day and night.
French hospital trains in American service were furnished with rations by
railhead officers upon request of the evacuation officer.^^ Patients on these
French trains were fed at station infirmaries at regular feeding points and stops
were arranged for in the schedule.
330
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
MESSING OF PATIENTS ON REGULAR HOSPITAL TRAINS
Immediately upon entrainment patients were given hot drinks, soups, or
other Ught nourishment. As the patients were to be on board only a relatively
short time, meals were standardized on a number of trains — e. g., train No. 53,
with the result that waste was minimized, the accumulation of unsuitable food
prevented.''
On train No. 58 patients were served a thick soup containing ingredients that
otherwise would have been served as separate dishes — such as beef, potatoes,
beans, hominy, and the like— and were given sandwiches.'* This method expe-
dited service and facilitated the feeding of bed patients and at the same time
conserved stove space needed for special diets. On other trains — e. g., No. 59—
patients received the garrison ration, except that special cases were given light,
soft, or liquid diets. '^
MESSING OF PATIENTS ON EXTEMPORIZED HOSPITAL TRAINS
As previously stated, patients on most of the trains rented from the French
were fed by station infirmaries while en route, at regular subsistence points, and
stops were arranged for in the schedule.'^ When there was intercommunication
between ward cars these stops were unnecessary. Certain of these trains were
equipped with kitchen cars where patient's meals were prepared en route and
served at certain stops specified in the schedule, and these trains were rationed
accordingly. All French trains which the United States employed were rationed
at railheads by local evacuation officers.'^
DETRAINING PATIENTS
Each of our large hospitals or hospital groups had a railway transporta-
tion officer, one of whose duties was the arrangement of priorities for the stop-
ping of hospital trains at proper detraining points.^ At each such detraining
point detraining parties were organized, charged with the proper unloading of
trains and with the duty of assisting train crews in the work of cleaning and
disinfecting the cars, as well as in the proper exchange of blankets, litters and
other supplies which might be unloaded with patients. This exchange was
made through the train commander.
On arrival at a base hospital the commanding officer of a train had in
readiness his "detraining state," which he turned over to the detraining officer
of the hospital, together with all documents pertaining to patients, including
any X-ray plates." These were duly receipted for. The detraining medical
officer informed the train commander of the order in which his patients were
to be removed; whereupon an officer of the train supervised the unloading,
taking care that patients' kits went with them. Officer patients' baggage was
turned over to a noncommissioned officer detailed by the detraining medical
officer to receive and receipt for it. Any articles whose ownership could not
be traced were turned over to the central hospital train depot, with full partic-
ulars regarding them."
The train commander informed the railway transport officer of any gas,
repairs, or water required and also gave the time when his trains would be
ready to proceed." Unnecessary delays were carefully avoided, as even a few
minutes' delay might mean the loss of a schedule, resulting often in a halt of
three or four hours before a new schedule could be obtained.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 331
SANITARY SUPERVISION OF TRAINS
The sanitary condition of these trains required constant supervision, as
patients were often received at the front with badly soiled clothing.^ Many
of them harbored vermin, and many suffered from infectious diseases. One
of the greatest difficulties experienced in train service was the provision of any
adequate supply of water under sufficient pressure for flushing out all cars,
though trains carried many lengths of garden hose to make distant water
connections.^ The French offered the use of their disinfecting apparatus
employed on their own trains, but their process did not utilize the methods
and agents which American authorities preferred.^ It was the American
practice to flush out trains from end to end as they returned to the front,
walls being washed with formaldehyde solution and floors scrubbed with
Fig. 85.— Hospital train at Base Hospital No. 27, Angers
strong cresol. Blankets were shaken, mattresses turned, and latrine buckets
cleansed and deodorized with chloride of lime. French trains placed at the
disposal of the American Army invariably had been disinfected with formalde-
hyde, though this measure consumed time which the American service employed
in returning trains to the front.^ One reason for our method was the shortage
of trains. When ours were held in garages or on sidings for any length of
time, galvanized-iron cans were placed under all waste and toilet discharges
and were emptied by train personnel into proper places before the train started.
This was always a troublesome process, especially in large freight yards such
as at Pantin, near Paris, where many trains of all kinds were placed on tracks
so close together that passage between them with these iron cans was almost
impossible.^
332
ADMINISTRATION, A:MERirAN FA'PEBITIONAH V FORCES
LAUNDRY
Laundry was exchanged either at replenishment depots, includiii*; that
of the regulating station, or at hospitals to which patients were taken."
TRAIN MOVEMENTS
As stated above, train movements were determined by the Railway
Transport Service, which made the necessary traffic arrangements.^ Amer-
ican trains were not allotted to any particular line but were interchange-
able and were operated according to Medical Department needs and traffic
facilities.
Immediately upon requisition of the first train, arrangements were made
for garage points and for routing and rates of speed on French railways.^
Through areas in advance of regulating stations it was never possible to route
hospital trains any faster than freight.^ This corresponded to the slow freight
train of America, but the disadvantage was not so great as might be supposed,
the distance between entraining points and regulating stations usually being
short. In routing trains from the latter stations, however, to points far in
the interior, and even to base ports, the transportation of patients at such
low speed was inadvisable, though the French used it for their hospital trains.'
Our need for a faster schedule arose from the fact that hospital trains
had to travel long distances to reach our base hospitals.^ After several con-
ferences on this subject, held in Paris with the fourth French bureau, the
French Government gave orders to the French director general of transportation
that American hospital trains traveling from regulating stations toward the inte-
rior be given the advantage of passenger-train schedules.'' In point of fact the
speed was that of military trains, but on lines in the interior a faster schedule
was followed whenever technical conditions permitted. In cases of emer-
gency trains were dispatched on fast schedules for the entire journey, provided
this "did not interfere with the schedule of military trains having priority. All
express schedules were authorized by the fourth bureau, general staff, which
arranged the intercommunicating schedules with the railway mangement.
These authorizations for rapid movement were transmitted immediately to
the regulating officers concerned, showing the advanced notice required for
dispatching trains and the proper railway authorities to be notified in each
case."
Constant liaison was necessary between the regulating officer and train
commanders, as the former could usually give the latter information con-
cerning the approximate time of the next trip.^^ Especially was this true
when trains were in one garage and where train trips followed consecutively;
that is, where the last train in was also the last train to go out. Trains were
often moved up to the loading points as trains already loaded pulled out. In
such cases it was difficult to determine the time of movement. It was
important, therefore, under such circumstances that trains always be fully
prepared to be called on to move at a moment's notice.
Trains were routed so as to reach their destinations in the shortest possible
time." They did not make stops en route even on sidings, if this could
be avoided, and only after previous consultations with the railway authorities.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 333
if this was possible. Long stops at railway stations w^ere permitted only
where tracks allowed loading or unloading without blocking the main line.
Trains were ordered not to halt on main lines for more than the briefest possible
time. At small stations unloading had to be done within a specified time,
and so far as possible these places w^ere avoided. Trains were split onl}^ in
case of absolute necessity.
Night service was not often organized on branch lines, and notice had
to be given in advance when trains were due to arrive at night.
The regulating officer selected new loading stations in the army zone
at points most convenient to the evacuation centers designated by the army
surgeon.
When a hospital train garaged at a regulating station was asked for by
the army, the regulating officer proceeded to route the empty train, fully
equipped, to an entraining point farther toward the front, where sick and
wounded were received from evacuation or mobile hospitals.^ The regulating
station then routed the train back, generally through the regulating station
and then farther on into the interior to base hospitals in the advance, inter-
mediate, or base sections designated to receive the patients.
The train made this journey under more difficulties than are at first
apparent.^ In all forward areas, railways were constantly congested by traffic,
and all rolling stock was routed on a priority schedule from which no deviation
could be made without causing great confusion. For example, bread trains,
passing forward daily through the regulating station, had priority over every-
thing except moving troops, and empty hospital trains going forward from
regulating stations had to take their chances for priority with all other railway
transportation loaded with army necessities. If one train at an entraining
point fell behind its schedule for starting on the return journey this might
for the next 24 hours throw out the schedules of other trains carrying all kinds
of supplies, for after loading, the hospital train proceeded back toward the
regulating station and it became one of a stream of empty trains passing to
supply bases qver the same route. After arrival at the regulating station,
another schedule had to be arranged for it by the regulating officer to get it
through to its destination or detraining point in the interior. Little outside
assistance could be given train commanders along this entire route, for which
reason full equipment had to be issued before the train could begin its journey.
In addition to this, excess equipment, rations, and supplies had to be carried,
to provide for the numerous emergencies and delays w^iich might occur before
it could reach its destination.
PROVISIONS FOR REPAIRS
It early became apparent that provision must be made for minor repairs
first, and major repairs later, which could not be made by the mechanic on duty
with each train unit; consequently, immediately upon acquisition of the first
trains, arrangements were made with the French fourth bureau for garage and
repair at the American car shops at Nevers.^ Necessary repairs always began
within an hour after the arrival of hospital trains at the shops, whether by day
334
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
or by night. Facilities were also provided at regulating stations in the army
zone for garage of hospital trains, minor repairs, reception of water, rations,
medical supplies, and the distribution of mail.^-'*
SECONDARY EVACUATIONS
For secondary evacuations the 2 trains constructed by and leased from the
French at the outset of our activities and the 19 trains built by the British were
those chiefly employed, for they were in effect rolling hospitals, self-sustaining,
and much better equipped for the care of patients during long hauls than were
the smaller trains rented from the French.^ The latter were therefore used for
primary evacuations.^® Secondary evacuation effected by the chief surgeon's
office pertained chiefly to the movement of patients from base hospitals to ports of
embarkation and the collection of certain types of cases — e. g., maxillofacial — at
hospitals designated for their special treatment. Patients sent to ports of
embarkation where those whom disability boards in the various hospitals had
reported unfit for further military service in France (class D) and those who would
require at least six months' hospital treatment before they could become members
of class A; that is, fit for any military duty. Because of their serious wounds or
their chronic illness, these class D patients required the most careful attention
during transport, and, being widely scattered throughout France, their system-
atic collection and treatment en route presented a very serious problem to the
transportation service. While many such patients made the necessary journey
on ordinary passenger trains to hospitals at base ports, whence they were to be
transferred to the United States, most of these were collected on hospital trains
so routed as to impose the least hardship through unnecessary handling and delay
in transit. The success of this secondary evacuation depended largely upon
the cars used by disability boards at hospitals in the advance and intermediate
sections in selecting such cases as were plainly able to bear both the journey on
hospital trains and the subsequent transfer to ships at the base ports. If cases
were selected at base hospitals for transfer to the United States which upon
arrival at base ports were found unable to continue the journey to the United
States, they had to be retained at port hospitals until such time as their condi-
tion warranted their embarkation and the long sea voyage. If such retention
was protracted, there was danger of overcrowding hospitals at base ports.^
Prior to the armistice the collection of class D patients (i. e., those to be
returned to the United States) for evacuation to the ports was a difficult prob-
lem, for these were cases of chronic illness or mutilating wounds, many of which
required great care while in transit.^
As already stated, certain of these cases which were not in need of extraordi-
nary care made the journey to base port hospitals by ordinary passenger train. ^
Among such catagories were cases of incipient tuberculosis and mental defectives
of certain types; also some of those suffering from healing wounds orother injuries
of the upper extremities could properly be sent in small parties accompanied
by the necessary attendants. Larger groups of such cases were sent in special
coaches furnished by the local railway transportation officer at hospital entrain-
ing points. Very often this method imposed hardship on certain types of cases
sent, for many times it happened that changes of cars not anticipated by the
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 335
railway transportation officer were ordered by the French en route, accommo-
dations sometimes being substituted which w^ere inferior to the standard which
the American service strove to maintain. But, whenever possible, patients were
carried to the ports on hospital trains, for on the w^hole the system described
above did not work well. It was resorted to only when hospital trains could
not be spared for the purpose and hospitals had to be emptied to make room
for fresh increments of the sick and wounded.
The movement of insane patients and mental defectives, including psy-
choneurotics popularly known as "shell-shocked," w^as always attended by
difficulty and embarrassment.^ The laws of France prohibited the transport
on French trains of men declared insane, but as a matter of fact this regulation
Fig. 86. — Entraining class D patients at Base Hospital No. 30, Royat
was sometimes disregarded, for mental cases developed in regular, small incre-
ments, making it impracticable to hold these patients for the accumulation at
hospitals of a sufficient number to warrant the routing of hospital trains to
collect them.^ Unless mental cases needed the closest supervision, or unless
they were such as to excite comment en route, many of these were sent, accom-
panied by proper attendants, on ordinary passenger trains as "observation
cases. " ^ We never had cause to regret dispatching these cases in this manner,
since they were chosen carefully for this method of transportation, and the
procedure prevented the accumulation of mental cases at hospitals which could
not maintain specially trained personnel for their care, observation, and
classification.^
13901—27 22
336 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
When occasion demanded, hospital trains made periodic visits to collecting!;
points such as the hospital center at Bazoilles on call of the psychiatric service
to transport cases accumulating therc.^ Some complaints arose from various
causes concerning the transportation of mental cases, but these were invariably
investigated by the evacuation service of the chief surgeon's office and no
instances were found in which such patients were subjected to conditions which
jeopardized their safety or ultimate recovery.^
Similarly, difficulties confronted the assembling of maxillofacial cases at
Vichy, where special apparatus and personnel were provided to care for them.*
These cases were received at base hospitals all over France, but their number
never warranted the use of hospital trains for their collection at one point.^
Though it is true that many of these cases were ambulant and were able to
make journeys on ordinary passenger trains, the French were very insistent
that mutilated patients be not routed on such trains, where the sensibilities
of the traveling public would be distressed.^ Aside from this issue, it was very
difficult for attendants to feed such cases en route from one hospital to another.
Transport of selected cases to the maxillofacial center at Vichy was therefore
a matter of exceptional difficulty, for their wide dispersion in hospitals through-
out France, and the paucity of cases in a given hospital did not warrant the
frequent use of a hospital train for their collection and conveyance.^ To a
degree the same difficulty applied to the assembly and evacuation of the blind.^
After the beginning of the armistice, and after battle casualties had been
cleared from field units, most of the hospital trains w^re engaged in evacuations
from hospitals in the advance or intermediate section to others near base parts,
but a few continued to serve the Third Army, making primary evacuations
from the area of occupation, until arrangements were made for shipment of
casualties down the Rhine. ^
SUITABILITY OF HOSPITAL TRAINS
During our active military operations of 1918 American hospital trains
proved excellently suited to our needs, except as noted below\^ When once a
patient was started on the journey on one of these trains, food, warmth, and
necessary treatment en route were assured. Patients sent on trains rented
from the French (other than the two first obtained) were not so conveniently
served, for these trains had limited kitchen facilities, or none at all, and routes
taken to American base hospitals were not provided with the rest and refresh-
ment stations found all along French evacuation lines. The American Expe-
ditionary Forces had no personnel for the operation of such stations. This
was one reason why French trains w^ere used preferably for short hauls from
the front hospitals in the advance section and American trains on longer trips
to hospitals farther to the rear. Though excellent in other respects, American
trains were so long and so heavy that French railway oflftcials found difficulty
in laying them on sidings and in providing space for them at garages and entrain-
ing points. In about 50 per cent of instances where trains were placed on sidings
it became necessary to divide them into two or sometimes even three sections.
In cold w^eather this was a great disadvantage, for the reason that it disconnected
part of a train from its circulating steam line.
ORGANIZATION AND ADZMINISTRATION OF CHIEF SURGEON'S OFFICE 337
AMBULANCES
Ambulances comprised two kinds of vehicles: Animal-drawn and motor,
Tlie Medical Department made use of both kinds of ambulances for the trans-
portation of patients in the American Expeditionary Forces; transportation
of patients was a responsibility with which that department was charged
throughout.
PROCUREMENT
In the American Expeditionary Forces, the use of animal-drawn ambu-
lances was very restricted. These ambulances were assigned only to Medical
Department units serving with combat troops; that is, one ambulance com-
pany of each divisional ambulance section was animal-drawn.^^ Both animal-
drawn ambulances and animals for them were supplied by the Quartermaster
Corps; " their procurement was not a responsibility of the Medical Department.
The procurement of motor ambulances, on the other hand, was a direct
responsibility of the Medical Department for the greater part of the war.^ In
discussing this question it must be considered from both sides of the Atlantic,
motor ambulances, though classed as Medical Department materiel when we
entered the World War, became Motor Transport Corps materiel some months
prior to the armistice. Since this change was effected considerably earlier in
the American Expeditionary Forces than it was in the United States, there
was a period when, as will be explained, the Medical Department in the United
States was purchasing motor ambulances and shipping them abroad on Motor
Transport Corps tonnage.
In December, 1917, what was then the Motor Transportation Service was
created a part of the American Expeditionary Forces.'^ Its purpose, in part, was
the technical supervision of all motor-drawn vehicles; their reception, organi-
zation, and assignment (except vehicles belonging to organized units) ; and the
organization and operation of repair and supply depots for motor vehicles.
Until May, 1918, motor ambulances in the American Expeditionary Forces
were not included in the classes of vehicles controlled by the Motor Transport
Service, A. E. F. ; however, they were maintained in a state of repair by that
service. From May, however, all motor ambulances arriving in the American
Expeditionary Forces were turned over to what had now become the Motor
Transport Corps, A. E. F., but being classed as special vehicles, motor ambu-
lances were held by that corps subject to the orders of the chief surgeon, A. E. F.^^
Between this time and the following August, though the Medical Department
procured motor ambulances in the United States, they were shipped overseas
on Motor Transport Corps tonnage.^" Subsequent to August, when the Motor
Transport Corps, in the United States, took over the procurement of motor
ambulances from the Medical Department,^' their shipment overseas became
a responsibility of the Motor Transport Corps. Thereafter shipments were
based on estimates furnished by the Medical Department, A. E. F.
338
ADMINISTRATION, AMERICAN EXPEDITIOXAIU' FORCES
ESTIMATES AS TO NUMBER
On September 22, 1917, the following memorandum was submitted by the
chief surgeon, A. E. F., to the chief of staff:
1 . The following motor vehicles of all classes will be needed by the Medical Department
to meet the demands of the forces which it is estimated will be here on July 1, 1918: Motor
ambulances, 1,446; motor trucks, 905; motor cars, 338; motor cycles, 557.
2. The motor vehicles should arrive per month as follows, based upon the contemplated
program of the arrival of troops:
October
November.
December .
January
February...
March
April.
May
June
Total
Motor
ambu-
lances
145
145
73
290
145
73
217
217
141
Motor
trucks
91
91
46
181
91
46
136
136
87
905
Motor
cars
338
Motor
cycles
56
56
28
112
56
28
84
84
53
557
On November 27, 1917, the following more explicit estimate of the needs of
the Medical Department in motor transport was submitted :
Re reply to memorandum from chief of staff, dated September 18, 1917 (corrected to
November 27, 1917).
The following motor vehicles of all classes will be needed by the Medical Department to
meet the needs of the forces which are estimated will be here by the 1st of July, 1918:
1. For the Army:
(a) Chief surgeon's office —
Motor cars 2
Motor cycles 2
(b) Central laboratory.
(c) Army laboratories (3 laboratories), each laboratory —
Motor car 1
Motor cycle 1
Motor truck 1
(d) One sanitary train (combat division) —
Motor cars 7
Motor cycles 17
Motor ambulances 36
Motor trucks 42
Total for the Army —
Motor cars 14
Motor cycles 24
Motor ambulances 38
Motor trucks 48
Special bacteriological cars 6
2. For each corps (5 corps) :
(a) Office of each corps surgeon —
Motor cars 2
Motor cycles 2
(6) Corps laboratories, each —
Motor car 1
Motor cycle 1
Total for 5 corps —
Motorcars 15
Motor cycles 15
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 339
3. For each division (30 divisions, including 10 replacement divisions) :
(a) Each division surgeon's office — •
Motor car 1
Motor cycle 1
(5) Division laboratories (1 each) — -Motorcycle 1
(c) Evacuation hospitals (2 per division) — •
Motor car 1
Motor cj'cle 1
Motor trucks 3
(d) Evacuation ambulance companies (1 per division) —
Motor car 1
Motor cycle 1
Motor ambulances 20
Motor trucks 2
(e) Motor ambulance companies and field hospitals (3 per division) — ■
Motor cars 7
Motor cycles 17
Motor ambulances 36
Motor trucks 42
Total for the divisions (30) — •
Motor cars 330
Motor cycles 660
Motor ambulances 1, 680
Motortrucks 1,500
4. Line of communications:
(o) Chief surgeon's office —
Motor cars 2
Motor cycles 2
(d) Surgeons at base ports (3 bases) —
Motor cars 3
Motor cycles 3
(e) Base port transportation (3 bases; 1 motor ambulance company at each
base)- —
Motor cars 3
Motor cycles 9
Motor ambulances 36
Motor trucks 9
(/) Medical supply depot (2 at ports, 1 in intermediate section, 3 in ad-
vance section; total, 6 depots), for each depot —
Motor cycle 1
Motor trucks 2
Motor car 1
(g) Base hospitals; to July 1, 1918, 130 will be needed and each hospital
must have —
Motor car 1
Motor cycle 1
Motor ambulances 3
Motor trucks 3
Total for line of communications (exclusive of 10 replacement divisions) —
Motorcars 148
Motorcycles 182
Motor ambulances 426
Motortrucks 411
Special bacteriological cars 4
% 4: :)c 3fe :f: :jc
Grand total:
Motor cars 507
Motor cycles 881
Motor ambulances 2, 144
Motor trucks 1, 959
Special bacteriological cars 10
340
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Before December, 1917, there had already developed an acute shortage of
ambulances, and shipments from the United States, because of procurement and
tonnage difficulties, were under our estimated need.^ Although cable after
cable was dispatched setting forth our emergency needs along this line, the
shortage continued to increase. The problem of estimating our requirements
was made more difficult by the lack of tables of organization in Services of
Supply, corps, and army units ;^ existing tables indicated transportation for
divisions only. By April 24, 1918, the following further-developed estimate,
concerning the motor transportation required by the various elements of the
Medical Department, A. E. F., was formulated:
1. For the Army:
(a)^Chicf surgeon's office —
Motor cars 2
Motor cycles (side cars) 2
(6) Central laboratory (1 laboratory) —
Motor cars 2
Motor cycles (side cars) 4
Motor ambulances 2
Motor trucks 3
Special bacteriological cars 6
(c) Army laboratories (3 laboratories), each laboratory —
Motor car 1
Motor cycles (side cars) 3
Motor truck 1
(d) One sanitary train (combat division) complete motor equipment —
Motor cars 10
Motor cycles (side cars) 22
Motor ambulances 48
Motor trucks 53
Trailmobiles, kitchen, and water carts 16
Repair trucks 4
(e) Dental service— special dental cars 2
(/) Evacuation ambulance companies (1 per division) —
Motor car 1
Motor cycle (side car) 1
Motor ambulances 20
Motor trucks 2
ig) Evacuation hospitals (2 per division) , each hospital —
Motor car 1
Motor cycle (side car) 1
Motortrucks 3
(h) Mobile hospitals (20 units) , each unit —
Motor cars 2
Motor cycle (side car) 1
X-ray truck 1
Motor trucks 2
Motor trucks (cargo, for moving only) 18
(i) Mobile surgical unit (20 units) each unit —
Motor car 1
Motor cycle (side car) 1
Motor trucks (cargo) 3
(j) X-ray service, motor — X-ray trucks.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE
341
2. For each corps (5 corps) :
(a) Office of each corps surgeon —
Motor cars 2
Motor cycles (side cars) 2
(h) Corps laboratories, each —
Motor car 1
Motor cycle (side car) 1
(c) Dental service — dental car 1
3. For each division (30 divisions, including 10 replacement divisions) :
(a) Each chief surgeon's office —
Motor cars 3
Motor cycles (side cars) 2
(b) Division " laboratories (1 each) — Motor cycle (side car) 1
(c) Field hospitals (4 per division) —
Motor cars 4
Motor cycles (side cars) 10
Repair trucks 4
Motor trucks 44
Trailmobiles 8
(d) Motor ambulance companies (4 per division) —
Motor cars 6
Motor cycles (side cars) 12
Motor ambulances 48
Motor trucks 9
Trailmobiles 8
(e) Field signal battalion — motor cycles (side cars) 2
(/) Dental service — Dental car 1
Services of Supply:
(a) Chief surgeon's office —
Motor cars 6
Motor cycles 4
Motor cycles (side cars) 3
Bicycles 5
(6) Divisions of specialists (laboratory service excepted) —
The administration office —
Motor car 1
Motor cycle (side car) 1
Chief of groups (2 main groups), each —
Motor car 1
Sections * (9), each section — Motor car 1
One section — Motor cars 3
(c) Advance section — ■
Surgeon's office 2
Motor cycles (side cars) 2
(d) Intermediate section, surgeon's office —
Motor cars 2
Motor cycles (side cars) 2
^(e) Base laboratories (4 laboratories), each laboratory —
Motor car 1
Motor cycle (side car) 1
Special bacteriological car 1
(/) Base laboratories, central for hospital groups (28 laboratories), each
laboratory — Motor cycle (side car) 1
« Medical supply unit (attached to divisional headquarters), each unit, 1 motor car, 4 motor cycles (side cars), 2
motor trucks.
* Recommended that O. U. section later have 3 cars and other 8 sections 2 each.
342 ADMINISTRATION, AMERICAN EXPEDlTIONAin' FOKCES
Service of Supply — Continued.
ig) Surgeons at base ports (5 bases) —
Motor cars 5
Motor cycles (side cars) 5
(h) Base port transportation (3 bases) , 1 motor ambulance compan\- at each
base —
Motor cars ' 3
Motor cycles (side cars) 9
Motor ambulances 36
Motor trucks 9
Trailniobiles 6
(0 Medical supply depot (3 at ports; 2 in intermediate section; 1 in ad-
vance section; total, 6 depots), for each depot —
Motorcar 1
Motor cycle (side car) 1
Motortrucks 6
(j) Hospital centers (10 centers) each center —
Motorcars 2
Motor cycles (side cars) 2
{k) Base hospitals (130), each —
Motor cars 2
Motor cycles (side cars) 2
Motor ambulances 10
Motor trucks 3
EVACUATION AMBULANCE COMPANIES
The Manual for the Medical Department, United States Army, 1916,
contained provisions for the organization of evacuation ambulance companies.
Since these were to be organized only in time of war, it is needless to state
that no such companies existed when we entered the World War.
They were to be in the proportion of one for each division at the front,
and their primary function was to be the evacuation of division hospitals, and
the care and transportation of patients therefrom to evacuation, base, or other
hospitals on the line of communications, or to points with train or boat con-
nections for rail or water transport to such hospitals. They were to be field
army organizations, and their personnel and equipment were to be that pro-
vided for a division ambulance company with such modifications as might
seem warranted.
On November 12, 1917, the Surgeon General notified the chief surgeon,
A. E. F., that the organization of three evacuation ambulance companies had
been begun and that the personnel of each would be two officers and 60 enlisted
men, and that its equipment would be that of a motor ambulance company
less dressing station equipment.^* To this the chief surgeon replied requesting
that vehicles for these units be increased from 12 to 20.^^
Independently, the chief surgeon, line of communications, on November 27,
1917, recommended that ambulance personnel and transport within his juris-
diction be organized into evacuation ambulance companies, each consisting of 5
sections with 20 ambulances each.^® He also urged that if it were possible 30
sections of the United States Army Ambulance Service then in the United
States but ready for shipment should be secured for the American Expeditionary
Forces in order to avoid the complete breakdown which he considered immi-
ORGANIZATION AND ADMINISTEATION OF CHIEF SURGEON'S OFFICE 343
ncnt.^'^ He remarked that the need of evacuation ambulance companies was
becoming more and more apparent.^^ The need for motor ambulance com-
panies, conveniently located to meet current needs, instead of ambulances
distributed among many combat and other organizations and the special need
for such an organization (under the control of the advance section. Services
of Supply) in the vicinity of the training areas was emphasized. Others as
needed were to be located at other places on the line of communications. It
was anticipated that personnel and materiel might ultimately be supplied from
the sections of the United States Army Ambulance Service but until that serv-
ice's resources were more than enough to meet its own needs, our evacuation
ambulance companies might be developed quickly though temporarily by
drawing in from various base and other hospitals all available transport and
personnel. Even though such an organization might lack symmetry it would
meet the situation temporarily until units of the United States Army Ambu-
lance Service could be made available.^*' The memorandum further remarked
that 88 sections of that service in the United States not yet assigned, might
be considered available for requisition for service on the line of communica-
cations. The necessity of a maintenance department with ample spare parts
and other equipment was noted and the necessity for the immediate establish-
ment of an ambulance park in the vicinity of the training areas was emphasized.
The same date (November 27, 1917) the chief surgeon, A. E. F., initiated
a cablegram to the Surgeon General to the effect that evacuation ambulance
companies should be organized from the equipment and personnel of sections
of the United States Ambulance Service, which had not yet been sent to France.
Under date of December 8, 1917, a memorandum for the chief surgeon,
A. E. F., emphasized the need for organizing on a large scale transportation
for casualties, noted the limited amount of transport and inadequate spare
parts available at camp and base hospitals, and requested that the chief of
United States Army Ambulance Service loan to the United States Army one
ambulance company section. It was further recommended that a cable be
sent to the War Department requesting shipment of the necessary transport.^*
A few days later (December 13) the chief surgeon, A. E. F., received a report,
from one of his subordinates who had been ordered to investigate transporta-
tion requirements, in which emphasis was laid upon the need for evacuation
ambulance companies; the wasteful results of assigning ambulances to small
scattered commands; the difficulty of making evacuations in training areas,
and suggesting number and locations of companies, sources of personnel and
materiel, facilities for repairs, etc.^^
On January 14, 1918, the chief surgeon, line of communications, reported
that it was imperatively necessary to make provision for more motor ambulance
transport in the advance section in order to evacuate the field hospitals, and
recommended that a provisional motor ambulance company be organized from
the resources of the 41st (the first depot) Division.^" This recommendation
was approved and the organization of this provisional company ordered Janu-
ary 17, 1918.^' This unit, first designated the 116th Evacuation Ambulance
Company and later Provisional Evacuation Ambulance Company No. 1 was
the first evacuation ambulance company of the American Expeditionary
Forces. It was located at Toul.^^
344
ADMINISTRATION, AMERICAN EXPEDITIONARY FOKC"ES
In converting sections which had been organized in the United States
for the United States Army Ambulance Service (to serve with the French
Army) to evacuation ambulance companies, A. E. F., some complexities arose,
shown best in the following correspondence.
In a letter which the Surgeon General wrote The Adjutant General of
the Army on January 30, 1918, he stated:
1. In cable from the commanding general, American Expeditionary P'orces, No. 322,
paragraph 3, subparagraph A, it was stated that it was the unanimous opinion that evacuation
ambulance companies be organized with the equipment and personnel of the sections of the
United States Army Ambulance Service. This request was referred to again in a letter from
the chief surgeon, A. E. F., written December 24.
2. In cable No. 486, paragraph 8, from the commanding general, A. E. F., the recom-
mendation was made that the remaining 73 sections United States Army Ambulance Service
be used in organizing the ambulance companies of the army sanitary train, item M201, and
evacuation ambulance companies, M406, and that the remainder be drawn on for all ambulance
personnel for replacement draft according to paragraph 4, cablegram 318.
3. The sections of the American Ambulance Service referred to are those now mobilized
at AUentown, Pa.
4. It is the understanding in this office that when these sections were organized they
were intended for service with the French Army, and they have heretofore been used for that
purpose.
5. A decision is requested as to whether these sections could be used for the purpose
indicated in General Pershing's cables.
6. It is to be noted that in some cases the officers attached to these sections are not
medical officers. Also that they are equipped and have been trained with Ford ambulances,
and that the ambulances provided for the ambulance companies of the Army are G. M. C.'s.
Should the use of these sections be allowed, the personnel will differ from that as authorized
for evacuation ambulance companies in the second indorsement of The Adjutant General's
office, dated December 28, paragraph 3, subparagraph 8.
On March 12 The Adjutant General replied
There is no objection to the use of the enlisted personnel of the American Ambulance
Service now at AUentown, Pa., organized under section 2, General Orders, No. 75, War
Department, June 23, 1917, as amended by section 1, General Orders, No. 124, War Depart-
ment, September 20, 1917, for any purpose for which the enlisted personnel of the Medical
Department may be used. The commissioned personnel may be used in a like manner
except that those officers who are not doctors of medicine will be assigned to such duties as
their technical training permits. It is, however, to be understood that this authorization in
so far as it relates to these officers is not to be construed as in any way modifying the provi-
sions of paragraph 3, Manual for the Medical Department, 1916, which prescribes that:
"An applicant for appointment in the Medical Corps of the Army * * * must be a
graduate of a reputable medical school legally authorized to confer the degree of doctor of
medicine, etc."
and as fast as these officers are separated from the service their places will be filled by the
appointment of medical officers.
In connection with the personnel of evacuation ambulance companies, the
Surgeon General on March 22, 1918, wrote The Adjutant General, United
States Army, as follows
1. Subparagraph H, paragraph 3, of second indorsement. Adjutant General's Office,
December 28, 1917 (322.3 Medical Department, Misc. Div.), gives the personnel of evacua-
tion ambulance companies as: 1 lieutenant. Medical Corps; 3 noncommissioned officers; 34
privates.
2. It is requested that this be amended to read as follows: 1 captain or lieutenant.
Medical Corps; 3 noncommissioned officers; 3 mechanics; 2 cooks; 24 wagoners; 5 privates,
first class, and privates.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 345
3. In General Pershing's organization project for evacuation ambulance companies, all
transportation is motorized and consists of 20 motor ambulances, 1 touring car, 1 motor cycle
with side car, 2 motor trucks.
4. The unit is liable to expansion by the addition of other ambulances.
5. The 2 cooks for the organization are necessary, the 3 mechanics are reciuired to keep
the motor transportation in proper order, and the 24 wagoners are the chauffeurs.
This request was granted in the following terms:
The following personnel for evacuation ambulance companies has been approved: 1
captain or lieutenant. Medical Corps; 3 noncommissioned officers; 3 mechanics; 2 cooks;
23 wagoners; 6 privates, first class, and privates.
This authorization must not be construed to change the numbers or grades of medical
officers provided for the Medical Department in War Plans Division 9199-25, approved
February 4, 1918.
Unfortunately, as may be seen from the following references to correspond-
ence between War Department and the American Expeditionary Forces, these
sections were not made available until the end of hostiHties. On August 26,
1918, the chief surgeon, A. E. F., initiated a cablegram to the Surgeon General,
in which he requested that the personnel of 48 ambulance sections, under process
of organization for service with the French Army, be sent to France as casuals
and without officers, since it was his desire to appoint officers in the American
Expeditionary Forces selected from experienced men, graduates of the French
motor service school.^'' To these recommendations War Department replied
that only 31 sections of the American Ambulance Company were available and
that these would be shipped in September." On September 14 the Surgeon
General notified the chief surgeon, A. E. F., that the 31 sections would be formed
and sent to the American Expeditionary Forces, and that the personnel of these
sections would be available for shipment in October instead of September, as
formerly stated.^^ On October 17 the Surgeon General notified the commander
in chief, A. E. F., that Ford ambulances were being sent for the equipment of
these sections.^''
As some difference of opinion had arisen between the Surgeon General and
the chief surgeon, A. E. F., concerning the number of ambulance company sec-
tions which had been organized and the number of sections yet remaining avail-
able under the Executive order authorizing them, the chief surgeon, A. E. F., on
September 21, 1918, reported to the Surgeon General as follows
Commander in chief requested 48 ambulance sections as part of exceptional Medical
Department replacements. The Adjutant General replied that only 31 sections were avail-
able. From the 169 sections had been already subtracted the number already organized,
giving credit in the latter for 49 organized in France, whereas only 30 were organized there,
and also they failed to consider 7 sections which had been disbanded and the enlisted per-
sonnel sent to France to fill up numerical shortages in the sections organized from the Ameri-
can Ambulance Service. It is a fact that there are 48 sections available and 9 others which;
however, it is not deemed desirable to organize at the present time because the officers of
these will be needed as supernumeraries for purposes of administration. It is requested
therefore that the 48 sections asked for by paragraph 12, cable P 1591 be sent without officers
in the manner requested by that cable. It is also requested that the shipment of Motor
Transport Corps tonnage and allotment be made as called for, for October. Request every
effort be made to ship material and personnel in October, and material remaining unshipped
will be covered in November Motor Transport Corps priority.
346
ADMINISTRATION, AIMERICAN EXPEDITIONARY FORCES
On October 30 the Surgeon General cabled that 31 ambulance sections
were formed and available and that the remaining sections, to complete the
48 asked for, would be ready to sail in a few days.^'
Meanwhile, on September 26, 1918, the chief surgeon, A. E. F., recom-
mended to the chief of staff, A. E. F., the issuance of a general order, whose
terms he proposed, concerning the operation of ambulances in the Services
of Supply.*^ In brief this was to provide that all ambulances in that territory
be assigned to 18 definite evacuation ambulance companies, with the enlisted
personnel then assigned to duty with these vehicles. The personnel of each
unit, as recommended, should be 2 officers (captains or first lieutenants,
M. D.), 2 sergeants, first class, 4 sergeants, 23 wagoners, 1 cook, 1 mechanic,
20 privates, first class, and 5 privates. The units w^ere to be equipped
with 20 ambulances or more, 1 motor cycle with side car, and such temporary
additional machines and personnel as might be necessary, and vehicles so
far as possible were to be garaged at hospital centers, base hospitals, camp
hospitals, and other camps where they were thus used, but would at all times
be under the orders of the commanding officer of the respective companies.*^
A list showed that from 9 to 22 ambulances were garaged at the more impor-
tant localities in the Services of Supply. In support of this proposed arrange-
ment the chief surgeon urged that this organization would promote service
by the pooling of ambulances and would provide units which in emergency
could be sent to the zone of the advance.^^ To these recomendations the chief
of staff replied that as the assigment of ambulances was under the jurisdiction
of the chief surgeon it was believed that they could be distributed by him
as required for the purpose mentioned. The formation of provisional evac-
uation ambulance companies of varying strength, as outlined by the chief
surgeon, was not favorably considered.^^
On November 2 the chief surgeon, A. E. F., requested orders concerning
pooling of ambulances at base ports, hospital centers, and other localities in the
intermediate and base sections of the Services of Supply," but the general staff,
general headquarters A. E. F., ruled that such orders were unnecessary, ambu-
lances being under the jurisdiction of the chief surgeon and he enjoying
authority to pool them if he so desired; accordingly, the chief surgeon,
on November 6, 1918, issued orders that this be done.^^
A total of 82 evacuation ambulance companies (including Provisional
Ambulance Company No. 1) saw service in the American Expeditionary
Forces. Of these, 12 which arrived after the armistice was signed were
disbanded and their personnel reassigned in base section No. 2.^^
Those which served overseas before the armistice, November 11, 1918,
are discussed individually in Volume VIII.
ASSEMBLY, SALVAGE, AND REPAIR
Assembly, salvage, and repair of ambulances w^ere important activities
pertaining to their provision and adequacy within the American Expeditionary
Forces.
On May 4, 1918, the chief surgeon informed the Surgeon General that
motorized Medical Department organizations under orders for France should
ORGANIZATION AND ADMINISTEATION OF CHIEF SLTEGEON'S OFFICE 347
leave the vehicles they used while training at their respective training areas,
receiving new and standard motor equipment in France.
This procedure was to obviate transporting used machines, which in most
cases could not reach France until after the organization had been supplied
there with other standard vehicles, another unit later receiving the used cars,
which were apt to be minus part of their equipment and tools.
In the early days of the war the General Motors Corporation type of
ambulance was adopted, because of its capacity.'^ The ambulances were
shipped to France, unassembled, the constituent parts of the bodies being
placed in crates, and a series of envelopes were made up containing the number
of screws, bolts, and nuts necessary for assembling the ambulances.^® Each
operation was numbered and the corresponding number was placed on the
envelope containing the hardware used.^® This ambulance body was not what
is regularly known as a knocked-down body, and it was appreciated that con-
siderable difficulty would be encountered in its assembly, unless trained men
fully familiar with body construction were available in France.'*' The Surgeon
General's Office accordingly organized a unit known as the motor ambulance
assembly detachment, consisting of 3 officers in the Sanitary Corps and 60
body builders and motor experts."' After arrival in France this ambulance
assembly unit began operations on January 2, 1918, at St. Nazaire.'® Within
two weeks the necessary shelters had been constructed, power lines had been run,
and the ambulance assembly commenced.'® A number of chassis and bodies
had accumulated on the beach at St. Nazaire, and there was an urgent call
from various organizations and divisions then in France for ambulances. The
shop soon took on the appearance of a modern American factory and ambulances
were turned out at the rate of 4 a day. This number was gradually increased
until a daily output of 15 was reached.'®
It was expected that all motor transportation would be delivered at the
port of St. Nazaire.'® This, however, proved to be impracticable, and before
long ambulances were being received at Le Havre, Brest, Bordeaux, Marseille,
and La Pallice.'® Certain numbers of the original motor ambulance assembly
detachment were sent to the parks at these ports and soon built up assembly
organizations composed of Medical Department personnel and Motor Transport
Corps personnel and the same efficiency was obtained as at St. Nazaire.'®
In general orders, general headquarters, A. E. F., and headquarters,
Services of Supply, ambulances were classed as "special vehicles. " '® While
orders covering assignments had been prepared by the Motor Transport Corps,
all requisitions had been submitted to the chief surgeon's office, A. E. F., and
that office had submitted requests to the Motor Transport Corps to assign
ambulances to the points where they were most needed.'® Many organizations
to which ambulances were assigned in the United States delivered them to the
ports of embarkation there and they were shipped to France whenever practi-
cable. However, no notice of prior assignment was taken in France and all
motor transportation received was pooled.'®
About one month before the armistice was signed a new type of knocked-
down body was shipped to France. Inasmuch as it was assembled and painted
in the factory and was then taken down in sections and shipped in crates, con-
348
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
siderable time was saved in the final assembly at base ports in Franco and very
much less personnel was required to operate the body shops. Four men could
assemble two bodies in a day.'^
The total number of ambulances shipped to France and Italy was (5,875;
3,805 were of the Ford type and 3,070 General Motors Corporation type.'^ The
former were used especially for primary evacuations in rear of the fighting
line and the latter in other services farther to the rear and throughout the
Services of Supply. There was never sufficient transport for the sick and
wounded.*^ Shortage of ambulances was placed at 40 per cent in April, 1918,
at 50 per cent in September, and at 20 per cent in October of that year. Only
by borrowing from the French and Italian Governments 30 of the ambulance
sections loaned by the United States to those countries could our needs be
met in the St. Mihiel and Meuse-Argonne offensives.*^
REFERENCES
1. Manual for the Medical Department, U. S. Army, 1916, par. 613.
2. Circular letter from the commander in chief, A. E. F., to the assistant chief of staff,
G-4, First Army and Paris Group and to regulating officers, August 29, 1918. Sub-
ject: Evacuation of sick and wounded.
3. Report of evacuation of the wounded into fixed formations, by Col. R. M. Culler, M. C.
On file, Historical Division, S. G. O.
4. Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 14,
1917. Subject: Weekly War Diary. Copy on file. Historical Division, S. G. O.
5. Report from the activities of the medical group, fourth section, general staff, G. H. Q.,
A. E. F., by Col. S. H. Wadhams, M. C, December 31, 1918. On file. Historical
Division, S. G. O.
6. Report of the evacuation system of a field army (undated), by Col. C. R. Reynolds,
M. C. On file, Historical Division, S. G. O.
7. Report of American hospital trains in France, by Maj. Howard Clark, M. C. On file,
Historical Division, S. G. O.
8. Report of Medical Activities in the zone of the armies, by Col. A. N. Stark, M. C. On
file, Historical Division, S. G. O.
9. Report of the evacuation of the wounded in the Meuse-Argonne operation, by Col.
H. H. M. Lyle, M. C. On file, Historical Division, S. G. O.
10. Instructions from the chief surgeon, A. E. F., to commanding officers of hospital trains,
December 18, 1917. On file, Historical Division, S. G. O.
11. Reports of Medical Department activities of hospital trains, prepared under the direc-
tion of the respective commanding officers. On file. Historical Division, S. G. 0.
12. Report of the hospital evacuating section, regulating station B, St. Dizier, made by
Maj. L. C. Doyle, San. Corps. Copy on file. Historical Division, S. G. O.
13. Report of the Medical Department activities of Hospital Train No. 55, prepared under
the direction of the Commanding Officer. On file, Historical Division, S. G. O.
14. Report of the Medical Department activities of Hospital Train No. 58, prepared under
the direction of the commanding officer. On file. Historical Division, S. G. 0.
15. Report of the Medical Department activities of Hospital Train No. 59, prepared under
the direction of the commanding officer. On file, Historical Division, S. G. 0.
16. Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May
I, 1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file.
Historical Division, S. G. O.
17. Tables of Organization and Equipment, U. S. Armv, series A, Table 28, W. D., April 17,
1918.
18. G. O. No. 70, G. H. Q., A. E. F., December 8, 1917.
19. G. O. No. 77, G. H. Q., A. E. F., May 11, 1918.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 349
20. Cable No. 1407, from General Pershing to The Adjutant General, July 3, 1918.
21. G. O. No. 75, W. D., August 15, 1918.
22. Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., September
22, 1917. Subject: Motor vehicles needed by the Medical Department by July 1,
1918. On file, A. G. O., World War Division, chief surgeon's files (451 Miscellaneous).
23. Letter from the Surgeon General to the surgeon, medical base group, A. E. F., October
27, 1917. Subject: Automatic replacement of supplies. On file. Historical Divi-
sion, S. G. O.
24. Letter from the Surgeon General, U. S. Army, to the chief surgeon, A. E. F., November
12, 1917. Subject: Evacuation hospitals and evacuation ambulance companies,
On file, S. G. O., Record Room (322.3).
25. Letter from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, December
24, 1917. Subject: Evacuation hospitals and evacuation ambulance companies.
On file, S. G. O., Record Room (322.3).
26. Letter from the chief surgeon, line of communications, to the chief surgeon, A. E. F.,
November 27, 1917. Subject: Evacuation ambulance companies. On file, A. G. O.,
World War Division, chief surgeon's files (322.321).
27. Cable No. 322S. from General Pershing to The Adjutant General, November 27, 1917.
On file, A. G. O., World War Division, chief surgeon's files (322.3212).
28. Memorandum from Maj. A. P. Clark, M. C, to chief surgeon, A. E. F., December 8,
1917. Subject: Transportation for evacuation of sick and wounded. On file
A. G. O., World War Division, chief surgeon's files (322.3211).
29. Memorandum from Maj. A. P. Clark, M. C, to the chief surgeon, A. E. F., December 13,
1917. Subject: Need of evacuation ambulance companies. On file, A. G. O., World
War Division, chief surgeon's files (322.3211).
30. Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., January 14,
1918. Subject: Provision of evacuation ambulance companies. On file, A. G. O.,
World War Division, chief surgeon's files (322.3212).
31. Telegram from the adjutant general, A. E. F., to the commanding general, line of commu-
nications, January 17, 1918. On file, A. G. O., World War Division, chief surgeon's
files (322.3212).
32. Report on evacuation ambulance companies (undated) made to the chief surgeon, A. E. F.,
by the officer in charge of transportation, chief surgeon's office, A. E. F. On file,
Historical Division, S. G. O.
33. Letter from the Surgeon General to The Adjutant General of the Army, January 30, 1918.
Subject: Use of sections LT. S. Army Ambulance Service as evacuation ambulance
companies. On file A. G. O., 322.3 (Ambulance companies, E. E., Miscellaneous
Division).
34. Second indorsement from The Adjutant General to the Surgeon General, March 12, 1918;
on letter from the Surgeon General to The Adjutant General, January 30, 1918.
Subject: Use of U. S. Army Ambulance Service as evacuation ambulance companies.
On file, A. G. O., 322.3 (Ambulance companies, E. E., Miscellaneous Division).
35. Letter from the Surgeon General to The Adjutant General of the Army, March 22, 1918.
Subject: Personnel evacuation ambulance companies. On file, S. G. O., Record
Room, 322.3212 (Evacuation ambulance companies).
36. Proposed cable from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army,
August 26, 1918. On file, A. G. O., World War Division, chief surgeon's files (322.3211).
37. Cable No. 1881-R, par. 6, from The Adjutant General to General Pershing, August 28,
1918. Copy on file, A. G. O., World War Division, chief surgeon's files (322.3211).
38. Letter from the Surgeon General, U. S. Army to the chief surgeon, A. E. F., September 14,
1918. Subject: Army Ambulance Service. On file, A. G. O., World War Division,
chief surgeon's files (322.3211).
39. Cable No. 2035 R., par. 3, from The Adjutant General, to General Pershing, October 17,
1918. Copy on file, A. G. O., World War Division, chief surgeon's files (322.3211).
40. Courier cable from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army,
September 21, 1918. On file, A. G. O., World War Division, chief surgeon's files
(322.3211).
350 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
41. Cable No. 45, from The Adjutant General, to the commanding general, X. E. F., October
30, 1918. Copy on file, A. G. O., World War Division, chief surgeon's files (322..3211).
42. Letter from the chief surgeon, A. E. F., to the chief of staff, A. E. F., September 26, 1918.
Subject: Proposed general order for evacuation ambulance companies. Copy on
file, A. G. O., World War Division, chief surgeon's files (322.3211).
43. Memorandum from the assistant chief of staff, G-1, general heackiuarters, A. E. F., to
the chief surgeon, A. E. F., October 18, 1918. Subject: Proposed general order for
evacuation ambulance [companies. On file, A. G. O., World War Division, chief
surgeon's files (322.3211).
44. Memorandum from the chief surgeon, A. E. F., to the assistant chief of staff, G-4, gen-
eral headquarters, A. E. F., November 2, 1918. Subject: General order for operation
of ambulance service in S. O. S. On file, A. G. O., World War Division, chief sur-
geon's files (322.3211).
45. Memorandum from the assistant chief of staff, G-4, general headquarters, A. E. F., to
the chief surgeon, A. E. F., November 5, 1918. Subject: General order for operation
of ambulance service in S. O. S. On file, A. G. O., World War Division, chief surgeon's
files (322.3211).
46. Circular letter (not numbered) from the chief surgeon, A. E. F., to base surgeons, Novem-
ber 6, 1918. Subject: Pooling of ambulances. On file, A. G. O., World War Divi-
sion, chief surgeon's files (322.3211).
47. Letter from the chief surgeon, A. E. F., to the Surgeon General, May 4, 1918. Subject:
Overseas motor transportation. On file, A. G. O., World War Division, chief sur-
geon's files (451).
48. Report from Brig. Gen. J. R. Kean, M. C, to the chief surgeon, A. E. F., April 24, 1919.
Subject: Data to be used by the Military Board of Allied Supply. On file. His-
torical Division, S. G. O.
CHAPTER X\ III
THE DIVISION OF HOSPITALIZATION (Continued)
THE PROFESSIONAL SERVICES
ORGANIZATION
The organization of the professional services in the American Expedition-
ary Forces, conformably to a plan which had been developed in the Surgeon
General's office, was undertaken by the chief surgeon in the autumn of 1917.
In Circular No. 2, November 9, 1917, chief surgeon's office, the organization
of these services was prescribed and the scope of their activities defined. This
circular provided for eight services each under a director, and for the future
assignment of assistant directors, consultants for corps, administrative sections
of the line of communications, larger hospital centers, and other commands.
The services prescribed were general medicine; general surgery; orthopedic sur-
gery; surgery of head; urology, skin, and genitourinary diseases; laboratories;
psychiatry; Roentgenology. It emphasized the fact that professional author-
ity did not include administrative control; directors were to be immediately
responsible to the chief surgeon, and the professional services of hospitals were
to be so organized that they conformed to the eight divisions prescribed above.
At about this time, a plan for the organization of the professional services
in hospitals was formulated in the Surgeon General's Office,' but no copy of this
was received by the chief surgeon until several months later, and after a state-
ment of organization of the professional services in the American Expeditionary
Forces had been cabled to the War Department.'
On March 9, 1918, the Surgeon General wrote the chief surgeon as follows
concerning the organization of the professional services in base hospitals :^
1. The attention of the hospital division has just been called, for the first time, to your
k'tter of November 9, Circular No. 2, paragraph 5, in which it is noted that the commanding
officer of each base hospital is directed to organize his hospital by the assignment of suitable
officers to duty in charge of each of the eight sections, and that each chief of section will
report direct to the commanding officer, to whom he will be responsible for the operation of
tiis particular section.
2. Attention is invited to the fact that this is not quite in accord with the plan of organ-
ization adopted by the Surgeon General of the Army in his memorandum of November 11,
wliicti should have been sent to you at that time.
3. It will be noted that instead of having eight independent sections there are three
main clinical services — surgical, medical, and laboratory — with a chief of each, and that each
service is divided into sections representing the different special branches, eight in all. This
was the result of many conferences and was finally adopted as a better plan of organization
tlian to have the eight independent sections.
4. It is not contemplated that this arrangement will in any way interfere with the work
of the different sections, but that the chief of each service will be the responsible coordinating
officer for all of the different sections of that service and that he will be responsible directly
to tlie commanding officer for the work of all the sections under his control.
5. It is not considered that this plan of organization of base hospitals would in any way
interfere with your plan of organization, as provided for in paragraphs 1 and 2 of your Circular
13901—27 23 351
352
ADMINISTRATION, AMERICAN EXPEDITrONARY FORCES
No. 2. All base hospitals now organized and in process of organization in this country for
service overseas are being organized in accordance with the Surgeon Generars nieniorandiun
of November 11.
In another letter to the chief surgeon, dated March 16, 1918, tlio Surgeon
General stated that the plan under which his office was then working provided
for nine sections, instead of eight, among the professional services.^ One sec-
tion concerned with food and nutrition had been added.
While the Surgeon General and the chief surgeon, A. E. F., were thus devel-
oping a continuity of policy in the provision and the orientation of the profes-
sional services, the services themselves were undergoing rapid development.
DEVELOPMENT
By General Orders, No. 58, general headquarters, A. E. F., November 10,
1917, "directors," as the chiefs of the several specialties were first designated,
were appointed, respectively, for the laboratory service, general surgery, ortho-
pedic surgery, and venereal, skin, and genitourinary diseases. In the following
month a director of psychiatry was designated and directors of Roentgenology
and general medicine in March of the following year.
On December 21, 1917, the following letter of instructions, which was
typical of that issued to other directors, was forwarded to the director of general
surgery : ^
You are hereby announced as director of the division of general surgery^ for the Amer-
ican Expeditionary Forces.
You will proceed to such places in the training areas as may be necessary from time to
time for consultation with medical officers serving with the American Expeditionary Forces,
in matters pertaining to general surgery^
In this connection, your attention is invited to General Orders, No. 58, dated November
10, 1917, an advance copy of which is herewith furnished you.
At the end of each month you will submit, for confirmation by these headquarters, a
list of the journeys performed by you under these instructions.
Commanding officers of the places visited by you are hereby directed to afford you
proper facilities for carrying out this work; this letter to yon is to be considered their author-
ity for such action.
Chiefs of all services were announced and their new official designation
prescribed by General Orders, No. 88, general headquarters, A. E. F., June 6,
1918, which is discussed below.
As shown by the histories of the individual services, there was great
development of their activities prior to the publication of the general order
last mentioned. The directors of all except the laboratory service were con-
gregated at Neufchateau, where they were technically under the control of the
hospitalization division of the chief surgeon's office, which was located from
September 1, 1917, to March 18, 1918, at Chaumont, some 45 miles distant.^
Means of communication between the two offices were at first very limited,
for transportation w^as scant, and mail and telephone facilities inadequate.
The group continued to receive its orders from the chief surgeon's office even
after this had been moved to Tours.*^
Until April, 1918, the group of directors did not function as an organized
body, therefore their activities were uncoordinated, each director seeking to
solve in his own way his very different and difficult problems.^ No specific
«
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 353
instructions had been issued governing their status. The only office provided
until April, 1918, which had the power to coordinate the efforts of this group
was that of the chief surgeon, A. E. F., which, meanwhile, was being concerned
with many other urgent responsibilities.
It is necessary to visualize the situation of the directors in the fall of 1917,
and during the earlier succeeding months, in order to appreciate the difficulties
of their task. Headquarters, A. E. F., including the chief surgeon's office,
were undergoing rapid expansion and incessantly meeting new emergencies.
The new professional directors, lacking military experience, were further
handicapped through not having special regulations detailing their duties, and
by lack of an agency for their effective organization and control.' Each
director believed that his appointment granted him authority to organize and
direct separately his special department. Each was an enthusiast in his own
specialty and the misnomer "director" seemed to imply administrative control
which in fact was not conferred.*^ Yet the direction and supervision of the
professional services in all sanitary formations, the provision for continuity of
treatment from front to rear, the modification, as need be, of accepted methods
of treatment and the inauguration of new ones, were some of the duties with
which they were charged.^ In the absence both of military experience and of
specific instructions some confusion was inevitable, and for these reasons the
zeal of the directors was at first to an appreciable degree misdirected as well
as uncoordinated."
Great embarrassments also developed in supplying members of the group
with transportation, for each director was authorized to utilize an automobile
for an unlimited time, though the multiplicity of their organizations and the
shortage of motor vehicles rendered their supply very difficult.®
During this period many of the most able operators had been detailed as
consultants in divisions and other formations, and thus removed from that
service which they were peculiarly able to perform.^ The professional services
were thus deprived of many of their best clinicians, for these officers were
placed in positions where they, under existing conditions, could neither exercise
their professional attainments nor handle properly the new situations that
arose.
When junior members of the special professional services began to arrive
and were assigned to combat divisions, the complications pertaining to the
general operation of the professional services considerably increased.^ These
officers were not recognized in the Tables of Organization, and the details of
arranging for billets, mess facilities and transportation already greatly over-
taxed were therefore difficult. For this reason the divisional specialists were
assigned for billet and mess to field hospitals or to those facilities at division
headquarters which accommodated transients and officers of junior rank.*^
Assignment to divisional hospitals separated them from the division surgeon,
for these units were not located at headquarters and this precluded the best
performance of the specialists' duties which were divisional in scope. These
complications now seem trifling, but they led to disturbed feelings which
impaired the usefulness of the junior consultants/
354
A DM IXISTHATION , AMKHICAX K\ I'KDI'IK )X A 1{ lOKCFIS
Usually division surgeons wore officers of the Regular Army, aiul were
trained along line of military administrative control. The specialist presented
a new problem concerning which the division surgeon had not been sufficiently
informed.' The division surgeon had the choice of taking the specialist into
his own overcrowded office, forcing him into a mess, where, usually, he was
not wanted because of inadequate facilities and because he did not hold one
of the positions which entitled him to membership, urging a harassed billet-
ing officer to make room for him in an overcrowded headquarters town, or
sending him to a hospital where also he was at once regarded as a person apai t.'
The specialist, because of his new and unique status, was brought out in sharj)
contrast to the other medical officers serving with divisions." If he was not tact-
ful, and he was not always so, his position was difficult. The division surgeon
found it hard to make suitable arrangments for specialists even in billeting
areas, and when battle conditions ensued the situation was almost impossible.^
By the spring of 1918, several divisions were in the firing line and addi-
tional divisions were arriving rapidly. As corps and armies were formed,
the complexity of the situation for the consultants increased enormously.^
Medical officers in administrative positions, as well as the specialists, knew
that a defective plan was in operation. All professional branches still lacked
coordination and there was much confusion of activity; there were too many
orders, too many reports, too many inspection trips; uncoordinated ideas were
surging up from below, and until April, 1918, there w^as lack of effective adminis-
tration from above.^ As the functions of the specialists were not well defined,
the problems of the special branches were being handled by many different
methods.
Some of the difficulties experienced by the consultants with divisions did
not as a rule exist in the hospital centers." There the consultants usually
were chiefs of services of base hospitals, who were assigned as consultants in
addition to their other duties. Their living facilities were thus already provided
and the geographical scope of their activities was limited. Though often
harassed by demands from the directors for reports, the duties of their positions
were generally well understood and systematically performed. There were
some differences in the methods followed by the several services, but there
were many basic similarities.
Though considerable attention is given above to the early lack of coordi-
nation, to the initial misconception of their duties on the part of directors,
and to the difficult position which the specialists occupied with divisions, the
fact should be stressed that despite these handicaps the initial work accom-
plished was of very great importance." After the group of chiefs of service at
Neufchateau was reorganized in April, 1918, its efforts coordinated, and the
duties of its members more clearly defined (in Circular No. 25, chief surgeon's
office, A. E. F.), the value of the consultants' services was greatly increased.'
On April 18, a director of professional services was appointed with station
at Chaumont,^ his office, for purposes of coordination, being in juxtaposition
to that of the representative of the chief surgeon, A. E. F., w^ith the general
statt".'- In the letter notifying him of this assignment the chief surgeon wrote
as follows:
OKCAXIZATIOX AXn A DIMIXISTRATIOX OF CHIEF SURGEOX'S OFFICE 355
By virtue of this appointinent, you are empowered to represent the chief surgeon,
A. E. F., in all matters pertaining to the administration, direction, and coordination of the
l)rofessional services. You are responsible for such professional matters relating to hospi-
talization, evacuation, laboratories, sanitation, and other activities as may pertain to the
proper sorting, distribution, and evacuation of sick and wounded through the channels
that will best insure efficient treatment from the front to the rear.
.\11 requests for the movement of personnel and supphes originating in t he professiona
services will be forwarded by or through you to the chief surgeon, A. E. F., or to some one
designated \)y him.
The consultants in the professional divisions will be recommended by you for detail as
teachers at the Army Sanitary School in such numbers and at such intervals as may be
re(|uestcd by the commandant of the school. In order that recent methods of treatment
may be standardized, it is desired to make the instruction course at this school as thorough
and intensive as circumstances will permit, and no effort will be spared in securing all instruc-
tion hours possible on the schedule of the school.
There is transmitted a tentative scheme of organization for the divisions under your
control, and, after it has been given a fair trial, should any changes, in your opinion, seem
warranted, you will submit appropriate recommendations to this office for recommendation.
The tentative scheme of organization to which allusion was made in this
letter was published, as finally developed, in Circular No. 25, chief surgeon's
office.
This circular charged the director with the supervision and coordination
of the professional activities of the American Expeditionary Forces. The
chief consultant in surgery was charged with the supervision of the professional
surgical subdivisions, their organization and coordinations; with timely recom-
mendations concerning changes in personnel, the formation of surgical teams
and reports of their activities; with recommendations concerning inspections
of his specialty. The chief consultant of the medical services was similarly
chai'ged with supervision of the medical subdivisions in the American Expedi-
tionary Forces, and with such recommendations as were necessary to insure a
high professional standard and complete harmony among his assistants in all
formations. Senior consultants were to coordinate imder their respective
chiefs, professional activities pertaining to their respective specialties, and to
make appropriate recommendations for instruction of consultants and spe-
cialists in divisional or other formations.
One senior medical and one surgical consultant, were to be assigned to
each tactical organization equivalent to an army corps, and consultants were
to be appointed in such numbers as might be necessary to assist divisional
cousultants. Senior division consultants were to be responsible for the duties
theretofore discharged by division consultants, were to make frequent and
complete surveys of professional practices in the division, supervise the activi-
ties of consultants, operating teams and other professional personnel attached
to the division; organize and distribute such teams, including those which
would serve newly arrived troops, and promote their efficiency; render appro-
priate reports, returns, and reconnnendations to the chief surgical consultant.
^■()u will direct the coniijilation of a classified roster by each chief consultant, of all
i)rofessional personnel, such as speciaUsts, consultants, or surgical teams among the various
army units of our own and allied formations, so as to facilitate their proper distribution
and utilization in emergencies as well as in routine. When the organization of the profes-
sional service is completed, you will direct its workings, either from general headquarters
or such other places as best serves the interests of the service.
356
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
With the three original divisions, medicine, surgery and laboratories as a basis, yon
will so coordinate the activities of the subdivision thereof that scientific research and clinical
proficiency may be eflfectuallj^ promoted.
Circular No. 2 and Circular No. 11, this office, will be revoked or modified, as will ail
other orders, letters and instructions heretofore issued which conflict with the instructions
contained in this communication.
A circular is now being prepared in this office along these hues.
The senior divisional medical consultant was to secure medical cases the
best and most advanced treatment possible and make appropriate reports and
recommendations to the chief medical consultant.
The divisional surgical consultant was to exercise immediate supervision
over the work of operating teams in the division, but in time of mobile or semi-
mobile warfare and when evacuation hospitals were lacking, this supervision
was to be exercised by the senior divisional consultant or his assistant, over
teams working in hospital for nontransportable wounded. Direction and super-
vision of the purely operative work in divisional formations was a duty of the
senior divisional surgical consultant or his assistants. Divisional medical con-
sultants were to supervise the immediate medical activities in the division to
which they were assigned. The division surgeon was to furnish the necessary
hospital facilities, supplies, and personnel other than those forming teams.
Such consultants for base hospital groups as were thought necessary by the
chief surgical and medical consultants were to be appointed from time to time.
Base and other hospitals so far as possible were to be organized in three services —
surgical, medical, and laboratory — each under a chief of service. Under the
chief of the surgical service were grouped general, orthopedic, and head surgery,
including that of the brain, nervous system, eye, ear, nose, throat, face, and
mouth; urology; roentgenology; and dentistry. Under the chief of the
medical service were general medicine, neurology, and psychiatry, and under
the chief of the laboratory service, pathology, bacteriology, and serology.
The first copies of Circular No. 25 were received simultaneously with the
notice that the corps would not function while our divisions were reenforcing
the French, and it was modified to permit the appointment of consultants to the
tactical equivalent of an army corps. One week after Circular No. 25 was
issued other changes were again instituted which permitted the consultants for
corps to function.
In effecting the reorganization of the professional services, the director of
these services found himself considerably embarrassed by the fact that individ-
ual organizations had been built up around each director; the harmonizing of
these, their coordination and summetrical development, therefore, were verv
difficult. «
An effort was made to procure a copy of the card index, prepared in the office
of the Surgeon General, showing the professional qualifications of all officers in
the American Expeditionary Forces, but this was unsuccessful and the director
was obliged, in making assignments, to rely upon his very inadequate personal ^
knowledge of the ability of each officer concerned. ^
The publication on June 6, 1918, of General Orders, No. 88, general head-
quarters, A. E. F., gave the directors, whose titles were now changed to consult-
ants, a status in the forces generally which promoted a boarder appreciation of
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 357
their responsibilities.^ This order directed that there be appointed for the
coordination and supervision of the professional care of the sick and wounded of
the American Expeditionary Forces a director of those services, and a chief
consultant in medicine and in surgery, respectively; also, that there be ap-
pointed for each army chief consultants, senior consultants, and consultants in
special subdivisions of surgery and medicine. It also assigned selected officers
as director of professional services, as chief consultants in the surgical and med-
ical services, and as senior consultants in the following branches: General
medicine; roentgenology; surgical research; neurological surgery; orthopedic
surgery; ear, nose, and throat surgery; general surgery; neuropsychiatry;
venereal, skin, and genitourinary surgery; maxillofacial surgery; ophthalmology.
The order further directed that other senior consultants and consultants for
hospital centers and other formations be designated from time to time as the
need for them arose and that specialists in neuropsychiatry, urology, and ortho-
pedic surgery be appointed from the divisional sanitary personnel.
It will be observed that Circular No. 25, unlike Circular No. 2, chief surgeon's
office, A. E. F., did not include the laboratory division among the professional
services, except in so far as the organization of base and general hospitals was
concerned. Nor was that division included among them by General Orders,
No. 88. Nevertheless, Circular No. 25, recognized the close relationship of this
specialty and that of dentistry with the other services by including them with
the special services in the hospital organization which it prescribed.
By General Orders, No. 88, and by Circular No. 25 the professional
services were centralized and their efficiency greatly enhanced.
On August 7, 1918, the chief surgeon, A. E. F., wrote to the director of
professional services stating that it was desired to have consultants in various
specialties stationed at each hospital center; he was requested to nominate the
officers who would be ordered to these centers for duty.'^ These consultants
were to include a specialist in diseases of the heart and one specialist in ortho-
pedics who it was planned would be attached to each convalescent camp which
formed part of a hospital center.
Each of these consultants was notified of his appointment and informed
that he was expected not only to act as consultant for the hospitals in his center,
hut also that at regular intervals he would visit others, which his letter of assign-
ment designated.'^ With respect to the hospitals visited, these visits were to
he made of service in establishing standardized methods of treatment and to
assist in selection of cases for evacuation to the United States or to other
hospitals.
On August 13, 1918, the chief surgeon asked the director of professional
services to designate certain hospital centers to which specialists arriving in
France might be sent, both in order to expedite their clearance from depot divi-
sions and to determine their capabilities."^ At that time Roentgenologists were
heing sent automatically to the hospital center at Bazoilles, and it was desired
that odicers skilled in other specialties be similarly distributed to other selected
places. The distribution was not to be made to apply to surgeons and internists
who had not practiced specialties. It was, therefore, recommended that psychi-
atrists and neurologists who arrived as casuals be sent to Base Hospital No. 117
358
ADMIXIvSTHATIOX, AMERICAN KXPKDITION AlO' KOHCES
at La Faucho; specialists in eye, ear, nose, and throat sur»j:ery and oi)hthal-
mology to Base Hospital No. 115, at Vichy; specialists in tuherculosis to Base
Hospital No. 8, at Savenay; urologists and dermatologists to Base Hos!)it)iI
No. 66, at Neufchateau; orthopedic surgeons to Base Hospital No. 9, at Cha-
teauroux, and specialists in neurosurgery to Base Hospital No. 4(), at Bazoilles.^
On August 27, 1918, certain orthopedic surgeons were appointed consultants
in their specialty for designated districts.'' Hospitals and other formations
in those districts which needed their services were authorized to apply to the
nearest consultant at the address given in Circular Letter No. 7a. This cir-
cular gave the names of these consultants, their respective addresses, and the
hospitals, hospital centers, and depot divisions which each of these consultants
was expected to serve.
On September 2, 1918, the chief consultant of the medical and surgical
services informed the chief surgeon that in order to meet the needs for (jualified
medical officers, it was essential that the chief consultants be authorized to
reserve such officers as might be necessary to carry out the work in their several
departments.'* They requested that the chief surgeon authorize such reserva-
tion of medical officers, and that their representatives be instructed to confer
with representatives of the chief surgeon in order to prepare and put in opera-
tion a method for dealing with questions relating to the personnel of the profes-
sional services. The chief surgeon considered this plan practicable within cer-
tain limitations and arranged for a conference whereby a thorough understanding
might be reached of the points involved.
On the same date the chief surgeon notified the director of professional
services that certain officers had been designated professional consultants and
heart specialists at five of the more important hospital centers; also, that they
had been informed that this designation did not necessarily relieve them from
their other duties.'^ It was recjuested that, if possible, in making future recom-
mendations to fill other vacancies among consultants in hospital centers, some
officer belonging to a unit in the center be selected.'^
On September 8, at the instance of the director of the professional services
the following general letter was addressed by the chief surgeon to all division
surgeons concerning the service of ps^^chiatrists, urologists, and orthopedic sur-
geons assigned thereto :
There is apparently some misunderstanding among division surgeons relative to the
duties and status of speciahsts assigned to divisional formations for dutj-.
During the recent activities one division surgeon assigned the psj-chiatrist to dressing
the slightly wounded. While he was engaged at this work, several hundred cases of slight
war neurosis were evacuated that would never have left their division if they had been exam-
ined by a trained psychiatrist.
The above instance is cited to show the importance of properly utilizing the services
of these trained specialists with a view in this instance of avoiding a repetition of the experi-
ences during the recent activities, when a total of nearly four thousand cases of slight war
neurosis were evacuated to base hospitals that should never have left their divisions.
I. General St.\tus and Duties
Orthopedists, urologists and psychiatrists are attached to tactical divisions solely to
aid in dealing with the medical and surgical problems of the division.s.
OHOANIZATIOX A.XJ) A D:\I1NI.STKATI0X OF ( HIEF SUKGEOX'S OFFICE 359
Their activities have two objects: (o) To keep the fighting strength of the division at
the highest possible point and (6) to bring about the prompt ohmination from the division of
tiiose who become unfit for duty.
These three branches of medicine and surgery are represented because they are concerned
witii those diseases and injuries which experience shows contribute most to noneffectiveness
of individual soldiers and troops in general.
The function of these specialists is to help the division surgeon in the clinical work
of the division in much the same way that the sanitary inspector does in sanitation and the
assistant to the division surgeon in administration. They should be attached to the office
of the division surgeon as additional assistants. In no other way can they render efficient
service. Their permanent assignment to any subordinate sanitary formation of the division
inevitably curtails their usefulness. In periods of stress, however, they should be stationed
by division surgeons in the post in which they can work to the best advantage (e. g. ortho-
|)cdists and psychiatrists in triages, the urologist in the surgical hospital during combat).
They should not be regarded as consultants representing an organization outside
divisional control, but as integral parts of the division sanitary personnel, wholly concerned
with the medical work of the division to which they are attached and directly under the
supervision of the division surgeon.
II. Specific Dutie.s
ORTHOPEDISTS
Division in training or rent. — (1) Instruction in api)licati()n of splints and dressings to
entire sanitary personnel.
(2) Instruction in proper care of the wounded during transportation.
(3) Instruction in prevention and treatment of shock and hemorrhage.
(4) Examination and reclassification of those unfit for combat due to faulty posture
and foot disabilities.
(5) The inspection of shoes and instruction in proper shoeing and care of the feet.
Division in combat. — (1) Supervision of sui)ply and distribution of splints and dressings.
(2) Continuance of instruction in application of splint dressing, treatment of shock
and hemorrhage, and care of wounded during transportation.
i'.i) Supervision of surgical treatment of wounded from front line to hospital.
(4) Prophylaxis of foot conditions arising in trench warfare.
UROLOGISTS
Venereal diseases. — Prophylaxis of venereal diseases: (1) Lectures to medical officers
and personnel of prophylactic statiojis.
(2) Inspection of prophylactic stations as to proper location, equipment, personnel,
teclniiquc, results, and failures.
(3) Cooperation with the A. P. M. in investigation of local conditions concerning
l)rostitution, regulated and clandestine, and alcoholism.
Treatment: (1) Supervision of physical inspections, early recognition of venereal cases
and evacuation to medical labor camp.
(2) Supervision of genito-urinary treatment and operations in divisions.
Skin diseases. — Prophylaxis: (1) Cooperation with other departments and officers
concerned in the bathing and disinfecting of troops and equipment.
(2) Instruction of personnel assigned to bathing establishments in the prompt recog-
nition of skin diseases, and the importance of removing them at once from their commands.
(3) Supervision of inspections for skin diseases made simultaneously with venereal
inspections.
Treatment. — Supervision of treatment of skin diseases in field liosi)ital or other medical
unit assigned for the i)urpose.
Cooperation willi the senior consultant in venereal, skin, and genito-urinary diseases
through the division surgeon in accunnilation of data concerning venereal, skin, and genito-
urinary surgery, by monthly reports.
360
ADMINISTRATION, AMERICAN EXPEDITION A KV FORCES
PSYCHIATRISTS
Division in training or rest. — (1) Elimination of iiisaiio. foeljlc-iniiKlod aiui epileptic
(especially among replacements).
(2) Mental examination of general prisoners in accordance with section 11, General
Orders, No. 56, current series.
(3) Instruction of medical officers regarding diagnosis, early management, and pre-
vention of war neurosis (shell shock).
Division in combat. — (1) Examination and sorting of officers and men returned to
advanced sanitary posts for exhaustion, concussion by shell explosion, and war neurosis
in order to control their evacuation.
(2) Treatment of light cases of exhaustion, concussion, and war neuroses in divisional
sanitary formations so as to preserve the greatest number i)ossible for duty.
(3) Mental examination of general prisoners and men suspected of having self-inflicted
injuries.
Concerning the withdrawal of consultants from the army corps, the
chief surgeon of the First Army Corps, on November 4, 1918, forwarded the
following record of his analysis of the situation:
The chief surgeon, First Army Corps, desires to call attention to certain features con-
nected with the organization of the Medical Department of a corps.
There appears to be a tendency to withdraw corps consultants. The undersigned
believes this would be a vital mistake.
The corps surgeon should have on his staff the following: (a) Internist; (6) psy-
chiatrist; (c) urologist work during active operations is concerned largely with bathing,
delousing, and skin diseases; {d) orthopedist; (e) medical gas officer; (/) sanitary inspector.
Evacuation of sick and wounded should be supervised by the commanding officer,
corps sanitary train.
All the above men should be carefully selected in order that each fits [)erfectly into
his place. Each must have the undivided support of the corps surgeon.
Concentration of these specialists in an army and attempting to control the work of
divisions without working through the corps will result in inefficiency. The army is too
far removed from the front line. Personal contact with conditions in the front line is
absolutely essential in order to properly appreciate the difficulties connected with divisional
work and to formulate means for their correction.
The only consultant whose services can be dispensed with in a corps under present
conditions is the surgical consultant. The chief surgeon. First Army Corps, however, feels
that mobile hospitals should be under the control of the corps surgeon, and in that event
a corps consultant in surgery would be indispensable. Mobile hospitals should work so
far forward that only the corps surgeon is sufficiently familiar with conditions to determine
promptly when and where they should be moved. The present system has iH)t been satis-
factory.
Divisions need constant supervision in all phases of their medical, surgical, sanitary
and evacuation work. Obviously, the corps surgeon would be helpless in attempting such
supervision alone. His staff of consultants furnishes him with an invaluable means for
keeping in touch with every phase of the work in the various divisions, and if properly selected,
supervised and supported, they are absolutely indispensable in enabling the corps surgeon
promptly to detect defects and to correct them.
This can not be done from an army largely because of the lack of personal contact.
In this plan, each division consultant would be under the direct supervision of the
corresponding corps consultant; each corps consultant under the supervision of the cor-
responding army consultant; each army consultant under the supervision of the corresponding
chief consultant, G. H. Q., A. E. F. The chief consultant, general headquarters, A. E. F.,
would formulate policies — the army, corps, and division consultants would be responsible
that these policies are enforced. Without supervision, they will not be carried out; with
proper organization and supervision, they will be carried out.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 361
The above plan gives a logical, balanced organization that will bring results. If corps
supervision is not included, there will be a missing link that will mean inefficiency.
Transportation is of course vital. Without it, consultants in either army, corps or
division are helpless.
It may be possible at some latter date that divisions may become so experienced and
well trained that this supervision may not be necessary. This is certainly not true at present
and we do not believe it will be true during the continuance of this war.
The chief surgeon, First Army Corps, feels so strongly in this matter that, in case the
corps consultants are not included as the general policy, he requests that the First Army
Corps be permitted to retain the staff as outlined above.
In commenting upon the above-outlined plan the chief surgeon, First,
Army, stated : "
It was thought at first the duties could be performed by assiging consultants to the
army with assi-stants to work with the corps, but this plan has not proven effective due
to the great distance the combatant troops are from the army headquarters, rendering
it impossible to keep in touch with them with the paucity of transportation.
The paucity of truck transportation has precluded the further use of complementary
{groups with divisions, and it has been necessary to move the mobile hospitals far to the
front to act as nontransportable hospitals, using the corps field hospitals for reservoirs.
The attitude of the chief consultant in surgery, concerning the plan of the
chief surgeon, First Army Corps, was expressed by him as follows:-^
The plan as outlined by Colonel Grissinger with reference to corps consultants is most
heartily approved.
His suggestion with regard to the disposition of mobile hospitals and their control
by the corps surgeon has been fully justified by recent experiences in the Argonne and is
also concurred in.
*******
On November 16, 1918, the chief surgeon instructed the director of pro-
fessional services to confer with the chief consultants in medicine and surgery
at the earliest possible date, with a view of compiling a report on the activities
of the different subdivisions of medicine and surgery. He felt that by uti-
lizing the services of the officers in the professional services during the then
inactive period, every phase of the subject, from front to rear, could be covered
without difficulty.
Unfortunately the early dissolution of the consultants' staff and the
return of many of them to the United States prevented a full realization of
the chief surgeon's project.
ACTIVITIES OF THE SURGICAL SERVICES
GENERAL SURGERY"
The section of general surgery, the parent stem from which the subsection
of the surgical services, A. E. F., were subsequent offshoots, came into existence
upon the appointment of a director of general surgery, November 10, 1917.
On December 22, 1917, two assistants to the director were appointed, and on
January 28, 1918, a joint office for administrative purposes was opened in Neuf-
chateau, with the directors of the "divisions" of orthopedic surgery, psychiatry,
and genitourinary surgery.
» The statements of fact appearing herein are based on " Report of the activities of the division of general surgery,
A. E. F.," by Brig. Oen. J. M. T. Finney, M. ('., chief consultant, surgical services, A. K. F. The report is on file in the
Ilistoriciil Division, Siimeon (Jeneral's Office, Washington, D. C. — Ed.
362
ADMINISTRATION, AMERICAN EXPEDITIONARY J'ORCES
The section of general surgery, being independent at the time in <juesti()ii,
as was true of the other professional services, reported directly to the chief sur-
geon, A. E. F. Pursuant to General Orders, No. 88, general head(|uarters,
A. E. F., June 8, 1918, the various professional services were cooidinated under
a director of professional services, and the director of the surgical services now
became the chief consultant thereof, with the following subdivisions, each in
charge of a senior consultant, directly under him : roentgenology ; surgical re-
search; neurological surgery ; orthopedic surgery ; ear, nose, and throat surgery ;
general surgery; venereal and skin diseases and genitourinary surgery; maxil-
lofacial surgery; ophthalmology.
Surgical Consultants With Tactical Units
The first step taken was the recommendation that a surgical consultaut
be appointed by the director of surgical services, following his ap])ointment in
November, 1917, for each of the tactical divisions then in France. After their
appointment, these officers met the medical officers of the divisions and advised
with and instructed them. When the tactical divisions went into the front line
the services of the divisional surgical consultants proved to be more valuable in
the hospitals, and thereafter their time was chiefly spent in the evacuation
hospitals. Consultants to our divisions operating in French armies occupied
their time chiefly in observing the methods and treatment in French hospitals.
There was in the beginning (in each division) a decided tendency to do
surgery in the field hospitals. The chief consultant in surgery received an order
from the chief surgeon, A. E. F., forbidding operations in a field hospital
when an evacuation hospital was available. This made it possible to place
consultants with mobile and evacuation hospitals only.
As the surgery was now all done in hospitals, other than divisional, save
in unusual circumstances, it soon became apparent that consultants were not
needed with divisions; therefore a consultant and assistant were then desig-
nated for each corps. This new arrangement was satisfactory until the First
Army was formed, when the same objections obtained as to consultants with
corps as proved true of divisions. A consultant for each army was then ap-
pointed, with a sufficient number of assistants, to supervise the surgical work
in all the evacuation and mobile hospitals. This policy was put in operation
in both the First and Second Armies and proved fairly satisfactory. Corps
surgeons were almost unanimous in the opinion that no consultants were needed
with divisions or corps.
Surgical Teams
Another important step, after securing the assignment of consultants to
tactical units, was the organization of surgical teams from the personnel of all
base hospitals. This was initiated on January 7, 1918. Each team consisted
of 1 operator and assistant anesthetist, 2 nurses, and 2 orderlies. A dozen
teams were ciuickly organized, and others as more hospital units arrived, so
that by the end of October some three hundred teams had been organized and
two hundred were operating with the First and Second Armies.
()R(;axizati().\ and ai:>:ministratiox of chief surgeox's office 363
The Preoperative Traix
Another improvement instituted by the chief consultant, surgical services,
was the "preoperative train" — a train filled with certain (unoperated) cases,
which would not suffer from transportation and a delay of 29 to 36 hours.
During the St. Mihiel operation the chief surgeon, First Army, was furnished
a list of the type of cases suitable and the plan was put in practice, thus relieving
the forward hospitals of many cases. No bad results followed except in a few
instances where trains were sent to more distant hospitals.
Surgical Consultants, Hospital Centers
The necessity for surgical consultants in the large hospital centers was
apparent to the chief consultant for a long time; however, through lack of
personnel, they could not be supplied until toward the end of active hostilities.
At the end of 1918, 16 hospital centers had surgical consultants.
Experimental Work
Early in January, 1918, a committee was appointed by the chief consultant
in surgery to study the best methods of blood transfusion for use in the forward
area. An excellent report was prepared and distributed to the medical officers.
Instruction in the treatment of shock was given at the central laboratory,
Dijon. Experimental work in connection with the problems of wounds of the
thorax also was done. The chief consultant suggested an interchange of per-
somiel between base and mobile hospitals and this plan was partly carried out.
Lectures
In addition to the activities directly connected with the treatment of the
wounded, the senior consultants of the subsections and the consultants with
ti'oops and hospital centers gave lectures at the Army sanitary school, Langres,
on surgical subjects connected with their various departments.
NEUROLOGICAL SURGERY ^
A senior consultant in neurological surgery was appointed on June 7, 1918,
and directed to organize a subsection. His problem was unique since no prec-
edent existed in any army. A rough estimate by him made it seem probable
that 25 per cent of all casualties would present neurological problems; unofficial
figures from British and French sources gave the following percentage of nerve
injuries: Wounds of the head, 16 per cent of all wounds; wounds of the spine,
2 per cent of all wounds; wounds of major peripheral nerves, 20 per cent of
all serious wounds of the extremities.
The problem presented two aspects: The immediate care, in forward
hospitals, of the more serious cranial and spinal cases; later care at base hos-
pitals of residual paralysis of peripheral nerves. The results at that time in
both cases were not encouraging; over 50 per cent of penetrating skull wounds
«■ The statements of fact appearing herein are based on "Report to the chief surgeon, A. E.F.,from the senior
eonsiiltant in neurological surgery, dated Neufchateau, Dec. 2, 1918, on summary of the activities of the department."
Copy on file. Historical Division, S. O. O. — Ed.
364
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
and 80 per cent of the spine were fatal. The wounds of peripheral nerves
were simply accumulating and awaiting treatment later.
The plan of organization provided for teams for hospitals in the zone of
the advance; representatives in the base hospitals; neurological centers.
For each team, one surgeon from each evacuation hospital was selected,
given special instructions and assigned to this work in his hospital; also proper
equipment was supplied. A difficulty was that in "centers" devoted exclu-
sively to diseases and injuries of the nervous system, as in the French Service,
on emergency these surgeons were often impressed for general work. Another
difficulty, in a rush period, was the slowness of head operations. Often the
tedious head cases were passed on to base hospitals that more cases might be
handled. Through June, 1918, there were teams only at Mobile Hospitals
Nos. 1 and 2; by July most of the evacuation and mobile hospitals had such
teams. Following this, more specialists arrived from the United States and
more instruments were available; so that, before the St. Mihiel operation in
September, each hospital in the forward area had an experienced team. Al-
though this operation was relatively short, it was seen that one team in each
hospital was not sufficient to screen out the cases; in some hospitals the teams
were off duty or doing general surgery, and the results were not satisfactory.
Fifty per cent of head cases died, exclusive of those dying later in base hospitals.
In preparation for the Meuse-Argonne operation, the senior consultant,
neurological surgery, urged the chief surgeon to supply two teams to each
hospital on the main line of evacuation — Fleury, Souilly, and Villers-Dancourt;
and to direct that field hospitals route suitable cases to one of these points.
Instead, the British plan was followed; one hospital at Deuxnouds, was selected,
and several teams concentrated there. Some 813 cases were secondarily routed
to this hospital, whose location and general arrangements were poor. Because
of these conditions and the changing personnel results were not entirely satis-
factory, resulting in the adoption of the former plan, that is having special
hospitals, farther forward, as named above. From 50 to 100 beds were set
aside for these cases at each of the three hospitals.
As to wounds of peripheral nerves little more could be done in the advance
hospitals than to prevent the destruction of nerves by extensive debridement,
and to have some divided nerves sutured. This latter procedure was neces-
sarily rare. These cases were generally handled in the base hospitals, where
provision was made as far as possible, for a specialist at each.
As a rule each hospital group, a center, had one selected hospital to which
proper cases were to be sent, either on arrival or later.
It was the intention to have a group of well-trained neurologists and neu-
rosurgeons for each of the large centers and this plan was put in operation
at some centers, as, Bazoilles, and Contrexeville. Military Hospital No. 1
served for the Paris group. Owing to lack of suitable personnel and to the
difficulties of secondary routing, the project of a district neurological center
had to be abandoned; though Base Hospital No. 115, at Vich}^, made a very
successful start in that direction.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 365
ORTHOPEDIC SURGERY
The orthopedic service began with the dispatch to England of an orthopedic
surgeon and 20 assistants in May, 1917. These officers were assigned to duty at
different orthopedic centers there pending the organization of the American
Expeditionary Forces.
The subject of splinting was taken up in July, 1917, and a committee was
appointed by the chief surgeon, A. E. F., for the purpose of formulating regula-
tions for the standardization of splints. This committee recommended a set of
splints, which were adopted, and described in the Manual of Splints and Appli-
ances for the Medical Department of the United States Army, 1917.
More orthopedic personnel was now arranged for, and in October, 1917,
45 orthopedic surgeons, with 3 Sanitary Corps officers trained for splint shop
work and 12 special nurses, sailed from the United States for England. All this
personnel was assigned (temporarily) to the British Service, partly for instruc-
tion and partly to assist the British Medical Service.
In November, 1917, a director of orthopedic surgery and two assistants
were appointed. The director and one assistant were stationed at Neufchateau,
the other assistant was stationed in London as liaison officer with the British
Medical Service.
Shortly after this time, our troops occupying training areas, the orthopedic
problems were chiefly static defects, such as flat feet, weak back and knees,
among line troops. To correct these static defects, a special training battalion
was established in the 26th Division, then at Harechamp, where the men were
trained to correct faulty habits of posture while on a duty status. This
battalion was successful and was later transferred to the First Depot Division at
St. Aignan-Noyers. By July, 1918, the need for class C men — that is, men unfit
for front line duty — was so great and the number of the men mentioned so great
and instead of attempting to make them fit for class A they were given short
periods of training and assigned directly to class C duty. In this manner, at one
time, 1,200 men were assigned to the Hospital Corps, 1,000 at another time,
1,000 for prison guard duty, 100 for military police, and others in smaller
groups.
In November, 1918, a number of our orthopedic surgeons were withdrawn
from service in England and assigned to combat divisions in the American
Expeditionary Forces for the purpose of training Medical Department officers
and men in the proper application of splints. At first three such orthopedists
were assigned to each division for this purpose. In addition they made a survey
of the entire personnel, and as far as possible, corrected defects of this. Later,
when the divisions entered combat, training in the application of splints became
a principal feature of the orthopedic section. Divisional arrangements for the
transportation, storage, and handling of splints were also in the hands of the
orthopedic surgeon.
Supervision of bone and joint cases was given to the orthopedic section.
To accomplish this, one of the assistants to the chief consultant was assigned to
' The statements of fact appearing herein are based on "Report of the senior consultant, orthopedic surgery, on the
activities of the department of orthopedic surgery, made to the chief surgeon, A. E. F." On file. Historical Division,
S. G. O.—Ed.
366
ADMIXISTHATIOX, A^FERICAX KXPEDTTION AH V KOHCKS
the zone of the advance and another to tlie hospitals in the rear; supervision of
the work in the combat divisions was given to a third. In addition to these,
special consultants were assigned to various groups, to centers, and hosj)itnls.
In order to care properly for the bone and joint cases, standardized methods
were announced and taught: First, splinting; second, transportation; third,
posture of limb injured. This standardization did away with the unnecessary
changing of splints and the possible harmful changes of methods of treatment.
"Splint teams" were organized, each consisting of one orthopedic surgeon and
two enlisted men. These teams took charge of the wounded man as soon as
his operation was completed, applied the necessary splints, and cared for him
(if retained in hospital at the front) or supervised his transport to the rear.
Groups of reconstruction aids were also employed for giving physical
therapy to the men in base hospitals; curative workshops were established.
The work of the orthopedic service demonstrated, first, that a large number
of physically unfit men can be restored to duty by pi'oper training, ami that many
such conditions as flat-foot and weak back should not be carried on the sick
report as sickness, but should be considered simply as weakness, to be corrected
by training; second, the use of standard methods of splinting, transportation, and
after treatment, reduced the mortality rate among combat casualties and greatly
reduced the amount of their later impaired functions.
ROENTGENOLOGY
The personnel of this department consisted of medical officers expert in
X-ray work; officers of the Sanitary Corps, called technicians; enlisted men
of the Medical Department. They arrived in France as members of hospital
imits or as casuals. Though some of the officers proved to have had little
or no actual experience in this line of work, a large percentage of them had
received an intensive course of training in the United States, and so arrived
iii France with a general knowledge of the physics underlying X-ray work
and with the construction and operation of the various types of X-ray machines
being used. Additional instruction was given in France, at first, at the X-ray
repair shop in Paris, and later at a school established at the hospital center,
Bazoilles. Several groups were instructed at Tours by a medical officer of
the French Army.
The installation and repair of apparatus was done by 12 officers of the
Sanitary Corps. The care and routine work was done by enlisted men, known
as manipulators. As a rule, these enlisted men were trained in the United
States, though some were trained in France.
The X-ray apparatus used in the hospitals in the American Expeditionary
Forces was similar to that used in military hospitals of the United States. The
large interrupterless type of machine was not suited to French conditions on
account of the current supplied; only bedside units and modified bedside
transformers were found suitable. At some places no current was available,
requiring the use of a gas engine. One bedside unit was found to be needed
for each 500 beds. This apparatus could be operated on practically any type
The statements of fact appearing herein are based on " Report of the activities of the Roentgenological servK >•
A. E. F., by the senior consultant, roentgenology." On file, Historical Division S. O. 0.~Ed.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 367
of current and used so little current that it could be attached to an electric
light plug. The Army portable outfit was found very satisfactory for base
hospital use.
Mobile hospitals were supplied with an X-ray motor truck of French
manufacture, which had a number of faults and disadvantages. A camion
devised in America was much superior, but did not arrive in the American
Expeditionary Forces until toward the end of hostilities.
X-ray work was done in all the army zones and sections. At the front
practically all battle casualties were examined in evacuation, mobile, and fixed
field hospitals; fractures were briefly described, foreign bodies located, and
evidence in chest wounds was recorded. X-ray work during an operation was
hut seldom necessary. The combat divisions did not need X-ray apparatus.
The proportion of patients X-rayed was 80 per cent in the field hospitals for
nontransferable cases and 90 to 95 per cent in evacuation and mobile hospitals.
To keep up with the work in times of emergency it was necessary to employ
two shifts and work continuously.
The base hospitals also employed the X ray extensively, especially in care
of wounded coming directly from the front.
MAXILLOFACIAL SURGERY ^
On April 18, there arrived at Brest a party consisting of 19 medical officers^
expert in oral and plastic surgery, and 15 special dental surgeons. Pending
active operations by the American troops, these oSEicers were scheduled for
assignment, some to a French hospital at Lyons and the remainder to British
hospitals at Croydon and Sidcup, England. The officers intended for Lyons,
however, were delayed and were assigned to a British hosp'ital instead. Other
officers were assigned to Evacuation Hospital No. 1, Base Hospital No. 15,
and American Red Cross Hospital No. 1. Those who had been sent to allied
hospitals were gradually withdrawn for general surgical and dental work, to
be reassigned to their own specialty when needed.
In authorizing the establishment of the maxillofacial service the chief
surgeon, A. E. F., directed that it be conducted as a part of the general surgical
service, but in such a manner as to receive the cooperation of the dental service
in the most efficient manner. The chief consultant, surgical service, the chief
dental surgeon, and the senior consultant of the maxillofacial service were in
accord as to the advisability of this plan. The general plan outlined specified
that the maxillary and facial cases should be in charge of a surgeon working in
cooperation with a dental surgeon. It was beUeved that if these cases could
receive proper treatment in the advanced hospitals, and this treatment con-
tinued in the base hospitals, they could be saved (except in a few cases with
great loss of time) from the reconstruction class and made fit for duty within
the time cases were allowed retained in the American Expeditionary Forces.
Further, that with proper care reconstruction would be simpler and more
successful. Experience proved this view to be correct.
• The statements of fact appearing herein are based on " Report of the senior consultant, maxillofacial surgery, on
the activities of the maxillofacial service, A. E. F., made to the chief surgeon, A. E. F." On file. Historical Division,
S. G. O.-Ed.
13901—27 24
368
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
As planned in the office of the Surgeon General, each evacuation hospital
was to have one surgeon and one dental surgeon for this special work. No
provision was made for mobile and American Red Cross hospitals.
It was soon learned that it was best not to designate these specialists for
the various hospitals by specific orders, but rather by individual understanding
with the various commanding officers, who were requested to assign the most
desirable officers of their personnel. The lack of special surgeons was later
compensated for by the appointment of local consultants.
In each base and evacuation hospital a specially qualified dental surgeon
was assigned to care for prosthetic and splint work. Unfortunately, not all the
mobile hospitals were so equipped, even at the signing of the armistice, and, in
a number of cases these dental surgeons were handicapped by having other
duties assigned them, such as those of evacuation officers and mess officers.
On June 11, 1918, the senior consultant, maxillofacial surgery, made recom-
mendation as to a definite plan of early treatment. This plan was authorized
by the chief surgeon, A. E. F., in a memorandum issued in October. Instruc-
tions were also issued by him covering the evacuation and transportation of
maxillofacial cases. It was directed that such cases, evacuated to the Paris
district, be treated in American Red Cross Hospital No. 1; other cases that
could be were to be transferred to any hospital having this special service, or
to Base Hospital No. 115. Base Hospital No. 115 had been designated as a
special hospital for surgery of the head. While there was much general surgery
done there, there were more special facilities for maxillofacial surgery, such as
expert modelers in wax reproductions, expert surgeons and dentists, and special
supplies. With all the above facilities, however, the contemplated plan of mak-
ing the repair of the soft parts in extensive injuries before return to the States
was practicable in but few instances.
In September, a number of local consultants were appointed. One was
assigned as local consultant, advance section, and also as assistant to the senior
consultant. Local consultants were assigned as follows: Base sections Nos. 1
and 5, station at Savenay; base section No. 2, station at Beau Desert hospital
center; area 3 (Toul, Bazoilles, Vittel, Chaumont, Rimaucourt, and Langres),
station at Toul; area 4 (Dijon, Allerey, Beaune, Mars, and Mesves), station
at Beaune; area 5 (Vichy group), station at Vichy; area 6 (Tours and Orleans),
station at Tours; Paris area.
Though the senior consultant remained in America until the special equip-
ment needed was ready for shipment, with the exception of one intratracheal
vaporizor, a few sets of oral and plastic instruments, and 500 emergency jaw
splints, none of this equipment had been received when the armistice was signed.
This shortage was partly compensated for by the collection and having made of
special jaw splinting material and by ingenuity in extemporizing material.
To sum up, the work done by the service included: (1) The training of a
number of surgeons and dental surgeons in the work to be done, both in special
schools and in French and British hospitals; (2) the organization of the work in
the American Expeditionary Forces. This included the general organization,
the appointment of local consultants, and the development of centers.
In so far as the American Expeditionary Forces are concerned the results
obtained in maxillofacial surgery were not as great in quantity as had been
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 369
anticipated, owing to the lack of both personnel and equipment, the utilization
of some of the personnel for other work, and the relative brevity of the period
of active hostilities.
VENEREAL AND SKIN DISEASES AND GENITOURINARY SURGERY^
Four members of the Medical Corps reported to the British Army in
p:ngland on June 8, 1917, for the purpose of studying the British methods of
treating venereal diseases. A month was devoted to this study in England
and in the British Expeditionary Forces, France. Numerous hospitals in
England and in France were visited, and the routing of venereal cases from
organization to hospital was studied. A second month was then spent in the
study of methods employed in French military hospitals, two of the medical
officers referred to making, in addition, an extended tour, accompanied by a
senior French medical officer, of several French armies with the view of observ-
ing the sanitary organizations.
As regards the British Army, it was found that, during the year 1916,
112,249 cases of venereal disease were treated in hospital. Of these cases,
52,495 were treated in 14 hospitals in England and 59,754 in 5 British Expe-
ditionary Force hospitals in France. The capacity of the hospitals in England
varied from 100 to 1,500 beds, and of the British Expeditionary Force hospitals
from 500 to 3,500. The largest hospital — that is, 3,500-bed capacity — had
treated 55,634 patients with venereal disease, including 12,000 syphilitics.
During the years 1915-16 the hospital referred to had treated 22,596 cases of
gonorrhea, representing 1,082,621 days lost in hospital, or an average of 48 days
each. Sixty per cent of the gonorrhea cases had complications, usually prosta-
titis or epididymitis; 17 per cent were readmissions for relapses of the disease
after supposedly having been cured. In addition to the days lost in hospital,
the patients lost from one to two weeks in traveling to and from hospital.
In respect to the French Army no statistics were obtainable by the medical
officers studying the venereal situation therein, as to the prevalence of vene-
7'eal disease, partly owing to the fact that uncomplicated gonorrhea had been
treated habitually by the French in regimental organizations. It had been
estimated by the French, however, that up to the end of the year 1916 there
had been 200,000 cases of syphilis in the French Army. These syphilitics
were treated in approximately 20 hospitals, the bed capacity of which varied
from 100 to 800, each patient remaining in hospital from 4 to 7 weeks. The
Fiench practice was to establish throughout the country centers for the treat-
ment of skin and venereal diseases, where both civil and military patients
received dispensary and bed treatment, as the case might call for.
As a result of this investigation, the officer who was subsequently to become
the senior consultant in skin and venereal diseases, as well as in genitourinary
surgery, concluded that the established system of transferring venereal patients
from their organizations to hospitals situated from 50 to 100 miles removed
was not the best method, and that such venereal diseases as might arise in
the American Expeditionary Forces could be treated fully as efficiently in the
' The statements of fact appearing herein are based on " Report of the division of urology, A. E. F., " by Col. Hugh
H. Voting, M. C. senior consultant in venereal and skin diseases and genitourinary surgery, Dec. 20, 1918. On file,
Historical Division. S. O. 0.--E<l.
370
AD^riNI.STRATION, AMERICAN EXPEDITIONAKY KOKC'ES
organizations to which the patients concerned belonged. This hitter method
had the following advantages: (a) Saving of time lost in the transfer of patient
to and from hospital. (6) More efficient treatment. Treatment of venereal
patients in their organizations permitted better control and continuity, espe-
cially as regards syphilis, (c) Saving in personnel and material by eliminatint;
large base hospitals for the treatment of venereal diseases.
The treatment of venereal diseases in the organizations to wliicli they
belonged, then, became the established procedure in the American Expedi-
tionary Forces. To facilitate this, a regimental infirmary urological set was
adopted and a supply of them was ordered for the American ^Expeditionary
Forces, delivery being made to the forces in January, 1918, and subsequently.
Also, a proper stock of drugs for the treatment of venereal diseases was ordered;
the injection treatment of syphilis was standardized; a condensed, one-page
syphilitic register was devised and placed in use; special ampoule syringes
containing gray oil, and ampjoules of novarsenobenzol, of sterilized distilled
water, and of cyanide of mercury were designed and supplied for the treatment
of syphilis. Diagnostic facilities in the examination of blood smears, for the
Wassermann reaction, the examination of urethral smears, were established
through collaboration with the director of laboratories, A. E. F. Owing to
the lack of suitable equipment in the field, the Fontana and Hollande stains
were adopted for the detection of spirocheta in the field, the dark field illumina-
tion being reserved for employment in laboratories established at central points
and at base hospitals. Individual prophylactic tubes for the prevention of
venereal disease were devised and supplied for the use of those who did not
have ready access to prophylactic stations, such as small detachments at
remote stations.
A beginning was made, at the instance of the senior consultant in urology,
to minimize the venereal infectiousness of the civil population of France. A
hospital was established by the American Red Cross at Neufchateau, with a
subsidiary hospital at Doulaincourt. From these places teams, each consisting
of a medical officer and a nurse, would make daily visits to surrounding towns
to establish clinics for the treatment of venereal diseases among the civil popu-
lation. Six routes were established covering 50 clinics in an area radiating
fully 50 miles in all directions from Neufchateau. The hospital, constructed
for the purpose at Neufchateau, was completed on March 15, 1918. It con-
tained 50 beds and had operating room and laboratory facilities.
To insure the systematic treatment of venereal diseases in the American
Expeditionary Forces, urologists at base hospitals were instructed as to the
methods to be employed, and specially qualified urologists were, after a pre-
liminary course of training, appointed as urologists in each tactical division
and in each base port.
In so far as the tactical divisions were concerned, the established system
of treating all venereal cases in their organizations operated satisfactorily until
these divisions began to take their places in the front line. Because many
commands then became so broken up with working parties as to make it
practically impossible for regimental medical officers to keep constantly in
touch with venereal cases, who, in many instances were at work at distances
varying from 5 to 10 miles from the nearest medical officer, it was necessary
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 371
to modify the organization for treatment. Accordingly, working camps now
were established in connection with divisions at the front, wherein were col-
lected all venereal disease cases in the division concerned. It proved that
approximately three-fourths of such venereal disease cases thus could be kept
on a duty status and supplied for working parties, under the direction of the
divisional quartermaster or engineer officer.
As to the location of the working camps for venereal cases, a tryout of
several schemes proved that such a camp could functionate best if established
in one of the divisional field hospitals. Therefore, the accepted practice was
to establish such a camp in conjunction with a divisional field hospital given
over to the treatment of venereal and skin diseases.
Venereal camps were established not only in connection with tactical
divisions but also at depot divisions, and on the same principles as obtained in
the combat divisions. In the depot divisions the venereal camps were used
for venereal cases sifted out from the replacement troops, thus preventing them
from becoming a burden to the tactical organizations at the front.
One of the final uses to which venereal camps were put was in connection
with home-going troops following the signing of the armistice. In this connec-
tion, it was required that all members of the American Expeditionary Forces
returning to the United States were to be examined for venereal disease prior
to embarkation, and that those found venereally infectious were to be detained
and placed in segregation camps.
A manual of military urology was prepared under the direction of the
senior consultant in urology and was distributed to medical officers of the
American Expeditionary Forces. This manual comprised sections on venereal
diseases, dermatology, and surgery of urinary and male genitalia. Also, it
contained appendices giving in full all promulgations concerning the subject
of venereal diseases and alcoholism both in the United States and in the American
Expeditionary Forces, and the French regulations on prostitution and alcoholism.
Concerning the problems connected with dermatology in the American
Expeditionary Forces, after an extensive study of the conditions in reference
to scabies and lousiness in both the American Expeditionary Forces and those
of our Allies, the plan of action decided upon was as follows : (a) Instructions
were prepared which appeared from time to time either as general orders,
hcad(juarters, A. E. F., or as circulars from the chief surgeon's office, A. E. F.
(b) Divisional and other urologists were especially instructed in the measures
for the prevention, diagnosis, and treatment of these diseases, (c) Specially
(pialifiod dermatologists were constantly in the field inspecting pertinent con-
ditions and in giving instructions on these topics, (d) Scabies hospitals were
established in connection with the divisional venereal camps, (e) Regional
disinfestation, rather than divisional, (f) Observance of the principles of the
prevention and treatment of skin diseases as outlined in the Manual of Military
Urology.
Though it was planned having special hospitals wherein cases requiring
genitourinar}^ surgery could be given special treatment, this was found to be
impracticable in view of the fact that such injuries or conditions were so rela-
tively scattered and few in number.
372 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
SURGICAL RESEARCH f
The section of surgical research of the surgical services, A. E. F., coinj)rise(l
a senior consultant and three consultants, with the necessary assistants. The
work of the senior consultant was done at Base Hospital No. 4, which operated
with the British Expeditionary Force at Rouen, and in collaboration with sev-
eral officers in his laboratories in Cleveland; one of the consultants carried on
his investigations at Base Hospital No. 10, also operating with the British
Expeditionary Force at Treport; the remaining two consultants established a
surgical research laboratory in connection with the central Medical Department
laboratory, Dijon.
It was under the broad interpretation of research as including anything
that would offer promise of yielding useful information that the work, nmch
of which was done in the British service before our forces became actively
engaged at the front, was made possible.
A program of work was planned by the senior consultant and in hand on
November 11, 1917, which was contemplated for the following winter months
of anticipated light military activity. It was during this relatively inactive sur-
gical period that the researches included not only general surgical subjects but
also subjects of interest to both the combatant and the medical arms. The latter
researches were made in collaboration with the British Royal Engineers' training
school, Rouen; however, during periods of active warfare these studies were
dropped and subjects of immediate surgical bearing were taken up. The fol-
lowing list will indicate the wide range of subjects thus investigated: (1) Phos-
gene poisoning, clinical and experimental; (2) biologic test of safe and danger
points in gas defense works; (3) research into carbon monoxide poisoning; (4)
research into psychic effect of minor explosives; (5) further research into the
effects of high explosives; (6) research into the effects of various infusions; (7)
the inceptive stage of shock; (8) research into the effects of hypertonic salines.
The following researches into practical surgical problems were made: (1)
Organization of resuscitation teams with the British Expeditionary Force,
France; (2) slightly wounded; (3) delayed infected wounds; (4) on blood
transfusion; (5) shock and hemorrhage ; (6) treatment of infections; (7) chem-
ical antiseptics; (8) delayed closure of wounds; (9) surgery of the chest; (10)
study of types of wound that bear transportation..
Apparatus was secured from the United States, and the central Medical
Department laboratory cooperated in every way; the American Red Cross
gave grants of money freely for supplies and sundry expenses. The Research
Society of the American Red Cross provided excellent opportunity for coopera-
tion with similar services in the British, French, and Italian Armies.
The plan for the laboratory which was necessary for the various researches
projected was perfected in January, 1918, and in April the laboratory was estab-
lished at Dijon. Here investigations were begun in May. The principal work
of this laboratory was along two lines: First, treatment of wounds of the chest,
and, second, shock and hemorrhage. The results accomplished appear in Vol-
' The statements of fact appearing herein are based on " Report of the activities of the division of surgical research ^
A. E. F.," made Dec. 18, 1918, by Col. O. W. Crile, M. C, senior consultant in surgical research, A. E. F On file Histori-
cal Division, S. G. O.—
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 373
unie XI, Part I. At this time it is only necessary to say that the treatment of
chest wounds was largely standardized, and by the organization of transfusion
and shock teams undoubtedly many lives were saved. The use of Bayliss'
solution of gum acacia as a substitute for transfusion was an important dem-
onstration; another was that of a measure of the degree of anemia requiring
transfusion.
OTOLARYNGOLOGY
When the senior consultant of otolaryngology was designated in June,
1918, there were 17 base hospitals actively functionating, with one otolaryngo-
logist on duty in each. There were already 50 camp hospitals established,
50 per cent of which were not functionating. Of those which w^ere active less
than one-third had an otolaryngologist assigned to them. The total roster of
otolaryngologists at that time was 32.
One-third of the base hospitals operating at the time were lacking in
otolaryngological instruments and equipment to care adequately for the
patients they were receiving. The senior consultant visited each hospital,
inspected the instruments and equipment, and assisted in compling a list for
rocjuisition from the medical supply depot. Plans for an examination and
treatment room for ambulatory patients were formed in those hospitals where
no provision had been made previously for them and suitable construction
was at once begun. Special wards were obtained for this department and
where possible specially trained nurses assigned to duty in these wards.
Of the camp hospitals operating only two had sufficient instruments and
equipment properly to care for otolaryngological cases.
In only one was an otolaryngologist on duty, with practically no instru-
ments or equipment with which to work. Otolaryngologists subsequently were
assigned to all camp hospitals in the order of their needs. Instruments and
equipment were obtained and examination and treatment rooms constructed.
None of the mobile hospitals established early had an ear, nose, and throat
surgeon connection with them. Officers were assigned to these hospitals as
needed and assistance was given to procure instruments and equipment suffi-
cient for the needs of the department.
In none of the field hospitals functionating was there an otolaryngologist
or any instruments or equipment for use in this department. Officers were
assigned as needed and instruments and equipment procured.
There were eight otolaryngologists on duty with various combat divisions.
Later the number was increased as requests were made, but at no time during
active military operations were there sufficient officers from this department
to meet the demands made upon it.
At hospital centers a set of buildings was assigned to this department so
that all the w^ork in the center could be accomplished at the one place. Special
wards and operating rooms were arranged and large examination and treat-
ment rooms for ambulatory patients fitted up, and a staff composed of officers
from the base hospital units of the center was formed. This obviated redupli-
*The statements of fact appearing herein are based on " Report of the activities of the ear, nose, and throat service
A. E. F.." made by Col. James T. McKernon, M. C, senior consultant, ear, nose, and throat surgery, A. E. F. On file,
Historical Division, S. O. O.—Ed.
374
ADMINISTRATION. AMERICAN P:XI'P:i)ITl()NAHY FORCES
cation of instruments and eqiiipmont and resulted in a better care for the
patients, besides allowing the excess officers in the department to be made
available for duty elsewhere.
At all the large hospital centers a consultant in otolaryngology was
appointed whose duty was to supervise generally the work in the center and
to act as consultant when called upon by the center otolaryngologist or the
individual units. This arrangement proved most satisfactory, resulting in a
better care for the patients as well as maintaining a more rigid discipline for
the staffs of the center.
The senior consultant visited all the hospitals, many times seeing cases
in consultation, operating when necessary, and consulted as to the needs of
the service with both the local otolaryngologist and the commanding officer
of the hospital. Many visits were made to evacuation, mobile, and field hos-
pitals in consultation during which advice was given as to the care and routing
of the otolaryngological cases; and later following up such cases as had been
routed to base hospitals in the rear, consulting as to the nature and amount
of reparative work to be done on them.
In December, 1918, there were 238 officers on active duty in this depart-
ment, and 12 others being held in reserve for future duty with the Third Army,
when needed.
OPHTHALMOLOGY '
The senior consultant in ophthalmology was appointed in June, 1918. As
the service developed, an assistant was added to the office, Neufchateau, and
in September, 1918, another.
Each base hospital unit arriving in France had one or more expert ophthal-
mologists. To visit, advise with, and supervise these officers was one of the
principal functions of the chief consultant. Some of the clinics were well
equipped (for example, that of Base Hospital No. 36 of the Vittel-Contrexeville
hospital center); others were not. Base Hospital No. 36 served as a special
ophthalmological hospital for the Vittel-Contrexeville center. Camp hospitals,
as a rule, sent all important cases to the nearest base hospital
Gradually local consultants were supplied to the principal hospital centers
and base areas.
One of the striking features of the subsection was the base optical unit,
which arrived in France May 4, 1918. This unit had a strength of 1 officer and
69 men. The equipment, stock, and machinery (amounting to nearly 19 tons
in weight) was delayed, but part of it reached Paris in July. Shortly after the
arrival of the unit, eight auxiliary units were organized and assigned to various
base hospitals; later, seven other units were made up and likewise assigned.
The shop was located first at Neuilly, but later it was removed to Port
St. Cloud. It began operating July 27, 1918, and was in full operation by
October 1. The equipment was sufficient for the production of 100 pairs of
glasses per day. From July 27 to December 1, 1918, the production was as
follows: 21,828 prescription jobs; 3,091 smoked spectacles; 1,620 repair jobs.
• The statements of fact appearing herein are based on " Report of the activities of the ophthalmological services,
A. E. F.," by Lieut. Col. Allen Greenwood, M. C, senior consultant, ophthalmology, A. E. F. On file, Historical Division,
S. G. O.—Ed.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 375
On account of the unusual amount of work to be done, a full day and night
force was in operation in the shop. A special attachment was devised to supply
the demand for prescription lenses in gas masks. The unit had men and machin-
ery sufficient to handle all work received, but could never get sufficient supplies
or material.
Artificial eyes were also supplied as needed; 1,000 were taken to France
with the unit and 700 were received later. Large stocks were kept at a few
j)laces and at the base ports.
The totally blind were given preliminary training at Paris, Savenav, and
Vichy, before being returned to the United States.
An important feature of ophthalmic surgery was the giant magnet. A
supply of magnets, shipped to France early in 1918, was lost for a long time.
When finally found, magnets were placed in two of the forward evacuation
liospitals and in base hospitals at Chaumont, Bazoilles, and Vittel. American
Red Cross Hospital No. 1, at Paris, was also supplied. As no more magnets
arrived, work was begun on the building of giant magnets at the Medical
Department repair shop in Paris, and five were turned out. Somewhat later
some medium-sized and small magnets arrived from the United States, and
with them it was possible to equip all hospitals necessary.
A trachoma survey was made of the labor organizations, A. E. F.; 12,461
laborers were examined and 261 cases found. Means were suggested for han-
dhng this problem.
Circulars of instruction were issued on such subjects as gassed eyes, injuries,
refraction, pterygia, strabismus, wounds of the eyelids and orbits, artificial eyes,
trachoma, and plastic work.
MEDICAL SERVICES '
The chief consultant, medical services, A. E. F., entered upon his duties
November 9, 1917. The fact that, at the time, the chief consultant was desig-
nated "director," has been explained above, and need not be gone into further
liore.
With the sudden and great expansion of the Army in 1917-18, the greater
part of tiie Regular Medical Corps was required for administrative work,
leaving the professional practice of medicine and surgery almost entirely to
temporary medical officers. Of this great body of new officers, generally
unknown to their commanders, lay the responsibility of the actual care of the
sick and wounded in the American Expeditionary Forces. On the proper
selection and supervision of this ever-increasing class of officers depended very
largely the cure and restoration to duty of the many thousands of sick and
wounded of the Army. The efficiency of the professional services depended
to a marked degree on this factor.
The chief consultant, medical services, understood that he had been
selected, in part at least, on account of his general acquintance with the character
and qualifications of the medical profession of the United States, and that
his duty was not only to supervise the practice of medicine in the American
' The statements of fact appearing herein are based on " Report of the activities of the office of the chief consultant ,
medical services, " made December, 191S, by Brig. Oen. W. S. Th-iyer, M. C., chief consultant, medical services, A. E. F.
»'n file. Historical Division, S. (5. O.— F.d.
376
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Expeditionary Forces, but also to furnish the chief surgeon, A. K. F., with
such information as to the special qualifications of various new medical officers
as might facilitate proper selection and assignments.
On March 12, 1918, a principal assistant to the chief consultant was
designated.
A study of medical conditions revealed considerable variations in ])r()los-
sional personnel and practices in the various base hospitals, tactical divisions,
and formations at the bases along the lines of communication. The need for
supervision was clearly seen; but with the multiplicity of organization, wide-
spread territory, and difficulties of transportation, this supervision could not
be exercised by one or two officers. Special consultant officers were necessary
for special localities, but few were available in France; internists who were
suitable could not be spared from their stations. Accordingly, officers were
sought in the United States. During April, May, and June, 1918, efforts
were made to obtain from America a number of clinicians of recognized ability,
who could be utilized as consultants, chiefs of service, or for special research.
The great and increasing need for officers especially qualified in internal
medicine led to a cabled request on June 10, 1918, for 50 such officers of the
grade of lieutenant or captain; and again, on September 26, for a request for
an additional 150.
In April, a consultant, general medicine, was assigned to the advance
section and zone of the army; consultants in tuberculosis and in cardiovascular
diseases were designated. In June, a consultant in gas poisoning was desig-
nated. In July, senior consultants. Air Service, and general medicine were
assigned. In the following month, consultants, general medicine, were assigned
to base sections Nos. 1, 2, and 115, and to the hospital centers at Bazoilles
and Vittel-Contrexeville.
The greater part of the medical officers requested in May did not arrive
in France until October, and despite the pressing need for consultants no more
designations could be made until their arrival. Beginning with October the
following assignments of medical consultants were made: To the hospitals at
Rimaucourt and Chaumont; Dijon, Beaune, and Allerey; Mesves; Vichy and
Clermont-Ferrand; Paris section; Mars; Orleans and Tours; Justice group,
Toul; and to base section No. 5; parts of the intermediate section; base
section No. 2.
At the end of October, a consultant for base section No. 3 was designated.
After the armistice was signed the consultant, gas poisoning, became consultant
to the camp hospitals in the advance section.
With the formation of army corps, consultants were assigned to each.
Likewise, when armies were organized consultants were assigned to each.
One of the earliest organizational procedures of the chief consultant,
medical services, w^as the institution of certain medical teams. The need for
the preparation of medical officers in the care of surgical shock and in the treat-
ment of men suffering from poisoning by suffocative gases was early apparent,
and, in view of the lack of such special training among the medical officers of
organizations at the front, special gas and shock teams were organized. The
officers of each shock team were habitually required to take the course in treat-
ORGANIZATIOX AND ADMINISTRATIOX OF CHIEF SURGEON'S OFFICE 377
inent of surgical shock given weekly at the central Medical Department labora-
tory, Dijon. With the onset of open warfare the shock teams, subsequently
called emergency medical teams, were in great demand for the treatment of
surgical shock.
The emergency medical teams did effective service; however, the employ-
ment of them at the front resulted in great hardship in base hospitals at times
because of the shortage of medical officers there, and inability to obtain replace-
ments during the absence of these teams.
TUBERCULOSIS ^'
The efforts of the senior consultant in tuberculosis were directed toward the
education of the medical personnel of the various hospitals, more particularly
base hospitals, of the American Expeditionary Forces, in the early recognition
of pulmonary tuberculosis, the investigation of the pervalence of tuberculosis
in the American Expeditionary Forces, and methods for its control.
Following the careful examination of the troops of the Army in the United
States and the exclusion of the manifest cases of pulmonary tuberculosis there,
the incidence of such cases in the American Expeditionary Forces was expected
to be low. Howev^er, despite this care in elimination, approximately 2,000
oases diagnosed pulmonary tuberculosis were transferred from the American
Expeditionary Forces to the United States prior to December 31, 1918. Of
these over 80 per cent had sputum positive for tubercle bacilli. For the same
period — that is, up to the end of 1918 — there were 250 deaths from pulmonary
tuberculosis among our troops in France. Unofficial reports from the French
Army, subsequently proving erroneous, had led to a fear in our Medical Depart-
ment, A. E. F., that there would be a greater development of tuberculosis
among the American Expeditionary Forces. The causes which underlay the
mistakes in the French Army also were found to obtain in the American Expedi-
tionary Forces; that is, delayed convalescence from pneumonia, bronchopneu-
monia, the bronchitides — especially those combined with nasal sinus conditions.
In January and February, 1918, it was noted in the Surgeon General's
Office that of the men being returned to the United States from France over 50
per cent failed to show positive evidence of the tuberculosis for which they had
been sent home. This situation was very easily and effectively remedied by the
senior consultant for tuberculosis as follows: (a) A change in nomenclature;
that is to say, only cases showing tubercle bacilli in the sputum were now to be
diagnosed frankly as pulmonary tuberculosis; all others were to be diagnosed
"tuberculosis, observative," (6) The establishment of three centers where
these cases could be more expertly studied, namely. Base Hospital No. 8,
Savenay; Base Hospital No. 20, Chatel Guyon; Base Hospital No. 3, Vauclaire.
(c) Visiting frequently the base hospitals to standardize the diagnosis of the
disease from the clinical, roentgenological, and laboratory viewpoints, (d)
Promulgating data, concerning these matters, to chiefs of medical services and
to medical officers who were registered as preferring tuberculosis work.
* The statements of fact appearing herein are based on "Report of the activities of the senior consultant for tuber-
culosis," made Dec. 18. 1918, by Lieut. Col. Gerald B. Webb. M. C, senior consultant for tuberculosis, A. E. F. On file,
Historical Division, S. (}. 0.~Ed.
378
ADMIXISTRATIOX, AMERICAN EXPEDITIOXAKY FORCES
As regards treatment, all patients suspected of having, or actually having,
tuberculosis and sent to any of the three hospitals mentioned above received
excellent care. Those with fever were kept at rest, the temperature and pulse
being carefully studied. Sputa were examined frequently, from 10 to 15 times
before a given case would be declared negative; when time permitted, concen-
tration methods were practiced in laboratories.
Patients found to be tuberculous were returned to the United States, their
phj^sical conditions permitting; others were given graded exercises, first in
hospital and later in a convalescent camp, and restored to duty.
PSYCHIATRY
- 1
Psychiatry was established as a professional division in the American
Expeditionary Forces in November, 1917, with a director. Subsequently, how-
ever, it was subordinated to the medical portion of the professional services, the
director then becoming senior consultant. On his nomination, a specially
qualified body of officers was assigned as division, army, hospital group, and
section psychiatrists. These officers, under the guidance of the senior consult-
ant, did valuable work in detecting early and treating wisely the psychoses
common to armies in the field.
A neurological hospital. Base Hospital No. 117, was established at La
Fauche, where patients with war neuroses were sent from army neurological
hospitals and all base hospitals in the American Expeditionary Forces. The
psychiatric department of Base Hospital No. 116, Bazoilles, was made to serve
as a collecting station for mental cases from the tactical divisions and from hos-
pitals in the advance section. Neuropsychiatric departments were established
in base hospitals at both the Mars and Allerey hospital centers, at the base
ports, and in Paris section.
The problems arising in the front areas in relation to the provisions for
the care and disposition of patients suffering from disorders of the mind and
nervous system can best be considered under two general heads: Conditions
which occurred during periods of relative military quiet, and those occurring
during active military operations.
Cases originating in front areas during times of relative quiet comprised
men who could be classified in groups exhibiting defective mental development,
constitutional psychopathic states, psychoneuroses— independent of combat
experiences— war neuroses, and, finally, psychoses. These cases were cared
for adequately in the divisional hospitals by the divisional neuropsychiatrists
in the following manner: All except those with war neuroses were kept under
observation sufficiently long to permit making proper diagnoses, w^hereupon
they were transferred to base hospitals especially provided to care for the
types of cases under consideration. Patients with war neuroses, which had
developed in quiet areas, and when the number of such patients was com-
paratively small, were successfully treated for the most part in the divisional
field hospitals; few required transfer to Base Hospital No. 117, at La Fauche,
' The statements of fact appearing herein are based on, (1) " Report of the activities of the section of neuropsychia-
r> , made by Col. Thomas W. Salmon, M. C, senior consultant, neuropsychiatry; (2) "History of advance neurological
formations, made by Lieut. Col. John H. W. Rhein, M. C, consultant in neuropsychiatry, First Armv On file His-
torical Division, S. G. 0.~Ed. ' ' '
ORGANIZATIOX AND ADMINISTRATIOX OF CHIEF SURGEOX'S OFFICE 379
which, as stated above, was the special hospital for such cases. Those that
were transferred to Base Hospital No. 117 were readily transported in motor
ambulances, since this hospital was situated sufficiently near to make this
possible.
Because war neuroses developed in much larger numbers during periods of
active military operations, their management at the front became much more
complicated. Our first relatively large experience with such cases occurred
(hn-ing the Aisne defensive. At this time, the plan proposed by the senior
consultant, neuropsychiatry, was to have the cases of war neuroses which
(Icvclopod during combat retained in divisional hospitals under the care of
divisional neuropsychiatrists for as long a period as possible (not to exceed
10 days or 2 weeks), especially such cases promising that degree of improvement
(luring the period in question as to make it seem possible they could be returned
to their organizations on a duty status. On the other hand, cases holding out
iio such promise were to be evacuated to Base Hospital No. 117, at La Fauche.
In so far as it was possible to do so, division surgeons were consulted with
by the consultants in neuropsychiatry who outlined the above plan for dealing
with cases of war neuroses incident to combat experiences.
Unfortunately, facilities for caring for such cases in divisional hospitals
at the time were inadequate; consequently, the results were on the whole
disappointing. Many cases were not retained at all in the divisional hospitals
hut were evacuated immediately through evacuation hospitals to base hospitals
with the general run of sick and wounded. This evacuation naturally tended
toward Paris where cases of war neuroses were received in base and camp
hospitals in relatively large numbers. Hence they had to be distributed to
hospitals farther rearward or to Base Hospital No. 117. Needless to say, the
capacity of Base Hospital No. 117 was taxed.
Though the plans went awry, the ultimate results in these cases were
satisfactory, for under the care of the neuropsychiatrists attached to the base
hospitals and after a short period of rest, patients, in a satisfactorily large
percentage, were discharged from hospital to duty.
Of the approximately 200,000 men engaged in the military operations
referred to above, the incidence of war neuroses was about 2 per cent of the
number engaged and 10 per cent of all casualties. Not only was this number
believed to be unnecessarily large but it was also thought by the senior con-
sultant in neuropsychiatry that at least 65 per cent of the men admitted to
divisional hospitals for war neuroses could have been returned to duty there-
from within a period of 10 days had suitable equipment for their local care been
on hand.
Based upon the above experiences, the senior consultant in neurospy-
cliiatry initiated the establishment of neurological hospitals in the front areas
a short distance to the rear of field hospitals. The purpose of these hospitals
was to care for men with war neuroses who in all probabilities would be fit for
(hity within two or three weeks.
For the St. Mihiel operation the plan was as follows: In addition to the
(Hvisional neuropsychiatrist, each division was supplied with an assistant
neuropsychiatrist. Thus one of these officers could sort cases coming through
380
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the divisional sorting station; the other could treat them in the field hospital.
For the cases of war neuroses, which appeared to require more time then the
specified time they should be kept in divisional hospitals, neurological hospi-
tals were established, one at Benoit Vaux and another at Toul. These units
functioned in an entirely satisfactory manner, thus retaining at the front,
after a few days' treatment, many men who otherwise would have i)opn
evacuated to the rear.
During the Meuse-Argonne operation, a third such neurological hos|)ital
was established at Neubicourt. Over 60 per cent admitted to the neurologi-
cal hospital at Benoit Vaux were returned to duty within a period averagint:
10 to 14 days; approximately 73 per cent of the patients admitted to the
neurological hospital at Neubicourt were returned to duty in an average of
10.4 days.
Neuropsychiatrists proved so necessary for expert examination of defec-
tives and of men about to be brought to trail by court-martial, as witnesses
during trial, and as experts in the examination of men with alleged self-inflicted
wounds, that they were retained throughout the war in the combat divisions.
So far as the combat divisions were concerned, this was true of only two other
specialties, urology and orthopedic surgery.
COMMUNICABLE DISEASES
Since the section dealing with the communicable diseases was in operation
only for three months prior to the end of 1918, many of the plans that were
contemplated could not be brought to completion and much of the work of
the section necessarily remained fragmentary and unfinished.
A large part of the time was devoted to the hospitalization and pro-
fessional care of the cases of communicable disease. A considerable number
of visits were made, either by special request or by order, to various parts
of the American Expeditionary Forces to consult upon diagnosis or the dis-
position of patients with epidemic diseases or upon individual patients suffering
with unusual infections.
Since the hospitalization of the communicable disease cases seemed of
mimediate and prime importance, visits were paid to many base hospitals
and to hospital centers to determine what conditions actually existed and
to consult with the commanding officers upon plans for the future hospital-
ization of these cases. During these visits it seemed obvious, when some
sort of segregation of these patients had not been made, that such a method
for their care would have to be adopted, and as a rule one of the following
methods of segregation was put into operation: (1) The establishment of
infectious disease hospitals; (2) the segregation of different classes of cases
in different hospitals or in different wards of a single hospital.
For hospital groups the former method seemed preferable for several
reasons: It would minimize the danger of spreading infection through the
hospital group; it would allow of the proper admission through observation
wards^f the undiagnosed infections and therefore reduce cross infections;
•-The statements of fact appearing herein are based on "Report of the activities of thesection of communicable dil
S Son's, a'a-'^."^"' "'^^""^"^ '° diseaTer o Tflle hIs-
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 381
it would allow of n concentration of the personnel especially qualified to care
for these particular diseases and therefore w^ould assure better professional
treatment; hospital epidemics, such as occurred in the late fall of 1918 in
H minor degree with diphtheria, could thereby be immediately recognized;
it would simplify administration and save hospital space and beds.
At one hospital center the first plan mentioned above was immediately
put into operation. One hospital of the center was selected to care for all
the communicable diseases, including influenza and pneumonia. According
to the center commander, this method as he developed it proved to be the most
efHcient one for the center from the administrative standpoint; and from visits
made by the senior consultant, infectious diseases, it was evident to him that
the patients were most excellently cared for from a professional point of view.
Froui practical application, therefore, the plan proved not only feasible but
also highly successful, even though it was not possible to develop it in an ideal
manner. In a few other centers similar organizations, though not quite so
complete, were instituted.
In several other centers w^here the second plan w-as put into effect it
proved not quite as satisfactory from a professional standpoint. As the plan
was worked out practically it was as follows: Cases of pneumonia and influ-
enza were sent to one hospital, mumps and measles to another, meningitis,
typhoid fever, and dysentery to a third, and so on. The objections that
arose to this plan in the hospitals where it was adopted were that the estab-
lishment of observation wards was not practicable and that occasionally
cross infections occurred, probably from admitting to a ward suspicious cases
of measles or scarlet fever. It also resulted in a rather uneven grade of pro-
fessional care of the infectious diseases, for though some wards were most
admirably cared for, others were not so well conducted. After a trial of this
method in several centers, it was the consensus of opinion that the first method
would be far preferable.
During the epidemic of influenza and pneumonia in the fall of 1918,
considerable time was spent both at the front and in base hospitals in con-
sultation with army and corps surgeons, and with commanding officers upon
the proper hospitalization and care of these cases. Hospitals were established
at Revigny and at Brizeaux in the First Army area for the exclusive care
of these patients, while the many patients that could not be accomodated
in these hospitals were adequately treated in other evacuation hospitals.
When it was possible to hold all these cases in hospital and not evacuate them
the disease ceased to overw^helm the forward hospital centers.
At this time a circular w^as prepared on the hospitalization and treatment
of influenza and pneumonia which was published as Circular No. 51, chief
surgeon's office, A. E. F.
During visits to hospitals the senior consultant gave advice regarding
(lie handling of infectious diseases and the proper forms of cubicling and masking
and when these methods were not in use they were insisted upon, or w^here
they were improperly devised the methods w^re corrected. During these
visits professional consultations were frequently held with chiefs of medical
services upon many patients.
382
ADMINLSTKATIOX, AMERIC AN EXPHDH lOXAHY FORCES
An attempt to furnish personnel for tliese infectious-disease hospitals
and wards was impossible. Plans had previously been made to do so, and
a group of clinicians had been trained in the United States for this purpose,
but the exigencies of the situation rendered it impossible to obtain the services
of these officers.
GAS POISONING "
The activities of the gas poisoning section of general medicine may be
classified as follows: (a) Instruction; (6) hospitalization and treatment; (c)
actual supervision of the care of the gassed.
Instruction
Instruction was carried out either by means of circulars of information or by
lectures. Circular No. 34, chief surgeon's office, which had to do with the treat-
ment of gassed patients, was prepared in this section. Other circulars in regard
to the treatment of gas poisoning were prepared from time to time in this section.
Either the consultant in general medicine in charge of gas poisoning, or other
representatives of his office, gave lectures on the subject of the care and hospital-
ization of the gassed. These lectures were given to medical officers either in
tactical divisions or at the Army sanitary school, Langres.
HosPITALIZ.\TION AND TREATMENT
The question of the hospitalization and treatment of gassed patients,
especially in division and army areas, was given much study. An endeavor was
made, by advice and conference with those in authority, to emphasize the
important but simple principles involved, and to achieve their acceptance
throughout the American Expeditionary Forces. After comparatively little
study it became obvious that the question of the care of the gassed was largely
an administrative one. From the clinical point of view the question was simple.
The question of the hospitafization of the gassed was a more compficated one.
Like the wounded soldier, the gassed soldier needed early examination and treat-
ment and it soon became obvious that each tactical division in active warfare
must have a mobile gas hospital as a part of its sanitary train. This need was
met by utifizing one field hospital per division which was supplied with the
necessary extra equipment to care for the gassed. Much correspondence and
conference with those in authority finally led to a simple and standard equipment
which could be used in divisional gas hospitals. The matter of the secondary
hospitalization of gassed cases was complicated by the promulgation of the
principle that gassed cases were not to be cared for in evacuation hospitals,
although it was recognized that the gassed needed special care in a hospital at
the level of the evacuation hospital, quite to the same extent as did the wounded.
The application of this principle led to the establishment of special hospitals
for the gassed. During the actions which preceded the St. Mihiel and Meuse-
Argonne operations there were no special hospitals for the care of the gassed.
Gassed cases were passed through the evacuation hospitals rapidly and often
Dec 17 T?18 tTjZZV\ h^'T,^'"! ""'^IV' ^'''^ °° activities of section of gas poLsoning. " made
.° the H 1 n ' n i° ^■'^^^'^^ '"«<l't-in<> for gas poisoning This report is on fiie
in tne Historical Division, Surgeon General's Office, Washington, D. C.~Ed.
ORGANIZATION AND ADMINISTKATIOX OF CHIEF SURGEON'S OFFICE 383
received their first hospital treatment at the bases, a system which was unsatis-
factory at best. In the St. Mihiel operation one gas hospital was estabhshed
at the Justice hospital center, Toul, and one in the French gas hospital at
Rambluzin. The personnel of these hospitals consisted of casuals or of officers
and men loaned from base or evacuation hospitals, ambulance companies, etc.
In each hospital one officer thoroughly conversant with the principles of the care
of the gassed was stationed. The consultant in general medicine for gas
poisoning had general supervision of the clinical work in both hospitals.
During the Meuse-Argonne operation, five hospitals were designated by the
chief surgeon. First Army, to receive gassed cases. These were: Rambluzin,
capacity, 250 beds; La Morlette, capacity, 550 beds; Julvecourt, capacity,
400 beds; Rarecourt, capacity, 250 beds; Villers Daucourt, capacity, 200
beds. These hospitals were enlarged by the addition of tentage and became the
most important gas hospitals in the area.
The officers and personnel of these hospitals, as was the case in the St.
Mihiel operation, were largely casual officers and men from ambulance compa-
nies, evacuation hospitals, etc.
After the first rush was over the five gas hospitals mentioned above carried
on the care and treatment of the gassed in an eminently satisfactory manner.
It was unfortunate that, owing to a shortage of nurses, only two nurses were
available for use in these gas hospitals during the period from September 26 to
November 11.
These hospitals received upward of 20,000 patients from September 26,
1918, to November 11, 1918. The cases were about equally divided between
those who had been actually exposed to gas and those who, though they entered
the hospital with a diagnosis of "gassed," had in all probability never been
exposed to toxic warfare gases. The large number of cases that could not be
classified as "gassed" were due principally to exhaustion, neuroses, light respira-
tory infections, or other unimportant conditions. The great proportion of these
men could have been returned to duty without having left the army area had
the proper machinery for this existed. In order that these light cases be
returned to duty, rest camps must exist. Only one of the three corps in the
First Army established a rest camp where men presumably fit for duty could be
returned from the gas hospital and be further observed and tested before
returning to the replacement battalion and the line. One corps had a replace-
ment battalion and no rest camp, while the third had neither replacement bat-
talion nor rest camp. With this imperfect machinery it was natural that large
numbers of men who could have been returned to duty perforce were evacuated to
the base.
The eft'ect of the treatment received in the Army gas hospitals during this
period on the condition of the men sent to the bases was apparent. There were
found in the base fewer serious eye conditions than ever before, burns of the
skin were in better condition, and cases of lung involvement were received in
better general condition. Each case of definite pulmonary irritation was con-
sidered as a possible pneumonia and was held at the gas hospital for observation
and treatment until it was deemed safe for the case to be evacuated.
13901—27 25
384
AD:MINISTRATI0X, AMERICAX EXPEDITIOXAHV FOHt'ES
The lessons learned during this period lead to the following conchisions:
(a) At least 1,000 beds for gas cases should be i)rovided for each corps
during active mobile warfare such as that of September and ()ctol)er, 1<»1S.
(6) To facilitate evacuation and to economize i)ei-sonnel, not more tlian
one hospital to a corps area is considered advisable. Experience has shown
that the principle of having gassed cases cared for in special isolated hospitals
is not a wise one. These hospitals were usually far from a railhead and off the
main traffic routes. This necessitated much extra ambulance carriage, and
increased the length of time that patients were in the ambulances. As no pro-
vision for gas hospitals was found in the Tables of Organization, these scattered
units had to be operated as annexes to evacuation hospitals. This arrangement
complicated the administration of these hospitals, and required duplication of
administrative personnel. Experience showed that the recommendation to the
effect that gassed cases be cared for in evacuation hospitals with augmented
equipment and personnel, made in the letter of May 7, 1918, from the senior
consultant in general medicine to the chief consultant, medical services, was
sound, and should be accepted as a guiding principle in the matter.
(c) The personnel of gas hospitals should be proportionately the same as
that of an evacuation hospital. The staff of medical officers need not be large;
no surgeons are necessary. A chief of medical service expert in the problems
of the diagnosis and treatment of the gassed and in the sorting of those pie-
sumably fit for duty is essential. The rest of the officers may be young men of
ordinary capacity. Nurses are absolutely necessary for the proper care of the
gassed.
(d) In order that men may be returned to duty, rest camps, where the men
may be observed for a time and tested by simple exercises to determine their
fitness for duty, are necessary. Whether the rest camp shall be under the im-
mediate management of the corps or of the army is open to discussion. It is
noteworthy, however, that while divisions change rapidly and frequently from
one corps to another, they do not as frequently or as rapidly leave an army
area. For this reason it would appear that the army would be able to return
the men to their proper organizations better than could the corps.
Supervision
In July, 1918, after conference between the medical director of the Chem-
ical Warfare Service, A. E. F., the chief consultant, medical services, A. E. F.,
and the consultant in general medicine for gas poisoning, it was recommended
that each division have one officer whose special duty it would be to take charge
of the organization of the treatment, care, and evacuation of the gassed within
the divisional areas. The officer was to be known as the divisional medical
gas officer. This recommendation was accepted and authorized by General
Orders, No. 144, G. H. Q., A. E. F., August 29, 1918. Owing to the late date
at which the divisional medical gas officers were authorized, many divisions
never received the full benefit of the services of such an officer. In those
divisions where an officer functioned as medical gas officer, the care of the
gassed immeasurably improved.
ORCIANIZATIOX AND AD:MIXISTRATI0X OF CHIEF SURGEON'S OFFICE 385
PERSONNEL "
(July 28, 1917, to July 15, 1919)
Col. William L. Keller, M. C, director of professional services.
SURGICAL SERVICES
Brig. Gen. John M. T. Finney, M. C, chief consultant.
Col. George W. Crile, M. C, senior consultant in surgical research.
Col. Arthur C. Christie, M. C, senior consultant in Roentgenology.
Col. Harvey Cushing, M. C, senior consultant in neurological surgery.
Col. Joel E. Goldthwait, M. C, senior consultant in orthopedic surgery.
Col. James F. McKernon, M. C, senior consultant in ear, nose, and
throat surgery.
Col. Charles H. Feck, M. C, senior consultant in general surgery.
Col. Hugh H. Young, M. C, senior consultant in venereal and skin dis-
eases and genitourinary surgery.
Lieut. Col. Vilray P. Blair, M. C, senior consultant in maxillofacial surgery.
Lieut. Col. James T. Case, M. C, senior consultant in Roentgenology.
Lieut. Col. Allen Greenwood, M. C, senior consultant in ophthalmology.
MEDICAL SERVICES
Brig. Gen. William S. Thayer, M. C, chief consultant.
Col. Thomas R. Boggs, M. C, senior consultant in general medicine.
Col. Warfield T. Longcope, M. C, senior consultant in infectious diseases.
Col. Thomas W. Salmon, M. C, senior consultant in neuropsychiatry.
Lieut. Col. Richard Dexter, M. C, senior consultant in general medicine
for poisoning by deleterious gases.
Lieut. Col. Alfred E. Cohn, M. C, senior consultant in cardiovascular
diseases.
Lieut. Col. Gerald B. Webb, M. C, senior consultant in tuberculosis.
Maj. Franklin C. McLean, M. C, senior consultant in general medicine.
REFERENCES
(1) Circular letter from the Surgeon General to commanding officers of hospitals, November
11, 1917. Subject: Speciahsts. Copy on file. Historical Division, S. G. O.
(2) Cable No. 427-S from General Pershing to The Adjutant General, Washington, Decem-
ber 30, 1917. On file, A. G. O., World War Division, chief surgeon's files, .321.62.
(3) Letter from the Surgeon General to the chief surgeon, A. E. F., March 9, 1918. Sub-
ject: Professional services. On file, A. G. O., World War Division, chief surgeon's
files, 321.62.
(4) Letter from the Surgeon General to the chief surgeon, A. E. F., March 16, 1918. Sub-
ject: Organization of general and base hospitals. On file, A. G. O., World War
Division, chief surgeon's files, 321.62.
(5) Letter from the adjutant general, A. E. F., to Maj. J. M. T. Finney, M. C, December
21, 1917. Subject: General instructions. Copy on file, A. G. O., World War Divi-
sion, chief surgeon's files, 201 (Finney, J. M. T.).
" In this list have been included the names of those who at one time or another were assigned to the division dur-
ing the period, July 28, 1917, to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names
have been arranged alphabetically, by grades, irrespective of chronological seijuence of service.— £d.
386 ADMINISTHATIOX, AIVFERICAX EXPEDITIONARY FORCES
(6) Report of the activities of the professional services, A. E. F., between April, 1918, and
December, 1918, made December 31, 1918, by Col. W. L. Keller, M. C, director of
professional services. On file. Historical Division, S. G. O.
(7) Bevans, M. L., Col., M. C: The function of medical and surgical consulting staffs
determined by the late war. The Military Surgeon, xlvi, No. 5, Washington, 1920.
(8) Circular No. 2, H. A. E. F., office of the chief surgeon, November 9, 1917.
(9) Report on the activities of the chief surgeon's office, A. E. F., to May 1, 1919, made 1)\
the chief surgeon, A. E. F., to the Surgeon General. Copy on file, Historical Divi-
sion, S. G. O.
(10) Final report of Gen. John J. Pershing, September 1, 1919.
(11) Based on reports of the activities of hospital centers, A. E. F. On file. Historical Divi-
sion, S. G. O.
(12) Report of the activities of G-4-B, G. H. Q., A. E. F., to December 31, 1918, by Col.
S. H. Wadhams, M. C. Copy on file. Historical Division, S. G. O.
(13) Letter from the chief surgeon, A. E. F., to Lieut. Col. W. L. Keller, M. C, April 18,
1918. Subject: Detail as director of professio'nal division, A. E. F. Copy on file,
A. G. O., World War Division, chief surgeon's files, 321.60.
(14) Letter from the chief surgeon, A. E. F., to the director of professional services, A. E. F.,
August 7, 1918. Subject: Consultants in the different specialties for hospital cen-
ters. On file, A. G. O., World War Division, chief surgeon's files, 211.52.
(15) Letter from the chief surgeon, A. E. F., to Capt. De Forest F. Willard, M. R. C, August
23, 1918. Subject: General instructions. Copy on file, A. G. O., World War Divi-
sion, chief surgeon's files, 321.62.
(16) Memorandum from the chief surgeon, A. E. F., to the director of professional services,
A. E. F., August 13, 1918. Subject: Designation of hospital centers for specialist.s.
Copy on file, A. G. O., World War Division, chief surgeon's files, 321.62.
(17) Circular Letter No. 7-a, chief surgeon's office, A. E. F., August 27, 1918.
(18) Letter from the chiefs of medical and surgical services, A. E. F., to the chief surgeon,
A. E. F., September 2, 1918. Subject: Personnel of professional services. On file,
A. G. O., World War Dwision, chief surgeon's files, 321.62.
(19) Letter from the chief surgeon, A. E. F., to the director of professional services, A. E. F..
September 2, 1918. Subject: Designation of professional consultants and heart
specialists at hospital centers. On file, A. G. O., World War Division, chief surgeon'>
files, 321.62.
(20) Letter from the chief surgeon, A. E. F., to all division surgeons, September 8, 1918.
Subject: Psychiatrists, urologists, and ophthalmologists in tactical divisions. On
file, A. G. O., World War Division, chief surgeon's files, 321.62.
(21) Letter from the chief surgeon. First Army Corps, to the chief surgeon, A. E. F., Novem-
ber 4, 1918. Subject: Corps consultants. On file, A. G. O., World War Division,
chief surgeon's files, 211.52.
(22) First indorsement from the chief surgeon. First Army, to the chief surgeon, A. E. F.,
November 5, 1918. On file, A. G. O., World War Division, chief surgeon's files.
211.52.
(23) Third indorsement from the chief consultant, surgical services, A. E. F., to the chief
surgeon, A. E. F., November 30, 1918. On file, A. G. O., World War Divi.sioii,
chief surgeon's files, 211.52.
(24) Memorandum from the chief surgeon, A. E. F., to the chief of staff, S. O. S., January -l
1919. Copy on file, Historical Division, S. G. O.
CHAPTER XIX
THE FINANCE AND SUPPLY DIVISION
MEDICAL SUPPLIES
In view of the fact that, in conformity with existing Field Service Regula-
tions, which prescribed that the chief surgeon of a field army concern himself
only with the broad principles underlying Medical Department administration
without maintaining an office of record, the chief surgeon, A. E. F., delegated
to the surgeon, line of communications, the immediate charge of medical sup-
phes of the American Expeditionary Forces, and of the further fact that, in the
reorganization of the American Expeditionary Forces, in accordance with Gen-
eral Orders, No. 31, G. H. Q., A. E. F., February 16, 1918, the chief surgeon,
A. E. F., came to occupy the dual office of chief surgeon, A. E. F. and Serv-
ices of Supply, it is in the interests of clarity to relate in so far as supplies are
concerned, first the office organization of the chief surgeon, A. E. F., then that
of the surgeon, line of communications. Following this, consideration will be
given to the border questions concerning medical supplies; however, in so doing
no effort will be made to differentiate, as controlling influences, the two offices
lef erred to.
Two experienced medical supply officers, having arrived in the American
Expeditionary Forces on July 18, 1917, the senior of these was made the surgeon,
line of communications; ' the other, the officer in charge of the medical supply
depot which had been established at Cosne.^ The surgeon, line of communi-
cations, had brought with him from the United States a small but especially
ciiosen detachment of Medical Department enlisted men, a part of which he
kept with him for his own purposes, the remainder being assigned to the medi-
cal depot at Cosne.^
There now was necessity, in the office of the surgeon, line of communica-
tions, for not only divisions paralleling those of the office of the chief sur-
geon, A. E. F., but for additional ones as well. These were the divisions of
supply and of transportation, and they were organized accordingly.^
It is necessary here to explain that, at the time in question, the officers of
both the chief surgeon, A. E. F., and of the surgeon, line of communications,
were not only in Paris but also they were in the same building there; conse-
(|uently, though they were separate, in effect the separation was to a lesser
extent than one would suppose. It was definitely understood, however, that
the surgeon, line of communications, in his capacity as such, was directly respon-
sible for all questions pertaining to supply, with the exception of purchases
al)road, whicli will be referred to below. This brought under his control the
inodical supply depots, and by this his responsibility was made to include dis-
tribution as well as procurement.
Initially, the amounts and kinds of medical supplies were prescribed in cer-
tain tables which appeared in the Manual for the Medical Department. All
• 387
388
ADMINISTHATIOX, A^fEKICAX KXI'EDITIOXAH V FOHCKf-
Medical DopaitnuMit units of the American Expeditionary Forces were field
units, consequently, medical supplies were initially provided for them -'and in
theory were taken by them to France. In this connection, however, two factors
influencing^ the medical supply question of the American ^Expeditionary Forces
must be taken into consideration. It was kntnvn from the first that, because of
the wide separation of our field of operations from the United States, a more pro-
longed and a higher quality of hospital treatment of our sick and wounded in
France would be necessitated, thus creating the necessity for more and a wider
variety of medical supplies than had been contemplated. Furthermore, in view
of the fact that there was a shortage in shipping facilities, there was every
necessity for obtaining abroad as many articles for our purposes as would, by
so doing, obviate the necessity for having them sent from the United States,
thus releasing so much tonnage space for other and more urgent purposes.^
The supply situation of course pertained to all supply branches of the Ani(>r-
ican Expeditionary Forces, and to obviate their entering the European markets
as purchasers without regulation and coordination, thereby being thrown into
competition not only with themselves but with buyers from the Allied armies
and the civil population as well, General Pershing, in August, 1917, created a
general purchasing board for the American Expeditionary Forces.^ Since each
supply department of the American Expeditionary Forces was to be represented
upon this board, the chief surgeon, A. E. F., appointed a medical officer, known
as medical purchasing officer, to represent him on the general purchasing board.'
In view of the fact that the general purchasing board functioned under general
headquarters, A. E. F., the medical purchasing officer consequently was answer-
able to the chief surgeon, A. E. F., in the performance of his duties, rather than
to the surgeon, line of communications, in whom, it may be recalled, was placed
the responsibility for procurement as well as the storage and distribution of
medical supplies. As it eventuated, however, it was not unusual for the medical
purchasing officer to adopt the less time-consuming method of having the sur-
geon, line of communications, approve his action in so far as purchases were con-
cerned.- This practice, begun after the removal of the office of the chief surgeon,
A. E. F., to Chaumont, and while the office of the surgeon, line of communica-
tions, was still in Paris, continued thereafter without objections being made to it.
In November, 1917, the chief surgeon, A. E. F., established in his office
at Chaumont a division of supplies.^ It was not his purpose to duplicate the
activities of the division of supplies in the office of the surgeon, line of commu-
nications, and for that reason the office force of the division of supplies at
Chaumont never assumed similar proportions. However, since matters per-
taining to medical supplies were constantly being presented to the chief surgeon,
necessitating detailed study before being acted on, and other matters of equal
importance were occupying the complete attention of all the existing divisions
of his office, the necessity for a supply officer could no longer be disregarded.
There was now, that is, about December 1, 1917, a supply division in the
chief surgeon's office, A. E. F., whose function was acting upon questions of
equipment, supply and transportation, and the division of supply in the offic(
of the surgeon, line of communications, whose function w^as similar, with thf
exception that it did not act upon matters of transportation.
OHGAXIZATIOX AND ADMIXI8TRATIOX OF CHIEF SURGEOX'S OFFICE 389
In the division of supplies, cliief surgeon's office, A. E. F., routine matters
such as approval of the many requisitions for medical supplies that were
received from tactical units in the advance section, were looked after. In
addition, however, early efforts were made to establish a policy of supplv.
This necessitated a number of studies, chief among which were those with ref-
erence to the general organization project and the priority shipment schedule.
It is not surprising that, with the existence of the two suppl^^ divisions
misunderstandings and seeming duplication of effort should arise. The fol-
lowing letter from the surgeon, line of communications, explains his conception
of the existing situation:
Headquarters, Line of Communications,
Office of the Chief Surgeon,
France, February 14, 1918.
From: The chief surgeon, L. of C.
To: The chief surgeon, G. H. Q., A. E. F.
Subject: Centralization of supply control.
1. Upon several previous occasions I have transferred to you communications illus-
trating the difficulties and delays inherent in our present system of supply with more or
less divided control. I feel it incumbent upon me now to make representation to you con-
cerning the general situation, to submit my recommendations for your consideration and
to request your decision. I do this because I am firmly convinced that the efficient and
smooth working of the supply system demands unified control of all issues, and will more
and more require it as the demands increase.
2. While the individual instances are not important in themselves, an accumulation
of them works confusion in the minds of the officers affected and thus lessens efficiency. A
recent instance is this: I received and acted upon a request from the gas officer for purchase
for his lal)oratory. I am informed by Major Card that other copies of the identical com-
munication were referred to you and acted upon — your action differing slightly from mine.
Purchases. — I have upon a number of occasions made purchases in France or England
for stock, although this is, under the provision of general orders, placed directly under you.
This matter should certainly be centralized, as I have previously written you, and I am
convinced that it should be placed in this office.
More and more the purchasing officer has referred direct to this office questions of
purchase, although he is immediately under you. This has probably resulted from the
proximity of the offices in Paris. But more and more, too, you have been sending commu-
nications to Major Card through my office, not only for my information but for action.
This I believe to l)e a tacit recognition of the advantage of the purchasing office being part
of mine.
Red Cross. — The present situation is confusing I am sure, not only for me but for the
Red Cross as well. A typical instance is the correspondence on mobile laundries referred
to me under date of February the 13th.
I am informed that requisitions approved by division surgeons are being sent directly
to the Red Cross. Inasmuch as these divisions are also making requisition upon the supply
depots under my jurisdiction, there is no way of preventing duplication. This duplication
I have attempted to prevent on the line of communications by directing all requisitions to
tlie Red Cross to be sent through my office. Upon receipt they are referred to the supply
depot for issue if the stock is available. The Red Cross is not called upon unless our depots
can not supply the material.
Divisions. — .\11 requisitions for whatever material should, in my mind, be referred to
the depot, and if the material can not be supplied at that point should be referred to my
office for suital)le action— purchase or reference to the Red Cross, as seems best.
3. While under these suggestions I seem to be taking over a good many of the functions
heretofore exercised by you, it is only because I believe that I am thereby relieving you of
the details.
390
ADMINISTRATION, AMERICAN KXP?:DITI0N ARY FORCES
4. The needs of the Army as a whole or of any division thereof wouUl be iiidicated to
me, and it would become my duty to supply those needs getting the material from whatever
source was available.
F. A. WiNTEK,
Colonel, Medical Corps, United States Army.
[First indorsement]
G. H. Q., A. E. F., C. S. O., France, February 20, 1918.
To Col. F. A. Wi.NTER, M. C, Chief Surgeon's Office,
U. S. P. 0. No. 717, A. E. F., France.
1. It is assumed that the questions raised above will be automatically settled when
the supply division, C. S. O., S. O. R., has been reorganized according to plans now con-
templated and becomes operative thereunder.
By direction of the chief surgeon:
A. P. Clark, Major, Medical Corps.
As is indicated in the indorsement to letter above quoted, at this time
plans had been consummated for the removal of the office of the chief surgeon,
A. E. F., to headquarters, Services of Supply, there to be combined with the
office of the surgeon, line of communications. Subsequently to this combina-
tion, effected on March 21, 1918, there was but one division of supplies for the
Medical Department;^ however, in view of the interest of the Medical Depart-
ment in getting its supplies shipped from the United States to France, the
chief surgeon, A. E. F., upon the removal of his office to headquarters, Services
of Supply, left a medical officer at Chaumont to represent him in the first
section of the general staff, general headquarters, A. E. F., since all questions
relating to ocean tonnage were handled in that section.^
PURCHASES IN EUROPE
As previously stated, the policy of buying everything possible in Europe
that would effect a saving in ocean tonnage was established early in the Ameri-
can Expeditionary Forces. But in so far as medical supplies were concerned
it soon proved that European markets were practically depleted and thus
would be unreliable as a possible source of supply.**
Upon the organization of. the general purchasing board, and the assignment
thereto of a medical purchasing officer, a copy of the Medical Department
supply table, as it appeared in the Manual for the Medical Department, was
furnished the board, with the view of having the possible European sources
of supply canvassed to secure whatever articles were available.^ It soon
proved that none of the desirable articles could be obtained in this manner
without a replacement of raw material; consequently, though arrangements
were made later, through the general purchasing board, to procure such raw
material, much of the work of the medical purchasing officer during the fall
of 1917 was confined principafiy to the making of small purchases in Paris to
meet the pressing needs of the dift'erent professional services of the Medical
Department, as well as those of medical officers, and to the procurement of
necessities, in small amounts and from time to time, pending the arrival from
the United States of similar articles or material.^
After arrangements had been made for the procurement of raw materials,
large purchases of such articles as bed frames, mattresses, pillows, sheets,
crockery, and tableware were made in England and in France.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 391
111 addition to purchases made by the medical purchasing officer, pur-
chases were made locally by certain officers of the Medical Department,
authority therefor being given from time to time by the chief surgeon.^ Thus
on December 15, 1917, the surgeon, line of communications, authorized com-
manding officers of base hospitals to expend Medical Department funds for
articles properly chargeable to the funds appropriated to that department.^
Such expenditures were not to exceed $100 per month. On January 28, 1918,
division surgeons were empowered by general headquarters, A. E. F., to
authorize medical officers under them to make expenditures, chargeable to
Medical Department funds, in amounts not to exceed $100.^ On the 14th of
the following month, section surgeons were empowered to authorize medical
officers in their respective sections to expend not to exceed $250. As hospital
centers were established, each hospital center commander was given a like
authority.^
This delegation of authority to expend funds w^as done with, the view of
giving local Medical Department administrative officers more freedom than
had formerly obtained, in so far as the purchase of articles in small amounts
was concerned. Much inconvenience had obtained because of the uncertainty
of the mail service, requests for articles frequently being delayed long beyond
the arising of the urgent need for them, thus forcing the local commander to
make emergency purchases, which under Army Regulations necessitated a
foi'inal report in each instance.^ The delegated authority to make local pur-
chases, referred to above, obviated the necessity for such formal reports.
In making foreign purchase of technical material for the Medical Depart-
ment, A. E. F., it proved necessary to delegate much of this to representatives
of the services concerned, such as X ray and laboratory.^
STORAGE SPACE
All departments were early called upon to make estimates of the storage
space that would be required for supplies needed for different numbers of men,
and it is interesting to note the relation shown by these estimates to the actual
figures later established.
In September, 1917, the surgeon, line of communications, estimated that
foi- 2,000,000 men in France there w'ould be needed 1,200,000 square feet, of
which 805,000 was to be at the base ports. At the same time he estimated that
tor 300,000 there would be required a total of 335,000 square feet.' Shortly
afterwards the follow^ing estimates were submitted: '
Square feet
300,000 men, 30 days, at Gievres 175, 000
1,000,000 men, 30 days, at Gievres 600, 000
7.5,000 men, 15 days, at Is-sur-Tille 20, 000
Additional (uncovered) 5, 000
1,000,000 men, 15 days, at Is-sur-Tille 100, 000
Additional (uncovered) 10,000
On November 17, 1917, a revised estimate was submitted in tables prepared
l)y the chief engineer, line of communications, for 2,000,000 men in all France of a
total of 2,880,000 square feet roofed, with an additional 220,000 unroofed,
(hstributed as follows: '
Base ports, 1,440,000 square feet, roofed, 80,000 square feet, unroofed.
Intermediate section, 1,200,000 square feet, roofed, 80,000 square feet roofed.
Advance area, 240,000 square feet, roofed, 60,000 square feet, unroofed.
392
ADMIXISTHATIOX, A.MKltK AX EXPEDITIOX'AH V FORCES
At the time of the signing; of the armistice, with nearly 2,000,000 men in
France, the Medical Department had the following storage space allotted: -
Location
Designation
Cosne-sur-Loire Intermediate medical supply depot
No. 3.
Gievres _ ' Intermediate medical supply denot
No. 2.
Is-sur-Tille _ Advance medical supply depot No. 1..
Liverpool, England ! Medical supply depot
Cristo, Italy __do
Montierchaume.- Field iiiedical sui)ply salvage depot. .
Treves, Germany Advance medical supply depot No. 2.
Montoir.. _ _ Base storage station
Nantes do
St. Nazaire.- Medical supply depot.
St. Sulpice Base storage station..
Bordeau.x Medical supply depot
Brest- ...do
Marseille Base storage station...
Le Mans Medical supply depot
Date
established
July 15, 1917
Oct. 10, 1917
Nov. 18, 1917
Aug. 7, 1918
July 29, 1918
Dec. 13, 1918
Dec. 27, 1918
May 1, 1918
Oct. 1,
July 1,
July 6,
May 6,
Dec. 21, 1918
July 8, 1918
July 20, 1918
1918
1918
1918
1918
Masl-
muin
storage
space
(square
fwt)
100,000
391,436
9.';, 862
24, m
2,700
102, .WO
100,000
186,000
32,000
10,000
27S, 000
2.S, m
2, 7011
76,000
10,000
WAREHOUSING
The fact that storage space was necessarily always assigned just as pressing
need therefor arose prevented the warehousing of supplies in the manner hest
adapted to issues, and necessitated the constant shifting of supplies from ware-
house to warehouse as supplies were received and space allotted.^
CENTRAL STORAGE FOR SORTING
As stated above, basic medical supplies were to accompany units going
overseas. Such a shipment of supplies was sent at the time the earliest expedi-
tionary forces went to France.^ Anticipating the arrival of these medical
suppHes in France and appreciating the necessity for securing in advance
suitable storage space for them, the chief surgeon laid his plans accordingly.
At the time it was understood that, roughly, our lines of communications
would extend from the west coast of France (Bordeaux — St. Nazaire— Brest)
through Tours, Nevers, Dijon, and Neufchateau to the front.* Using these
lines as a guide for the subsequent distribution of our medical supply units,
and the further fact that the Gondrecourt area had been selected for billeting
and training the 1st Division,"^ Nevers was selected as a choice situation for
the establishment of our first medical supply depot. Assurances were given
the Medical Department that Nevers would be assigned to it; however, it
proved later that Nevers was more suitable to other purposes than those ol
the Medical Department, in consequence of which another site for the interior
location of a medical supply depot had to be selected. This secondarily
selected site was Cosne," and the recital of this in itself would have little if
any present pertinence were it not for the fact that, whereas Nevers was on
the main line from the base ports to the front, Cosne was on a secondary rail-
way, and about 20 kilometers northwest of Nevers.
It is proper here to explain that the selection of a site for a medical supply
depot so far inland as Cosne was based upon the fact that, because of the
submarine warfare, it never could be foretold to which of the base ports convoys
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 393
of supplies in hulk from the United States would eome. With such supplies
as medical supplies, there are many items of which the amount used or the
supply on hand is so small that original packages must first be sent to a central
depot and there be distributed in smaller bulk to other depots. So, as soon as
medical supplies were received at one or another of the several base ports
they were shipped in bulk to the medical supply depot where they were sorted,
placed in stock, and accounted for. From here they could be distributed as
the occasions arose, and though some shipments necessarily had to be made
back over the lines toward the base ports for Medical Department activities,
the seeming disadvantages of such a method were far outweighed by the advan-
tages of the arrangement adopted. -
As stated above, Cosne was the site for the first medical supply depot.
When taken over by the Medical Department, A. E. F., the site consisted of
an incomplete aerial bomb depot, being used at the time by the French.^ The
relatively few, floorless, and otherwise incomplete buildings available com-
prised about 50,000 square feet of floor space. Despite the absence of unloading
facilities, a lighting system and other requirements of an activity of this size,
this place was developed into our first fixed medical supply depot, a full-stock
distribution point, and from this the entire Medical Department distribution
system was largely elaborated. For a considerable period of time practicalh^
all medical supplies were concentrated at and likewise distributed from Cosne,
intermediate medical supply depot No. 3.
The original plan was to develop the medical supply depot at Cosne.
However, since, as stated above, Cosne was on a secondary railroad and the
French avowedly were unable to handle increased shipments therefrom, the
original plans for its expansion were abandoned and a substitute was adopted.
Before further reference is made to the establishment of other medical
supply depots, it is essential to state here upon what the supply system of the
American Expeditionary Forces as a whole was based.
On August 20, 1917, when there were about 25,000 of our troops in France,
General Pershing announced his policy of supply to the chiefs of the various
services, American Expeditionary Forces.'-' In his memorandum of announce-
ment, with its subsequent additions, there w^as outlined a definite method of
supply procurement, both from the United States by shipment overseas and
by purchase in foreign markets. In this it was furthermore specifically set
forth by what policy, under procurement, the increment of reserve supplies
was to be accumulated. The supplies w^ere divided into the following three
classes: Automatic supply for articles regularly consumed so as to permit of
iui automatic supply; replenishment supply for articles of which specified
stocks had to be maintained; and exceptional supply for articles of which no
specific stocks had to be established. Furthermore, on September 7, 1917,
Ociu'ial Pershing, in a cablegram to The Adjutant General, announced his
decision to establish in France reserves of all classes of supplies for 90 days.'*
This reserve was based on authorized issues, where such issues were regular,
and on active periodic consumption of other articles based on British and
French experiences during the war. General Pershing directed the chiefs of
the various services, A. E. F., to prepare estimates, for cabling, first, a list of
394
AT):\riNISTRATIOX, AAIERICAN EXPEDITIONARY FORCES
four months' supplies to accompany each movement of troops from the I nitcd
States. This provided not only a 90 days' reserve, but, in addition, one
month's automatic supply for consumption and emergency. Second, a list
showing the amounts which would have to be shipped monthly for each 25,000
men of the American Expeditionary Forces. In terms of days, the 90-day
reserve plan provided for 15 days of the reserve to be in the advance section,
30 days in the intermediate section, and 45 days in the base ports.
Now, in accordance with this plan to have 90 days' reserve medical sui)j)lies
in France, supply depots were established as follow^s: Base medical depots at
each of the ports utilized by American troops; an intermediate depot at Cosne
(intermediate medical supply depot No. 3, referred to above); an advance
depot at Is-sur-Tille.^^
To revert to the Cosne depot: The substitution depot, intermediate
medical depot No. 2, was at Gievres, approximately midway between Tours
and Nevers (the site originally selected for an intermediate depot) on the main
line from the base port St. Nazaire to our front. This depot, established
October 20, 1917, was to replace the depot at Cosne as the main issuing depot,
the Cosne depot being retained as an auxiliary.^ As the situation developed
the depot at Gievres w^as increased in capacity and utilized largely for ship-
ments of carload lots.-
DISTRIBUTION DEPOTS
With the view of having a distributing depot in the advance section
advance medical supply depot No. 1 on November 18, 1917, was put into
operation at Is-sur-Tille, a place subsequently used as our principal regulating
station.'^ This depot, an extremely important unit, largely took over the
distribution of medical supplies to troops and units in the advance section.
It w^as not, however, until considerably later that this depot was made a full
stock unit. Prior to its being made a full stock depot, its activities were con-
fined largely to the supply of medical units on duty with combat organizations.
Lack of storage space throught France added many difficulties to the
medical supply question, but those difficulties were particularly increased
by the lack of storage space at base ports and by the insufficient docking
facilities at the ports assigned.^ It was appreciated early that a large amount
of storage space w^ould be required at base ports, and efforts were made to
secure such space. No department could meet this need, however, until
construction by the American Expeditionary Forces was accomplished, con-
sequently it was many months before confusion at the docks w^as eliminated.
During this period the Medical Department, as was the case with other depart-
ments, sent to the docks representatives whose duty it was to search for
and sort out the supplies, and to make shipment of them to the proper depot
in the interior.^ Even later w^hen this work was taken over by the Army
Transport Service the representatives referred to remained at base ports
to assist the Army Transport Service.^ Shipments were received in every
available port, many of which, for example. La Pallice, La Rochelle, Rochefort,
Les Sable d'Olonne, had no storage space, though usually some temporary
shelter was provided. Representatives of the Medical Department supply
OEGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 395
division were assigned to duty in each of these ports. ^ SuppHes were from
time to time received in the ports of Cherbourg and Le Havre. -
In the vicinity of St. Nazaire, a large storage depot was estabhshed at
Montoir.^ Close to Bordeaux, a depot at St. Sulpice was established.- A
depot was established at Miramas, adjacent to Marseille.- In each of these
depots, the Medical Department was allotted space. ^ No depot was estab-
lished at Brest and later when the shipments through that port were con-
siderable, this lack of local storage space necessitated keeping stores without
protection against the elements until sufficient railway cars could be provided.^
No depot was established at Le Havre, through which port many of the supplies
purchased in England were received.^
The car shortage in France was such that never was it possible to ship
promptly from the ports material received from ships. ^ Though it was desired
by the commanding general. Services of Supply, to establish a system of priority
shipment from the base ports, this was not possible until after the establishment
of the depots mentioned above. The following letter shows the situation
in so far as it concerned the Medical Department:
Headquarters, Line of Communications,
Office of the Chief Surgeon,
France, January 24, 1918.
Memorandum to the commanding general, line of communications:
1. Referring to your memorandum of January 23, subject "priority of shipments from
Ijase sections," the following remarks seem pertinent concerning medical supplies.
2. In my opinion the principle is good. Under present conditions at the base, however,
I can not see how any classification of medical supplies other than in one group as "medical
supplies" can be made, owing to the multiplicity of articles upon the Medical Supply Table
and to their varying importance — from articles of absolute necessity for the preservation of
life to articles that might be well dispensed with in time of great pressure. This brings up
tlie great importance of having at the base a classification warehouse, referred to in my
memorandum of January 19.
3. Under present conditions, should our depots at the front or in the intermediate
section need articles of vital necessity, such as gauze, ether, morphine, request upon you for
order of priority for such articles would involve an order of priority for all, of all medical
sui)plies, many of which might not be needed, and the importance of many of which would be
loss than articles supplied by other departments, thus working a hardshij) upon those other
departments.
F. A. Winter,
Colonel, Medical Corps, United States Army.
[First indorsement]
C. G., L. of C, A. E. F., France, January 24, 1918
To the C. in C, A. S., G. S.
1. Forwarded. I am strongly of the opinion that the Medical Department requires
storage space at base sections 1, 2, and 5, in order that some classification of medical supplies
may l)e made in those areas prior to shipments to the intermediate and advance depots. It
is also appropriate in maintaining the 45 days' stocks in base areas.
2. The facts set forth in the memorandum from the C. S., L. of C, are decidedly perti-
nent, and it is easily comprehensible that shipments of important medical supplies to fill
existing emergencies would be delayed, unless it were possible to make a separation of these
su|jplics from those of unimportant variety. I believe the matter of storage space for classi-
fication at these ports for the Medical Department is a very important consideration.
F. J. Kernan,
Major General, National Army.
396
ADMIMSIHATIOX, AMERICAN EXPEDTTIONAK V FORCES
Bocaiiso shipping medical supplies from France to En<i;land, for the use of
our Medical Department units there, proved difhcult, arrangements wei-e made
to have such supplies shipped directly from the United States.^ This neces-
sitated the establishment in England of a medical supply depot, one being opened
in Liverpool on August 7, 1918.^ It functioned under the surgeon, base sec-
tion No. 3, and was supplied in part through purchases made in Great Britain.^
"army dumps" (medical)
The need was early felt for medical supply depots in advance of advance
medical supply depot No. 1, Is-sur-Tille ; the lack of them was considered not
only uneconomical in the maintenance of supply but also a source of real danger
to the supplies themselves.^ So long as our tactical divisions operated inde-
pendently, during which time they were moved from sector to sector, relieving
troops of another nation whose equipment differed materially from our own,
it was necessary for each division to have available at all times complete equip-
ment, including many things not listed in the field equipment.^ Division sur-
geons, in order to protect themselves against possible emergencies, overstocked
their divisions; when movement of divisions was ordered, they necessarily
left behind a good deal of material.^
In an effort to overcome this situation the surgeon, line of communications
made the following proposal:
February 11, 1918.
From: The chief surgeon, line of communications.
To: The commanding general, line of communications.
Subject: Storage for Medical Department.
1. I request that the Medical Department be avithorized to provide itself with one or
more small storage warehouses with capacity of approximately 5,000 square feet each so
situated that they can be reached by truck direct from the troops in the field. These store-
houses are considered essential to the proper supply of divisions for the following reasons, and
I believe that they should be provided at the earliest possible date. No elaljorate system of
issue is contemplated, simply a dump where the essential articles such as ether, gauze, dress-
ings, morphine, first-aid packages, and standard Red Cross dressings can be stored and issuer!
in emergencies: (a) Is-sur-Tille is too far from the line to be reached by truck, and rail
transportation for less than carload lots is necessarily slow. I have from the start been con-
vinced that for Medical Department storage, Is-sur-Tille is not suitable for the most advanced
depot, (b) The problems of the Medical Department differ considerably from the other
staff departments in that shipments to any one organization are neither so large nor a matter
of daily occurrence, (c) Another important reason is the fire risk. Should the Is-sur-Tille
depot be wiped out it would be most advantageous if there were small stocks in the front
area sufficient to maintain supplies until such time as shipments from Cosne or Gievres could
reach that area, (ri) Economy: In my judgment if the troops in the field have absolute
assurance that supplies can be had promptly when needed they will cut their requisitions to
their immediate needs. They will thus not encumber themselves with unnecessary impedi-
menta.
2. If this recommendation meets with your approval, I request that the paper be referred
to the commanding general. Advance Section, for selection of the towns and for leasing of
the necessary buildings.
F. A. Winter, Colonel, Medical Corps.
With the organization of the Paris group and, later, of the First Army, the
establishment of army dumps became essential. In connection with the Medi-
cal Department purchasing business in Paris, there had been established previ-
ORGANIZATION AND AD:MINISTRATI0X OF CHIEF SURGEON'S OFFICE 397
(lusly in Paris a small medical receiving warehouse; and although this was
utilized somewhat in the manner of an army dump, it was not essentially that
type of depot. The first army dump established was at Lieusaint,"' and this
was organized and administrated for the purpose of supplying combat units in
the Paris group and, later, the First Army.
The supply table authorized for an army dump, which in common parlance
later became known as the "Lieusaint list," grew out of the establishment of
this army dump.'" The original basis of the "Lieusaint list" was the replace-
ments necessary for one combat division for eight days, and the officer in charge
ol' this distribution point was authorized to maintain in storage as many times
this amount as there were combatant divisions in his area.''' This practically con-
stituted a stock maximum for his depot. Practically this same system, although
with a modified list, was adopted for use in planning the distribution of medical
supplies when the offensive operations, directed toward the reduction of the St.
Mihiel salient, and later against the Meuse-Argonne area, were in preparation.
Gradually, however, a policy was developed of establishing army dumps for
which there was authorized a definite fixed stock maximum without reference
to the number of combat units to be supplied, but based more upon the number
of such dumps established in relationship to the known number of divisions to
he employed in the operation. Such dumps, for instance, were established at
Tonl, Souilly, Vaubecourt, Fleury, and Les Islettes, and in the order named."''
HOSPITAL CENTER DEPOTS
Upon the adoption of the plan of concentrating beds in hospital centers,
there was need in each center of more than 5,000 beds for an issuing medical
supply depot. The following letter on this subject was submitted to head-
(|uarters Services of Supply by the officer in charge of the supply division of the
ciiief surgeon's office:
Office of the Chief Surgeon,
American Expeditionary Forces,
Headquarters, Services of Supply,
France, April 23, 1918.
.Meinoraudum for the General Staff:
1. I am informed that the present scheme of construction for hospitalization includes
for storage sj)ace for medical supplies the following: For each l^ase hospital of 1,000 l)eds, one
20 by 160 foot building.
I understand that provision for a sorting warehouse for all supplies has been made
Tliis warehouse to l)e 24 feet of a 50-foot wide building for each 1,000 beds.
2. I am of the opinion that in this matter the needs of the supply division have not
beon adequately provided for, and I request that the matter be given consideration, not alone
from the standpoint of storage for a group of base hospitals, but as part and parcel of the
entire scheme of storage and distribution of medical supplies in France.
The following data are pertinent: With a peace-time strength of 100,000 men and with
an average morbidity rate of approximately 3 per cent, there were in the United States the
following dejrots: New York supply, St. Louis supply, San Francisco supply, and field medical
J^upply dei)ot, Washington. I am unable to give the combined floor space of these depots.
3. It would therefore seem probable that the needs of a hospital center of 10,000 or
5,000 beds would be sufficiently great to warrant the establishment of not only storage space
l)ut of an i.ssuing depot. It has been found by experience that beyond a certain point the
amount of work done in an issue room may not be expanded without loss of space and energy
and tliat it is desirable wlien that point is reached that another issue room be established.
398
ADMINISTRATION, AIMERICAX EXPEDITIONARY FORCES
When this becomes necessary no advantage is gained by establisliing that second Issik
room in immediate proximity to the first, and in fact there are many adv'antages of it^
establishment elsewhere.
4. The advantages accruing to the service in this matter of an issue depot at tl)e hospital
centers are as follows: (1) Lessened fire risk. The disadvantage of having all supplies in a few-
depots is apparent. (2) Direct shipments. With a depot at the center direct shipment of
bulky articles can be made from the ports, avoiding the difficulties and the use of rolling stock
incident to transhipment at the main depots. (3) Economy. A full knowledge on tiie part
of the hospital commanders that their emergency needs could be promptly met will unques-
tionably lead to small requisitions and particularly to an elimination of those articles infre-
quently used. (4) Embargo. With a depot in the immediate vicinity in times of railroad
stress, shipments by the Medical Department can be entirely suspended so far as these
centers are concerned.
5. It is apparent that, aside from the additional issue room, no greater amount of storage
space is involved by these establishments than would be required for storage at the larger
depots. If it is thought that this involves further construction and unncessary storage space
for the Medical Department, I recommend that this storage space be provided in lieu of an
equal amount of space at Gievres. This space could be later provided at Gievres if condi-
tions warrant it. I am confident that the Medical Department will require the space asked
for.
6. I have estimated 10,000 square feet as the minimum that will be necessary for this
depot, and I am inclosing an exhibit which is an approximate list of the supplies that will he
carried in this depot, with their cubic feet contents. In addition to the actual space occupied
by the materials, there would be necessary approximately 2,000 or 2,500 square feet as an
issue room.
7. Of the 50-foot wide building, a 24-foot length of which is already authorized for each
1,000 beds, I am informed that the quartermaster desires 20 feet. This would leave for mv
purposes 200 square feet for each 1,000 beds, a total of 2,000 square feet, which is not suffi-
cient for the Medical Department.
8. I therefore request that this storage building now authorized be increased in size to
take care of the needs herein specified.
By direction of tlie chief surgeon.
F. A. Winter,
Colonel, Medical Corps, United States Army.
April 29, 1918.
Memorandum for the chief of utilities:
1. Forwarded. Request from chief surgeon for the increase in storage area at base
hospitals.
2. Approval in general principle granted. Action to be taken in individual cases as
supply of labor and materials is available.
By order of the C. G.
J. N. Parsons.
H. C. Smither,
Assistant Chief of Staff, 0-4.
Hospital center medical supply depots were established, and shortly before
the armistice were at the following principal hospital centers Allerey, Bazoilles,
Beau Desert, Beaune, Clermont-Ferrand, Commercy, Kerhnon, Langres,
Limoges, Mars-Sur-AUier, Mesves, Perigueux, Rimaucourt, Riviera, Savenay,
Toul, Vichy, Vittel-Contrexeville.
MEDICAL SUPPLY PERSONNEL
More and more it became apparent that efficient service in the supply divi-
sion of the chief surgeon's office was being hindered by the lack of trained
personnel and particularly by the lack of sufficient personnel of any kind.^ The
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 399
needs of the supply service, though appreciated, could not be met by the person-
nel division of the chief surgeon's office until such need became absolutely pressing.-
Plans were submitted by the officer in charge of the supply division, chief
surgeon's office, calling for personnel in the main supply depots for training
j)urposes far in advance of the establishment of other depots, but these plans,
although carried into effect in part, were never put into full execution and the
result was that the establishment of large depots necessitated interference
with the normal working force of the main depot. ^ This occurred repeatedly
in intermediate medical supply depot No. 3, Cosne, from which depot a large
part of the personnel for Is-sur-Tille, Gievres, Bordeaux, St. Nazaire, and hos-
pital center depots and army parks were supplied.^ From Is-sur-Tille also a
considerable number of men were sent to army parks and other depots.^
Certain units, known as medical supply units, and consisting of 3 officers and
45 enlisted men, well selected as a rule, arrived from the United States from
time to time, but because of the medical supply situation in France, and because
the method of administration and distribution was so entirely different from
that which had been taught the members of the units in the United States, it
was deemed inadvisable to send them out as units; furthermore, because the
need was so pressing that personnel as it became available had to be allotted to
a number of depots, at no time could the number of men comprising one of these
units be spared for any one depot. ^
MEDICAL SUPPLY INSPECTORS
It was planned also to have officers from the office of the chief surgeon
act as medical supply inspectors. It was intended they should inquire into
tlie adequacy of supplies; to instruct in the method of requisitioning; to meet
incoming organizations and to advise them of the location of medical supply
depots and the methods followed in the American Expeditionary Forces, the
local situation, etc., to acquaint new units with the shortage of supplies and
the necessity for economy; to supervise the establishment of storerooms at
camp hospitals, wherein supplies could adequately be cared for and conserved;
to direct the return to the proper depot of excess supplies; to receive criticisms;
to make suggestions following investigations, as to the manner in which dis-
tribution of supplies could be better accomplished.^ Such personnel it was
never possible to obtain.^ Officers of the Sanitary Corps, formerly noncom-
missioned officers, were thought to be best prepared for this w^ork, but their
services were in demand for other purposes and it was difficult to secure them
in sufficient numbers even for the purposes of medical supply depots.^
CIVILIAN EMPLOYEES
Authority for the employment of civilians by the Medical Department,
A. E. F., was issued from the supplies division, chief surgeon's office.^ With
tlu> establishment of territorial sections in the American Expeditionary Forces
tliis authority was delegated to section surgeons.- Many of the early hospital
luuts took over old buildings, oftentimes cut up into many small rooms and
therefore unsuited for hospital purposes. The personnel assigned to the units
13901—27 2G
400
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
was insuflicient and due to the critical shortage of enlisted personnel, Medical
Department, it was impossible to supply reinforcements. Camp hospitals
were established in large number with a skeleton personnel from casuals, since
these organizations were not provided for in the original Tables of Organization.
A liberal policy in the employment of civilians was therefore estahlisiied by
the chief surgeon, A. E. F., and many were employed in lieu of Medical
Department personnel not then available.^ The maximum number of civilians
employed was 4,273.
SPECIAL UNITS
A number of small Medical Department units were sent to the American
Expeditionary Forces and there functioned partly under the control of the
supply division of the chief surgeon's office.^ Chief among them were the
motor assembly units, instrument repair units, and optical units.
Motor Assembly Plant
This plant consisted of a unit of officers and men for assembling and,
later, repairing motor ambulances.^ The services of such skilled men were so
in demand that they were utilized at the base ports for assembling all motor
transportation, and later on w^ere turned over to the Motor Transport Corps.^
Instrument Repair Shop
An instrument and typew^riter repair unit of officers and men was also
sent. Preparation for the reception of this unit had been made by the supply
division of the chief surgeon's office and it w^as installed in a building in Paris.^
Later, upon the publication of General Orders, No. 10, G. H. Q., A. E. F.,
January 6, 1918, which provided for the organization of the salvage service,
the typewriter repair men were asked for by the chief cjuartermaster, and this
portion of the unit was turned over to his department.^
Optical Shop
Personnel for eight branch shops were also sent to France completely
eciuipped.^ The main shop was established in Paris in connection with the
instrument and repair shop ; the eight branches were sent to various hospital
centers.^ Later, others were established.
The demands on the instrument and optical shops were so great that the
original equipment and quarters proved inadequate. These were then moved
to a larger building and an X-ray repair unit was organized in the original
Cjuarters.^
As no specific provision had been made for the repair of electrical instru-
ments, the X-ray repair shop undertook this w^ork as far as it was possible to
do so with the staff available.^
The work of the repair units w^as by no means confined to repairs, as it
was found desirable to alter equipment to meet the needs of military service
as w^ell as to build much special apparatus urgently needed in hospital practice.'
During the entire period of their operation these shops were called upon
to work to their full capacit3^^ They fully demonstrated the wisdom of their
selection and the necessity for such auxiliary units for the successful operation
of the functions of the medical service.
ORGANIZATIOX AND ADMIXISTEATION OF CHIEF SURGEON'S OFFICE 401
AUTOMATIC SUPPLY
On September 18, 1917, in compliance with General Pershing's instructions
concerning automatic supply, previously referred to, the first list of medical
and hospital supplies for automatic shipment from the United States
was submitted to general headcjuarters, A. E. F.^ It was appreciated at the
time that there were many inadequacies connected with this list that would
necessitate constant correction, for the requirements of the Medical Department,
in so far as any one item was concerned, could not readily be anticipated.
Futhermore, the multiplicity of articles, together with the varying needs for
them, made it practically impossible to anticipate exact amounts required.
At the time in question, no great amount of data was available from allied
sources; such data as were available had not been given much study. ^
On February 1, 1918, the chief surgeon, A. E. F., caused to be revised
the automatic supply list that had been prepared in September.^ This was in
conformity with the Surgeon General's request. One of the first steps in this
revision was a further simplification; this was followed by an effort to deter-
mine what articles, because shipped in small original packages, should be
shipped overseas every three months rather than monthly, and to determine
what articles should be controlled by requisition. As a result, on April 2, 1918,
the chief surgeon, A. E. F., submitted a table of articles, subsequently referred
to as the automatic supply table. ^
Though the principle of automatic supply never was questioned by the
Medical Department, A. E. F., so far as the demands of that department
were concerned, the automatic supply was not reduced to a working basis,
chiefly for the following reasons: ^ At the time the table was submitted the
stock of medical supplies in the American Expeditionary Forces was critically
low. Not only was no information available as to the amounts of each article
that would be used, but it was vitally essential that a reserve in France be
established; consequently, in many instances, amounts specified in the revised
automatic supply table were recognizedly excessive. It was not intended to
perpetuate this; on the contrary, it was the intention from the first, to modify
the automatic supply list from month to month, once an adequate reserve had
been established in France. That this was difficult of accomplishment may
be shown by the fact that stores ordered from medical supply depots in the
United States in one month in amounts based upon strength figures for the
American Expeditionary Forces for that month, usually did not reach France
for several months thereafter, and were not available for issue for fully an
additional month because of the necessity for their shipment to an interior
medical supply depot for sorting preparatory to distribution.^ Furthermore,
l)ogiiming with the spring of 1918, and by reason of military necessity, the
troop movement to the American Expeditionary Forces was expanded in a
totally unlooked for manner, in consequence of which, when supplies ordered in
'bimiary and based on the size of the American Expeditionary Forces at that
time, were received six months later, they were obviously entirely inadequate.^
402
ADMIXrSTRATIOX, AMERICAN EXPEDITIOXAKY FORCES
STATISTICAL STUDIES
Principally with the view of acquiring data that would permit of an intel-
ligent revision of the automatic supply table, a statistical section of the supplies
division, chief surgeon's office, was instituted in the early summer of 1918.-
It was the function of this section to tabulate the amounts of supplies
received; amounts available at each medical supply depot; the daily niovo-
ments of railroad cars containing medical supplies; the movement of supplies
(both by weight and bulk) into and throughout France; the rate of issue per
unit of men under varying conditions.- With such work it was the intention
to so gain a position as to insure estimating accurately the stores required for
replacements under any and all conditions presenting. Such an end, unfortu-
nately, never was reached.^
One of the difficulties connected with this work was the fact that there
were available neither figures on the amount of supplies required by each unit
of men for a given period, nor the relation of weight to bulk for the medical
supplies that would be required for the American Expeditionary Forces.^ As
a matter of fact, during the entire history of the Medical Department, A. E. F..
initial supply formed a large part of the requirements, this in itself making the
bulk of overseas shipments assume larger proportions to the weight than
would have been true later after the movement of troops stabilized. The dis-
proportion of bulk to weight was more marked as regards Medical Department
supplies than was true of other branches, a fact that required repeated explana-
tions. What led to such queries was the situation with the British. Though
efforts were made to compare their Medical Department with ours, in so far
as the relationship of bulk and weight of supplies is concerned, this could not
be done because our Medical Department was importing bulky, permanent
equipment through the necessity of a prolonged hospitalization of our sick and
injured in France.^ The British, on the other hand, elaborately equipped their
hospitals only in Great Britain to which their sick and wounded could be readily
transported.^
Though, as stated above, the work of the statistical section did not, and
could not, reach desired results by reason of its late establishment, nevertheless
it proved of great value and formed the basis of the later estimates of Medical
Department tonnage required.^ Also, this section provided the data upon
which subsequent revisions in the automatic supply table were made, and upon
which shipments of medical supplies from the United States were increased,
decreased, or suspended.^
MEDICAL SUPPLY ECHELONS AND SYSTEMS OF REPLENISHMENT
Essentially this scheme of distribution involved the use of several echelons.
From front to rear they were as follows Divisional medical supply unit;
army park medical supply dump (for each corps); army medical supply depots
(for each army); Services of Supply depots (advance and base).
Toward the end of hostilities the manner of distribution from the supply
echelons at the base to those in the most forward areas had been worked out
with exceeding care. The plan of distribution, as evolved, was an elaboration
of the policies under which the units previously had been functioning, but it
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 403
was better balanced, and all echelons were much more clearly defined. This
was also true as regards the important technique of filling the requests for
supplies of forward units from the unit next in the rear.'**
AT THE FRONT
The officer in charge of the divisional medical supply unit normally indi-
cated the need of all organizations in his particular division upon a consolidated
ro(iuisiti()n, which, after passing through the office of the division surgeon and
that of G-1, was forwarded for filling to an army park.'** Often the division
medical supply officer was far removed from the division surgeon and the divi-
sion staff generally, and as a result numerous requisitions had to be sent to the
nearest army park in a most informal manner and without any visa or approval.
This was recognized as a necessity, and such contingencies were provided for
by authorizing the park personnel to honor such emergency calls. It was
found in practice that such authorizations increased the confidence of those in
the forward areas and that the end result was a better and closer cooperation
of all concerned.'^
The logical medical stock for army parks included only articles of combat
e(|uipment and supplies and trench stores, and divisional units would naturally
requisition only such articles, but in the early developmental days of the corps
echelon it was found necessary to carry limited replacements at these parks, for
such units as mobile and evacuation hospitals. It was very soon learned,
liowever, that this produced a useless dispersion of equipment which it was
difficult to obtain, and quickly rendered immobile the army park medical sup-
ply (lumps — units, which of necessity, must remain mobile. It therefore became
tiie policy to confine articles on the fixed stock maximum of such parks to those
of combat material and trench stores. Just as soon as this decision was made
it necessitated the establishment of a new echelon, inasmuch as large hospitals
in the advance zone would now be required to replenish their stock from a new
advance supply unit.'''
It was therefore contemplated immediately to establish (and sites were
actually selected) full-stock army advance medical supply depots on a basis of
one per army.'^ This unit, although carrying a complete stock, carried its
articles, in so far as quantity w^as concerned, upon a very limited time basis.
The functions, then, of this larger unit would be primarily to fill the calls of the
army parks and secondarily to fill requisitions from medical units in the advance
zone. The latter was obviated as far as possible by distribution from the rear
through "controlled stores" in other depots.'^
SERVICES OF SUPPLY
COXTROLLED StORES
As medical supplies began to arrive in France in amounts larger than the
inuuediate needs therefor, it became possible to begin the stocking of depots
other than that maintained at Cosne.^
At first only articles of w^hich there was a supply more than sufficient to
luoet the immediate needs were stocked in the base storage stations, all others
being sent to the depots in the intermediate section to maintain the stock
there.- Later as supplies began to come in larger amounts, more and more
404
ADMIXISTHATIOX, AMERICAX f^XPEDITIOXARY FORCES
articles and larger and larger amounts were retained in the base storage stations. -
A typical instance is that of beds and bedding, in fact of all initial e(iui|)iucnt
except the highly technical equipment that needed especially trained labor for
its care and selection. It was impossible to distribute such material if for no
other reason than the lack of available technical personnel to provide for its
care in all the depots.
Because of the harbor faciUties at Brest, shipment of supplies from the
United States to France, assumed large proportions in so far as that port was
concerned, and, as previously mentioned, the fact that there were no facilities
for storage made it necessary to ship out as cars could be provided. Practi-
cally all the supplies received at Brest had to be routed to Gievres which acted
therefore as a reservoir for that port.^ Is-sur-Tille needs were supplied from
Miramas to the fullest extent possible.^
As fast as the medical supply depots were built and became available,
they were stocked with such articles as were in France in sufficient quantity
to warrant distribution.^ While the desirability of having completely stocked
depots was appreciated, as matter of fact, it never became quite possible to
accomplish this.^ Though there was an abundance of such material as gauze
and bandages, never at any time was there a sufficient amount of surgical
instruments to permit stocking more than a few depots with them. It was
felt that the depot should be stocked in the following sequence: First, inter-
mediate medical depot No. 3, Cosne, which was then the main distributing
depot; advance medical depot No. 1, Is-sur-Tille, a distributing depot for the
advance area; the supply depots in the various sections; finally the hospital
center depots. Necessity of the decentralization of issues was early appreciated,
but complete decentralization could never be effected because of the absence
of sufficient stock of several important items, and it was not until shortly
before the armistice began that the medical stock was sufficient to permit
its distribution to these depots.^
At first it was the practice of local district surgeons to secure from the
docks such articles as were needed in their areas, making report thereof to the
surgeon, line of communications.^ This practice was permitted in view of the
shortages in medical supplies at the ports and in view of the long delay in
shipping to and from the depots in the intermediate section; but in order
that equal distribution might be made, that accounting could be effected with
the view of gaining knowledge of stocks available in France and, finally, that
unnecessary rail transportation might be prevented, on July 1, 1918, the
policy of "controlled stores" was established.^ Thereafter, all supplies enter-
ing a base port were immediately under control of the representative of the
supply division, chief surgeon's office, A. E. F., and were shipped in accordance
with his instructions, or placed in storage subject only to the order of the
chief surgeon, A. E. F.^ In each of the base sections a local supply depot
was established whence issues could be made upon the approval of the section
surgeon, but issues from the controlled stores were not under his jurisdiction."
Reports of all receipts and issues from controlled stores were made to the office
of the chief surgeon. Here they were tabulated daily, thus permitting the
condition of stock in France and in each depot to be known at all times.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 405
Requisitions
From organizations. — Requisitions were submitted to the chief surgeon, in
one copy only; ^ upon approval, they were forwarded to the proper depot.
This method was established with the view of eliminating so far as possible
all paper work and of issuing so far as possible all supplies asked for.^ How-
ever, the fact that there was no duplicate requisition on file barred any possible
checking against previous requisitions from an organization; every requisition
was therefore acted on solely upon its face. Later, with the object in view of
further expediting action upon requisitions, these were ordered sent from
organizations direct to the depot. The officer in charge of the depot was
designated assistant to the chief surgeon and was given authority to modify
requisitions, but instructed to make such modifications largely upon the basis
of the stock on hand.^ Though this delegated authority placed upon the
officer in charge of the depot the burden of responsibility for modifying requisi-
tions, not ordinarily his, it was necessary in view of the many shortages in the
stock in the early days.^
From supply depots and hospital center depots. — Requests from hospital
center depots and from supply depots were sent to the chief surgeon, A. E. F.,
in whose office extracts were made according to the availability of stock and
to the railroad situation; shipments were made from the most available point. -
This permitted shipments to be made in carload lots direct from the ports to
the requisitioner, thus conserving labor and time in the loading and unloading
of cars and also the saving of cars. Frequently shipments were made direct
from the docks.
PROPERTY ACCOUNTABILITY
In so far as accountability at the depots for goods received from the United
States is concerned, it was early demonstrated that either accountability must
he abandoned or the needs of the American Expeditionary Forces must be
neglected.^ Frequently invoices of medical supplies would be received from
each of the several depots in the United States, bearing the same numbers.
Since packages were numbered serially at each such depot, a shipment of sup-
plies from the United States, when received at a depot in the American Expe-
ditionary Forces, would contain not only not all of the supplies invoiced on one
invoice, but several packages bearing the same number, thus making it impos-
sible to determine from which depot the supplies were shipped and to which
invoice they should be credited. Many supplies were received in France
marked for special units and no invoices were furnished. Frequently these
found their way into the medical supply depot and because the storage space
was so inadequate there they were placed in stock and issued.^ Supplies
marked "Replacement supplies — division" were received and likewise placed
in stock. In a similar way supplies received from European sources arrived
at the depots. Partial shipments were made on purchase orders. It was
therefore determined that accountability at the depots would be for those
supplies actually received.^
Maiutaining any system of accountabifity at the front proving impractical,
(Joneral Orders, No. 74, G. H. Q., A. E. F., December 13, 1917, provided for
the cessation of all accountability there.
406
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
EXPENDITURES
The system of payment from medical and hospital funds by a central
disbursing officer upon an approved voucher proved to be full of difliculties.-
Payment for laundry work done for moving organizations, payment for civilian
employees who demanded payment weekly, payment for purchases made in
emergency in small amounts, sometimes by a moving command, all theoretically
had to be vouchered on Form 330, M. D., approved, submitted to the disburs-
ing officer and paid by check. In order to obviate this difficulty the chief
surgeon authorized the payment of such accounts in cash from hospital funds,
making upon Form 330 a certificate to that effect, following which reimburse-
ment would be made.^ Such a system was required in the absence of actual
cash being made available to officers commanding Medical Department
formations.
INFLUENCE OF TRANSPORTATION ON THE MEDICAL SUPPLY SITUATION
From the source of supply, whether this was in the United States or in
Europe, to the ultimate consumer the distribution of supplies was influenced
by the overburdened transportation system.^ Necessarily, the railroads and
the ports of embarkation in the United States were congested; equally con-
gested were the ports in France, several of which were illy equipped with
docking facilities and cranes. The car shortage in France was great, and
embargoes, complete or partial, were of frequent occurrence.^ Differences in
the languages added to the difficulties there. For a considerable part of the
time lack of storage facilities at the base ports rendered impossible any satis-
factory sorting of supplies, and lack of trained personnel to recognize the prop-
erty of the various departments all combined to delay receipt of supplies at
their proper depots.^ Every available means of transportation was used, and
this resulted in the splitting of consignments.^ Frequently shipments were
made by motor trucks and by canal barge from Havre and from inland points.
The use of these various means of transportation at first caused an uncertainty
as to whether or not delivery of the supplies would ever be made. With the
growth of the American Expeditionary Forces, however, a system of convoy
was established whereby trains or cars were accompanied by members of the
American Expeditionary Forces. This in a large measure corrected the fault.
The result of all the factors outlined above was that the availability for
issue of stocks received was much delayed, and that many supplies, even though
known to be "somewhere in France," could not be considered as forming part
of the reserve.^
MEDICAL SUPPLY LIAISON WITH THE UNITED STATES
It was early appreciated by the supply division of the chief surgeon's office
that it lacked information concerning supplies for the American Expeditionary
Forces available to supply officers in the Surgeon General's Office.^ In other
words, the supply division, chief surgeon's office was groping "in the dark"
along certain lines. To remedy this, it was felt that conferees should be inter-
changed or that written reports should be submitted, but such a plan could not
be effective by reason of the lack of adequate personnel.^ On the other hand,
ORGANIZATION AND AD:^IINISTRATI0N OF CHIEF SURGEON'S OFFICE 407
in the light of after events, it is thoroughly appreciated that one egregious error
committed in the supply division of the chief surgeon's office was that, though
it was known there that the automatic supply table was excessive, this was not
made known to the Surgeon General's Office, thus creating a confusion in an
activity that should have worked smoothly. Proper liaison would have obvi-
ated this.^
AMERICAN RED CROSS MEDICAL SCPPLIES
Regulations obtaining at the time we entered the World War required that
organized voluntary aid for our land forces would, through the American Red
Cross, constitute a part of the Medical Department.'^ In the American Expedi-
tionary Forces, in conformity with the regulations referred to, the American
Red Cross military hospitals which had been established became a part of the
Medical Department. However, the American Red Cross was charged by the
commander in chief, A. E. F., with many activities entirely unrelated to the
Medical Department (for example, civilian relief), and the chief of the Ameri-
can Red Cross in France was, by General Orders, No. 8, H. A. E. F., July 5,
1917, placed on the administrative and technical staff of the comander in chief,
\. E. F., independent of the Medical Department. In this independent work,
the Red Cross obviously required medical supplies, consequently large quan-
tities were procured.
Since these supplies were freely made available to Medical Department
units, the result, so far as these supplies were concerned, was duplication not
only of effort but of supplies as well.^ Our Medical Department personnel,
being for the most part new and untrained in the methods of obtaining supplies,
secured them from whatever source they found most available, and frequently,
having no realization of the dangers of shortage of supplies in the world markets
(hipHcated their requisitions and obtained supplies from both the American Red
Cross and our medical supply department.^ As an example, there was always
a shortage of sheets during the period of hospital expansion.^ The chief sur-
geon, A. E. F., established the policy of issuing six sheets per bed, and with
this arrangement the Medical Department managed to keep just ahead of the
demand.^ Meanwhile the American Red Cross in France also had sheets and
was being called upon to issue to units other than those for whose supply they
had accepted responsibility, including some who had already received their
allotment of six.^ This duplication of supply resulted in a shortage in many of
our hospitals at a time when these articles were needed. The result of this
demand upon the American Red Cross was a financial burden to that organi-
zation which it should not have been called upon to bear and which, in fact,
its officials had no desire to bear.^
In extenuation, however, it should be stated that, if the personnel of the
Medical Department was largely untrained, so, too, much of the Red Cross
personnel was equally or more so. But being exceedingly desirous of rendering
service and frequently entirely unfamiliar with the normal method of supply, the
officials in immediate charge of issuing Red Cross supplies felt that the burden of
supplying hospitals was upon them. In some cases they were even unfamiliar
with the existence of the Medical Department supply service; as a result, they
not only made issues whenever called upon regardless of the fact that the articles
408
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
could have and should have been supplied from Army depots but they also
failed to convey the information necessary to prevent a repetition of the dcMiiand
upon them in the future.^ In an effort to meet this situation, after consultation
with the chief of the American Red Cross in France, and in full agreement witli
him, orders were issued by the chief surgeon, A. E. F., permitting issues from
the Red Cross only after approval by division, corps, section of army surgeons,
or by the chief surgeon, A. E. F.- As a matter of fact it was believed by the
officer in charge of the supply division of the chief surgeon's office and by the
American Red Cross officials in Paris that a further restriction would have been
better; however, with the extensive unfamiliarity with our medical supply
methods that obtained among requisitioning officers, it was felt unsafe to in
any manner bar the way to the prompt securing of supplies. -
It is obvious that the purchase by the American Red Cross of articles also
purchased by the Medical Department interfered to some extent with markets
in Europe and in America. Articles that were available in the United States were
shipped on both Medical Department tonnage and Red Cross tonnage and this
duplication resulted in an overstocking of such articles in the American Expedi-
tionary Forces.^ This double procurement system did not in any way improve
the situation in the American Expeditionary Forces in so far as the articles of
which there were still a shortage were concerned, since that shortage resulted
largely from the depletion of the markets at home and in Europe.^
Following conferences on the subject with the Red Cross officials, the chief
surgeon, on February 11, 1918, initiated a cable to War Department asking
that an agreement be reached in the United States with the American Red
Cross headquarters, and that the great amount of made-up garments prepared
by the women of America be collected by the Red Cross and turned over to the
Army to meet their needs, thus permitting the demands upon the manufac-
turers to be reduced to a like extent. ^
Red Cross contributions to the Army were considerable. Not only did
this society establish entire hospitals in emergency, but also at all times its
entire stock of supplies was made available to the Medical Department.^ It
supplied large quantities of front-line parcels made in France, which practically
supplanted first-aid packets, and turned over in bulk to our depots and to the
hospitals by direct shipment, in pursuance of a program given them by the
chief surgeon, A. E. F., enormous quantities of made-up surgical dressings.^
It undertook the production of standard splints and met the need thereof en-
tirely until splints began to arrive from the United States.^ It undertook the
production of nitrous oxide and oxygen for the American Expeditionary Forces
and established a plant in Paris for that purpose.^ In all of these activities it
turned over in large part the products to the Medical Department by which
distribution was made.
FINANCE AND ACCOUNTING
PURPOSE
An act of Congress, dated September 24, 1917, authorized the Comptroller
of the Treasury and the Auditor for the War Department to send to the Amer-
ican Expeditionary Forces portions of their organizations for performing there
the functions of their offices. As a result of the establishment of the offices of
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 409
the Assistant Comptroller of the Treasury and of the Assistant Auditor for the
War Department in France,'^ and in accordance with the request of General
Pershing, the chiefs of the various War Department bureaus organized units to
function in the American Expeditionary Forces in a manner similar to the finance
and property divisions of the several departments in the United States. Thus
the unit formed in the Medical Department eventually became the finance and
accounting division of the chief surgeon's office, A. E. F.^°
PERSONNEL
In availing himself of the authorization referred to above, the Surgeon
General had an officer of the Medical Corps ordered to Washington for consulta-
tion, and upon arrival directed him to obtain and organize a force sufficient to
care for the Medical Department accounts for an army of 2,000,000 men.^
After consultation with the Assistant Auditor for the War Department and with
various other departmental authorities this officer modeled his organization on
that of the corresponding division of the Surgeon General's Office.** In order
to get men qualified for this work all the large banks as far west as Chicago,
and a large number of insurance companies, railroads, and department stores
were requested to supply the names of drafted men qualified for service in this
group. ^ Prompt replies were obtained but, meanwhile, almost all the men
named had been assigned to such duties that their transfer was not feasible.
Banks were then asked to supply lists of their employees who were about to
he called to the colors and from these by induction and enlistment the number
desired was obtained. From time to time personnel to a total of 7 officers
(including the chief of the division) and 135 men pertaining to this group were
sent to France.^ It was purposed, in so far as the men were concerned, that
many of them would perform clerical service not only in the office of the chief
surgeon, A. E. F., but also at medical supply depots, with division surgeons,
and in similar assignments.^
Because of numerous transfers, the enlisted personnel of this unit was
further reduced to 37 men. One of the officers was sent to Paris for duty in
the bureau of accounts, A. E. F., and one was assigned to duty with the general
purchasing board, A. E. F.
On April 1, 1918, when the unit was attached to the office of the chief
surgeon, it consisted of 6 officers and 47 men. Gradually other personnel were
added until in February, 1919, this division consisted of 10 officers, 132 enlisted
men, and 15 French civilians. This was its maximum strength.^
PREPARATORY WORK
In November, 1917, a temporary office was established at the New York
medical supply depot where the plan of organization was developed, and recruits
were examined to determine their technical qualifications.** These men were
then sent to Governors Island to be recruited and temporarily quartered. While
there they were given some drill and were instructed in their prospective duties.
Supplies also were collected at this place and plans made for the details of
[)ioce(lur(' and work of the detachment abroad.
410
ADMIXISTRATIOX, A^FERICAN EXPEDITIONARY FORCES
The first section of the detachment, consisting of 5 officers and 100 inon,
left the United States on January 4, 1918, and arrived at St. Nazaire on January
17.^ From Januar^^ 24 to February 13 the group was stationed at Bois, where
its organization was perfected.^" Plans of procedure were charted and sugges-
tions worked out for the improvement of the methods of handling money and
property accounts of the Medical Department.
After the unit moved to Tours, on February 13, it established its office,
and about March 15 began its actual work in rooms assigned to it in barracks
No. 66. «
A second section of this group, consisting of 2 officers and 35 men, which
had arrived in France on February 9, was broken up, only the officers and 2
enlisted men eventually joining the original unit now at Tours. ^
On May 1, 1918, the finance and accounting division became a part of
the division of supplies of the chief surgeon's office, A. E. F.''
SCOPE OF ORGANIZATION
At first, the division had three chief activities: Money accounting, dis-
bursing, and property accounting.'^ As occasion demanded, other functions
were added until eventually the division had 15 distinct but related activities
and was divided into corresponding sections.^"
DISBURSING
This section paid French commercial bills, all doubtful vouchers (when
found to be legal) which were referred to it by other disbursing oflftcers of the
Medical Department, all laundry accounts, and all civilian personnel pay
rolls. For the month of January, 1919, these disbursements amounted to
844,207.70 francs, representing 573 vouchers. Prior to March 1, 1919, the
disbursing officer paid one-third of the total number of Medical Department
vouchers settled in France. Before payment the audit checked up duplica-
tions. A liaison was established with both the hospitalization division, chief
surgeon's office, and the quartermaster department, A. E. F., in matters pertain-
ing to laundry accounts whereby many hospitals through use of near-by quarter-
master laundries saved many thousands of dollars. By April 30, 1919, this
section had paid 4,593 vouchers. This section made considerable savings by
eliminating duplicate payments and by arranging that hospitals use existing
facilities instead of purchasing supplies and labor in open market. Records
were made of the time elapsing between dates of purchase and dates of payment,
and every effort was made to expedite settlements, thus promoting good will
on the part of French vendors. Arrangements were made whereby quarter-
master disbursing oflficers at base hospitals and hospital centers might pay
accounts of civilians then employed, the Medical Department appropriations
to be reimbursed by Treasury transfer. The importance of this provision is
borne out by the fact that on November 30, 1918, there were 3,782 French
civilians on Medical Department pay rolls. The average amount of purchases
made direct by field organizations were made of record, by which many pos-
sible expenditures, by certain units which were given to extravagance, were
eliminated.
ORGANIZATION AND ADMIXISTRATIOX OF CHIEF SURCxEOX'S OFFICE 411
AUDITING MONEY VOUCHERS
In this section were audited all accounts which already had been paid
(except those on civilian pay rolls) by disbursing officers of the Medical Depart-
ment, A. E. F.^" So far as possible any errors in these accounts were corrected
before they were forwarded to the Treasury Department at Washington for
final audit. Vouchers were examined to determine whether they were legal,
were correct charges against Medical Department funds, conformed to autho-
rization for disbursement, were arithmetically correct, and there was no
duplication. The analysis also included such matters as the time interval
between delivery of supplies and payment therefor; the size of average pur-
chase; comparison of volume and prices of similar articles purchased by
different units. Data thus gained made possible not only an expedition of
payments, but also an elimination of unnecessary purchases and an approxi-
mate standardization of prices. Because of this careful auditing very few
suspensions were made by the Treasury Department in the accounts of Medical
Department disbursing officers. By cancellation of erroneous vouchers and
by securing the agreement of other departments, A. E. F., to pay items which
properly belonged to their appropriations, many millions of dollars were saved
to the Medical Department. A cash refund of approximately $15,000 worth
of overpayments was received, as a result of detection of overpayments and
duplication of vouchers. The value of carefully auditing money vouchers
and recording financial data was fully demonstrated when it was necessary
finally to submit the accounts of medical disbursing officers to the Assistant
Auditor for the War Department. These accounts were in such condition
that they could be accepted without causing any difficulty to the disbursing
officers.
ANALYSIS AND RECORD OF DISBURSEMENTS
This section made an index and abstracts of all vouchers before they
passed out of the possession of the Medical Department.-" These important
abstracts included such data as the name of the vendor, material, price paid,
date paid, by whom paid. They were made with the view of facilitating
future settlement of claims which previous wars showed would continue to
be made for many years.
ANALYSIS AND RECORD OF ACCOUNTS OF CIVILIAN PERSONNEL
This section audited and made abstracts from pay rolls of civilian personnel
before the rolls were forwarded to the Treasury.^" The abstracts showed names
of civilian employees, authority for employment, when and where employed,
when and l\y whom paid, etc. Prior to payment many erroneous items were
eliminated, some refunds were procured, and some payments were transferred
to other corps. Also in this section, efforts were made to provide for prompt
payments.
ANALYSIS AND RECORD OF HOSPITAL FUNDS
This section audited the individual hospital fund statements rendered by
the mess officers of the various Medical Department units, maintained a file
of custodians of hospital funds, and records covering the amounts due to
various hospitals from individual officers for subsistence while they were
412
AD]MINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
patients in hospital.-'" At the peak of this work in March, 1919, 691 organiza-
tions were rendering monthly statements and the transactions represented hy
them amounted in one month to approximately 35,000,000 francs.^" Not only
were man}^ underpayments and overpayments corrected, but efforts were made
also to promote prompt payment of bills rendered by French civilians.'^ Defi-
cits were prevented by issuing warnings to those concerned; in some instances,
when gross negligence was evident, liquidation was secured from the private
funds of officers who were responsible. Arrangements were made for the
transfer of food stocks between organizations. The decision of the Comptroller
of the Treasury giving the Medical Department the right to retain proceeds
from sales of waste, and the right to turn in to the Quartermaster Corps unused
food stocks led to relatively large savings; proceeds thus secured from the
sale of garbage amounted to several hundred thousand francs.'^ One of the
activities of this section pertained to the collection of funds from officers for
payment of their subsistence while in hospital at the rate of $1 per day.'^
Many officers inadvertently overlooked this obligation, but thousands of dollars
were saved by carefully following them up.'^
TRAVELING AUDITORS OF HOSPITAL FUNDS
This section consisted of a small staff which checked up records when
there appeared to be anything irregular, but whose chief duty was instruction
in the field of mess officers and hospital fund custodians in technicalities per-
taining to these funds, the correction of errors, and the proper execution of
disbursing and property papers. Constantly in the field, they gave instruction
to Medical Department clerks in the preparation of disbursement vouchers,
property vouchers and returns; also, they assisted very materially in closing
money and property accounts of units returning to the United States.'^ Always,
there were more calls for their services than could be met.^*^
CUSTODIANSHIP OF CENTRAL HOSPITAL FUND
The work which engaged this section was taken over about September 13,
1918, when the hospital fund in the chief surgeon's office amounted to 18,800
francs. ^2 Subsequently, this section controlled the central hospital fund, the
loan or donation of small amounts to new organizations, the transfer of hos-
pital funds between organizations, the reception of funds from disbanding
units, and the closure of balances.^" The fund on May 1, 1919, was over one
hundred fifty times what it had been when taken over in the previous September,
the item of interest alone amounting to almost as much as the initial central
fund.^o By May 9, 1919, it amounted to 2,862,792.31 francs; bv May 24,
it was 3,084,000 francs.^^
LIAISON WITH FINANCE DIVISIONS AND TREASURY OFFICIALS
By means of this section the finance and accounting division maintained
close Haison with similar divisions in other departments, A. E. F., the finance
officer, the finance requisition officer, and the officials of the Treasury in the
American Expeditionary Forces. 2° This contact proved to be of value in
keeping abreast of the various developments in financial matters in the Ameri-
can Expeditionary Forces.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 413
ISSUE OF CLEARANCE CERTIFICATES
Through this section clearance certificates were issued covering money
and property accountal)ility.-° In the cases of deceased officers these certifi-
cates were issued to the Treasury Department and in the case of others to
the officers themselves. This work became considerable during the later
history of the finance and accounting division; however, its performance was
expedited through advance information concerning organizations or individuals
leturning to the United States which thus permitted the preparation of clear-
ances even before these were called for. Arrangements were such that these
certificates were issued at any hour of the day or night, usually a few minutes
after they were requested. Of the total number of clearances issued prior to
April 30, 1919 (other than those to deceased officers), only f56 were for parts
of the accounts concerned, all other clearances being complete. Officers were
assisted in every possible way in placing their accounts in correct form, and
every effort was made to create good will among those returning to the United
States and to civil life. Only 312 of the many certificates for deceased officers
were for partial clearance and practically all of the debits in these cases were
for small charges while in hospital.
BILLING ALLIES FOR HOSPITAL CHARGES
One section of the finance and accounting division was engaged in compil-
ing data, from all available sources, relative to the hospitalization of allied troups
in American hospitals, in converting these data into proper bills, and in sub-
mitting them to the governments concerned.^'' During the period that this
work was being conducted by this section, these bills amounted to $194,084.32.
In April, 1919, this work was turned over to the Medical Department represent-
ative at Paris in compliance with orders that that officer be charged with the
conduct of all financial transactions with foreign governments. Also, this
section formulated some of the bills against other departments of the American
FIxpeditionary Forces but this work also was turned over eventually to the
Medical Department representative in Paris.
COMPILATION OF STATISTICAL DATA AND FINANCIAL REPORTS
This section compiled monthly, semiannual, and annual financial reports of
various kinds, and also certain special reports which were of peculiar value at
different times.^*' These financial reports, which were rendered to the offices
concerned, covered almost every phase of the financial operations of the Med-
ical Department. From statistical data which this division maintained it was
possible to trace completely all Medical Department funds from the time they
left the United States Treasury until they were expended for material and labor.
These records covered the financial transactions of the Medical Department
from the inception of the American Expeditionary Forces until April 30, 1919.
EXAMINATION AND FILING OF PROPERTY VOUCHERS
This section maintained from 7,500 to 10,000 individual files each of which
concerned an accountable or responsible officer.^" During its most strenuous
period approximately 3,500 vouchers per week were handled. Invoices,
414
AD^rrxrSTKATIOX, AMERICAX EXPEDITIONAH V FOHCES
receipts, and returns were compared; discrepancies noted; certihcates were
audited, recorded, and filed; a card index for all officers responsible lor medical
supplies was maintained. The determination of property responsibility was the
source of much trouble throughout the entire period of activity of the finance
and accounting division, for it was seriously handicapped by the uncertain states
of property accountability in that jurisdiction. This was occasioned by eon-
fusing orders capable of various interpretations. Before the armistice was
signed accountability was especially uncertain, but an attempt was made to
require a strict accountability, subject to due consideration of the conditions
incident to active warfare. By May 1 returns to that date had been audited.
Whenever necessary, statements of differences were drafted and the balance of
the returns filed in such a w^ay as to be accessible and to show the final disposi-
tion of the case and the authority for this action.
EXAMINATION OF PROPERTY RETURNS
More than 1,000 returns were received and audited by the section engaged
in this duty.'^ It w^ould have been completely overwhelmed had not Circular
No. 68, chief surgeon's office, February 8, 1919, been issued, conformably to
existing orders. This circular limited the officers responsible for Medical Depart-
ment property to those at base hospitals, supply depots and schools and thus
eliminated from such accountability thousands of other officers who would have
been required to render returns.
LEGAL REFERENCE LIBRARY
The section in charge of the legal reference library maintained complete
files and formulated indices of Army Regulations, general orders, bulletins, and
circulars issued by the different headquarters, whether the United States Army
or the American Expeditionary Forces, abstracts of statistics and decisions of
the Comptroller of the Treasury, the Auditor for the War Department, the Judge
Advocate General, etc.^*' This section had been organized merely for the use
of the finance and accounting division, chief surgeon's office, in settling ques-
tions of legality and in keeping up to date different files of orders and decisions,
but in addition, copies of its compilations were used by Treasury officials, the
advisary board of war risk insurance, the secretary of the general staff, finan-
cial bureaus of other departments of the Army, and by various officers of the
Medical Department either in the office of the chief surgeon or elsewhere.^
This section was also called upon to draw up contracts. Questions were
referred to it much as opinions were asked of attorneys in civil life, for the per-
sonnel of this section were law^yers in civil life.
LIAISON WITH BUREAU OF ACCOUNTS AND FINANCE BUREAU
With the formation in Paris of the bureau of accounts by General Orders,
No. 5, Services of Supply, 1918, and the Finance Bureau, by General Orders.
No. 199, G. H. Q., A. E. F., 1918, a member of the finance and accounting
division, chief surgeon's office, w^as in liaison with each of them and was per-
mitted to pass upon many contemplated plans which affected financial opera-
tions in which the Medical Department was concerned. The cash expenditures
ORGANIZATION AND ADMINISTRATION OF CHIEP' SURGEON'S OFFICE 415
of that department until April 30, 1919, amounted to $15,000,000. By May 8,
1919, the Medical Department had purchased in Europe medical and hospital
supplies to a value of $21,084,943.14, exclusive of the cost of 19 hospital trains
(approximately $5,166,666.67).-"
CENTRAL HOSPITAL FUND, THIRD ARMY
By March 21, 1919, instructions had been given for the establishment of a
central hospital fund in the office of the surgeon. Third Army, and authority
had been given that office to give or take from hospital funds of units in the
Third Army such sums as might seem proper, to retain in the central fund such
portions of hospital funds, of departing units as might seem desirable, to
audit hospital fund statements of units in the Third Army and to retain audited
statements, to arrange for payment of civilian personnel out of the hospital
funds. Third Army, and to audit civilian pay rolls.
ARRANGEMENTS FOR RETURNING IMPORTANT FINANCIAL AND PROP-
ERTY PAPERS TO UNITED STATES
Early in April, 1919, arrangements were made to send important financial
and property papers to the United States by regular courier service, and at the
same time a commissioned officer from the finance and accounting division,
who was thoroughly acquainted with these various documents and could explain
them to the interested departments in the United States.-^ A section was estab-
lished in this division to collect all these Medical Department finance and prop-
erty papers to be sent back to the United States and to compile a complete
index of all communications and other papers which previously had been sent
there.
DISCONTINUANCE OF FINANCE AND ACCOUNTING DIVISION
By May 14, 1919, the chief surgeon, A. E. F., approved the discontinuance
of the finance division as of June 15 following.^" Small detachments of the office
force were to remain in service at Tours, Coblenz, Antwerp, and Washington,
while other members of it were to be discharged. The entire division was then
[)reparing copies of all records that might be needed after the originals had been
returned to the United States. These copies were to be retained in the chief
surgeon's office, A. E. F.^°
A small part of the finance and accounting division continued in the chief
surgeon's office, to make such disbursements as were necessary and to maintain
liaison with fiscal offices in the United States.^" This service continued after
the American Expeditionary Forces was succeeded by the American Forces in
France and the American Forces in Germany."
During the period August to November, 1919, the closing months of our
activities in France, claims for services rendered or supplies delivered to various
hospitals and units throughout France were investigated and vouchers prepared
and paid." Many of the accounts so paid were of long standing, the original
bills apparently having been lost." Investigations of these charges were diffi-
cult, not only on account of insufficient receipts but also because officers who
gave the orders, received the supplies, or engaged the services had returned to
the United States.
13901—27 27
416
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
After November 15, 1919, no further payments were made by the Medical
Department, but all vouchers were prepared and submitted to the quart(M-
master disbursing officer for payment." Since the medical disbursing officer
ceased to function, a total number of 70 claims for services rendered or supj)lios
delivered (many of these being final settlements covering a series of transactions
with the various persons or companies and requiring a complete check of all
bills rendered and paid in order to avoid duplication) were investigated and
vouchers prepared for submission to the quartermaster for payment.
PERSONNEL
(July 28, 1917, to July 15, 1919)
SUPPLIES
Brig. Gen. Francis A. Winter, M. C, chief.
Col. A. P. Clark, M. C, chief.
Col. Norman L. McDiarmid, M. C, chief.
Col. C. C. Whitcomb, M. C, chief.
Col. Larry B. McAfee, M. C.
Col. Norman L. McDiarmid, M. C.
Col. J. R. Mount, M. C.
Lieut. Col. Harry G. Ford, M. C.
Maj. John M. Corson, San. Corps.
Maj. John S. Fielding, San. Corps.
Maj. Donald B. Inman, San. Corps.
Maj. Arthur W. Morehouse, San. Corps.
Maj. Arthur W. Proctor, San. Corps.
Maj. William G. Soekland, San. Corps.
Capt. Bertrand Emerson, jr., San. Corps.
Capt. Thomas W. England, San. Corps.
Capt. Morey Feder, San. Corps.
First Lieut. J. R. Shea, San. Corps.
First Lieut. John Shotwell, San. Corps.
FINANCE AND ACCOUNTING
Col. Henry D. Snyder, M. C, chief.
Lieut. Col. W. D. Whitcomb, San. Corps, chief.
Lieut. Col. W. D. Whitcomb, San. Corps.
Maj. Henry Aicklen, San. Corps.
Capt. E. O. Foster, San. Corps.
First Lieut. Eugene J. Berry, San. Corps.
First Lieut. Fred W. Eckert, San. Corps.
First Lieut. Russell W. Goodyear, San. Corps.
REFERENCES
(1) Memorandum for the chief of staff, H. A. E. F., from the chief surgeon, A. E. F., July 21,
1917. Subject: War diary. Copy on file. Historical Division, S. G. O.
(2) Report on the activities of the supply division, chief surgeon's office, A. E. F., made to
the chief surgeon, A. E. F., May, 1919, by Col. N. L. McDiarmid, M. C. On file,
Historical Division, S. G. O.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 417
(3) First indorsement, War Department, Surgeon General's Office, July 25, 1917, to the
chief surgeon, A. E. F. Subject: Forwarding medical supplies without requisition.
On file, A. G. O., World War Division, chief surgeon's files, 400.314.
(4) Final Report of Gen. John J. Pershing, September 1, 1919.
(5) Memorandum for the chief of staff, H. A. E. F., from the chief surgeon, A. E. F., Septem-
ber 2, 1917. Subject: War diary. Copy on file, Historical Division, S. G. O.
(6) Memorandum for the chief of staff, H. A. E. F., from the chief surgeon, A. E. F., Novem-
ber 25, 1917. Subject: War diary. Copy on file. Historical Division, S. G. O.
(7) Report on activities, medical group, fourth section, general staff, G. H. Q., A. E. F., for
the period embracing the beginning and end of American participation in hostili-
ties, December 31, 1918, by Col. S. H. Wadhams, M. C. Copy on file. Historical
Division, S. G. O.
(8) Memorandum for the chief of staff, H. A. E. F., from the chief surgeon, A. E. F., October
7, 1917. Subject: War diary. Copy on file. Historical Division, S. G. O.
(9) Historical report to the secretary, general staff, G. H. Q., A. E. F., on the Medical
Department, A. E. F., to May 31, 1918, made by the chief surgeon, A. E. F. Copy
on file. Historical Division, S. G. O.
(10) Outlines of histories of divisions, U. S. Army, 1917 1919, prepared by the Historical
Section, the Army War College. On file, Historical Section, the Army War College)
(11) Report on the activities of the chief surgeon's office, A. E. F., from the arrival of the
American Expeditionary Forces in Europe to the armistice, by the chief surgeon,
A. E. F., March 20, 1919. On file, Historical Division, S. G. O.
(12) The Medical Department, A. E. F., to November 11, 1918, compiled by Capt. E. O.
Foster, S. C, from the chief surgeon's records, A. E. F., under the direction of the
chief surgeon, undated. On file, Historical Division, S. G. O.
(13) Memorandum, G. H. Q., A. E. F., August 20, 1917. Subject: Automatic supply.
Copy on file. Historical Division, S. G. O.
(14) Cable No. 145-S from General Pershing to The Adjutant General, September 7, 1917.
(15) Report of medical activities, line of communications, A. E. F., during the war period,
by Brig. Gen. F. A. Winter, M. D., undated. On file, Historical Division, S. G. O.
(16) Report of activities of G-4-B, medical group, fourth section, general staff, G. H. Q.,
A. E. F., by Col. S. H. Wadhams, M. C, December 31, 1918. On file, Historical
Division, S. G. O.
(17) Locations of Medical Department units, prepared in the office of the chief surgeon,
A. E. F., as of October 17, 1918. Copy on file. Historical Division, S. G. O.
(18) Manual for the Medical Department, U. S. Army, 1916, par. 536.
(.19) A handbook of economic agencies of the war of 1917. Monograph No. 3. Prepared
in the Historical Branch, War Plans Division, General Staff, 1919.
(20) Report on the activities of the chief surgeon's office, A. E. F., to May 1, 1919, made to
the Surgeon General by the chief surgeon, A. E. F. On file. Historical Division,
S. G. O.
(21) Letter from the officer in charge, finance and accounting division, chief surgeon's office,
A. E. F., to the chief surgeon, A. E. F., May 12, 1919. Subject: Report for week
ending May 9, 1919. On file, Historical Division, S. G. O.
(22) Letter from the chief surgeon, A. E. F., to the chief of staff, A. E. F., May 28, 1919.
Subject: War diary for week ending May 24, 1919. Copy on file, Historical Division,
S. G. O.
(23) Letter from the officer in cliarge, finance and accounting division, chief surgeon's office
A. E. F., to the chief surgeon, A. E. F., March 24, 1919. Subject: Report for week
ending March 21, 1919. On file. Historical Division, S. G. O.
(24) Letter from the officer in charge, finance and accounting division, chief surgeon's office
A. E. F., to the chief surgeon, A. E. F., April 14, 1919. Subject: Report for week
ending .\pril 11, 1919. On file. Historical Division, S. G. O.
(25) Letter from tlie chief surgeon, American Forces in France, to the commanding general,
A. E. F., December 30, 1919. Subject: Report from July 1, to December 30, 1919.
Copy on file, Historical Division, S. G. O.
CHAPTER XX
THE VETERINARY SERVICE
AS PART OF REMOUNT SERVICE
As related in Chapter V of Volume I of this history, when we entered the
World War the Veterinary Corps of the Army, established the preceding year
(1916),' was not completely organized. This accounts for the fact that, when
(Jeneral Pershing's headquarters sailed for France in May, 1917, it included
no personnel lor a veterinary service, nor did it carry plans pertaining thereto;
none were existent. Veterinary officers were soon sent abroad in small numbers
as requested, but the calls for them did not become urgent until shipments of
animals in considerable numbers began in October of the same year.
In the absence of data concerning the organization of a veterinary service,
and regulations for its guidance, it was necessary to develop these independ-
ently in the American Expeditionary Forces. The general organization project
approved by headquarters, A. E. F., July 10, 1917, provided for 1 mobile
veterinary hospital, staffed by 4 officers and 150 men for each corps, and for a
unit of the same composition for each army. Since this project did not specify
the veterinary service of divisions, the Surgeon General, on September 12, 1917,
cabled General Pershing as follows : -
In your report on organization you recommend 1 mobile veterinary hospital, consist-
ing of 4 officers and 150 men, for each corps and for each army. This personnel seems
inadequate according to best advice obtainable here. Surgeon General recommends 1 mobile
section of 1 officer and 20 men for each division and 1 base hospital, 5 officers, and .3.50 men
for each 12,500 horses in forces based on probability of 10 per cent incapacitated. Does
this meet with your approval?
In explanation of his plans General Pershing, on September 24, 1917, sent
to War Department the following cable: ^
Referring to your cablegram 169, report shows only one mobile veterinary hospital
of corps and army; it does not include lines of communication veterinary hospitals which
are in process of being organized. Am now organizing advance veterinary hospitals of
lines of communication for 1,000 animals, which will be pushed up close into troop area;
also base hospitals for 500 animals. Third Cavalry upon arrival will be used exclusivelv
in remount service to which veterinary hospitals were attached. While immediate project
not large enough for ultimate needs, it nevertheless is very flexible and will permit of any
expansion necessary. Therefore, do not recommend any changes from present plans until
we have more experience. Details of project for these hospitals will be found in study of
service of the rear forwarded to The Adjutant General, by me September 21.
*******
419
420
ad:mixistration, American fa'peditioxahv fokces
The project for the services of the rear of the American Expeditionary
Forces alluded to above, based on the needs of 20 combatant and 10 rei)lace-
ment divisions, was approved by General Pershing September 18, 1917. That
part of this project which applied to the remount and veterinary service was
as follows:
Remount and veterinarian
Item
num-
ber
Service
Unit
Total
number
of units
Total
strength,
ofBcers
and
soldiers
Animals
Reference
Q-105
Q-106
Q-209
Q-210
Q-43I
Q-432
Q-433
Q-434
Q-435
Corps ---
do...
Army
do..
Line of communications.
do
do...-
do
Total
Remount depot
Mobile veterinary hos-
pital.
Remount depot
Mobile veterinary hos-
pital.
Advance remount depot.
Veterinary hospital
Base remount depot ....
Base veterinary hospital.
5
5
1
1
775
770
.504
154
2,000
2,500
2,000
500
.\. E. F. project, July
11, 1917.
Do.
Do.
Do.
26
2
2
2,043
7,592
2,044
298
6,000
26,000
6,000
1,000
Do.
11, 977
1,000
Line of communications.
10 per cent replacement.
Notes.— Q-431. Two squadrons Cavalry increased so <is to have 1 soldier per 3 animals; 28 oflTicers, 2,000 men aud
1 captain quartermaster, 6 veterinarians, 2 field clerks, 4 sergeant clerks, 2 sergeant storekeepers; total, 2,043.
Q-432. Seven veterinarians, 1 quartermaster sergeant, 10 sergeant farriers, 2 sergeant clerks, 2 sergeant checker.s,
2 sergeant overseers, 3 sergeant horseshoers, 1 sergeant saddler, 1 corps saddler, 10 corps farriers, 3 cooks, 250 privates; total,
292.
Q-433. One squadron cavalry increased so as to have 1 .soldier per 3 animals; 14 officers, 1,000 men, and 1 captain
quartermaster, 3 veterinarians, 1 field clerk, 2 sergeant clerks, 1 scrKt'iiiit storekeeper; total, 1,022.
Q-434. Four veterinarians, 1 sergeant quartermaster, 1 sergeant clerk, 1 sergeant checker, 1 sergeant overseer, 2
sergeant horseshoers, 5 sergeant farriers, 1 corporal clerk, 1 cori)or;U saddler, .") corporal farriers, 2 cooks, 125 privates; total,
149.
Q-435. Replacement to furnish all school details.
The project for the services of the rear could not constitute a comprehensive
veterinary program, for a veterinary service was necessary wherever there
were animals, whether at the front or at the rear. No provision was made
in this project for veterinary officers in the higher administrative positions
with corps and armies, or with the sections of the line of communications,
and for this reason close contact between the troops and the service of
evacuation and hospitalization was lost. The veterinary service, A. E. F., for
almost a year was conducted conformably to General Orders, No. 39, G. H. Q.,
A. E. F., September 18, 1917. This order attached the veterinary service to the
remount service, which in turn was a part of the Quartermaster Department,
A. E. F., and thus provided that the veterinary service, despite the provisions of
the national defense act, would function outside the Medical Department, for it
charged the remount service not only with the reception, care, training, condi-
tioning, and purchase of all public animals for the American Expeditionary
Forces, but also with jurisdiction of both the mobile and stationary veterinary
hospitals.
General Orders, No. 39, also providied that a 1,000-animal veterinary
hospital with a staff of 7 officers and 293 enlisted men be attached to the
advance remount depot in the proportion of 1 per army, and that it be capable
of subdivision as required. The advance veterinary hospitals were ordered to
care for disabled animals from the corps and army, and for all that might be
abandoned by units. Intermediate veterinary hospitals were to be provided as
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 421
required, and base veterinary hospitals were attached to the base remount depots
in base sections Nos. 1 and 2.
The tables of organization for the American Expeditionary Forces allowed
1 remount depot and 1 mobile veterinary hospital for each corps, and the same
for army troops. They also provided for 1 advance and 1 base remount depot
and 1 veterinary hospital and 1 base veterinary hospital for the line of commu-
nications, but gave no details for the organizations of these units.
No arrangement was made for the coordination of the veterinary service in
the line of communications with that of the several divisions nor even for the
coordination of this service in the different sections of the line of communica-
tions. Inevitably there ensued defective coordination in this service in these
several jurisdictions, for in each of them the veterinary service developed quite
independently.
General Orders, No. 42, G. H. Q., A. E. F., September 26, 1917, author-
ized 1 private, first class, or private, Medical Department, as assistant with
each veterinary surgeon, and 1 sergeant. Medical Department, with each
principal veterinary surgeon of each regiment of Cavalry and Field Artillery,
in addition to the privates above authorized. This order also specified that
when animals were treated in a regiment the commanding officer of the organ-
ization concerned would detail men from the troops, batteries, or Quartermaster
Corps to care for them.
The Surgeon General believed it inadvisable under any circumstances to
depart from the principle that the veterinary service should be controlled by
the Medical Department, and to facilitate the adoption of this viewpoint,
as well as to assist in organizing the veterinary service along lines similar to
those planned for the Army in the United States, in November, 1917, he had
two well-qualified veterinary officers sent to France for consultation in con-
nection with organizing, equipping, and supplying the veterinary department
of the expeditionary forces.^
These officers carried an advance copy of Special Regulations, No. 70,
W. D., 1917, concerning the organization of the Veterinary Corps. They
made a very comprehensive survey of conditions in the American Expeditionary
Forces, and, in conformity with a request of the chief surgeon, A. E. F., one
of them, on December 27, 1917, made the following explicit recommendations
concerning the organization and operation of a veterinary service for the
American Expeditionary Forces: ^
1. Briefly stated, the objects of the Veterinary Corps should be to prevent disease
among the animals of the Army; to relieve organizations, especially the mobile units, of sick
and disabled animals, particularly those whose mobility is affected; to treat such of these
animals as may be restored to a useful condition, and to attend to the destruction of those
which arc incurable or which can not be economically treated. With a sufficient and suit-
al)le pensonnel, properly organized and intelligently directed, these objects are easily within
the range of attainment.
2. The necessary personnel is provided by General Orders, No. 130, Paragraph III
I War Department, October 4, 1917), which directs the organization of a Veterinary Corps,
National Army, for the period of the existing emergency, and authorizes 1 commissioned
ofl^cer and 16 enlisted men for each 400 animals in the Army, the veterinarians of the Regular
.\rmy, of the National Guard drafted into the Federal service, and of the Officers' Reserve
Corps in active service to be considered part of the total commissioned personnel authorized.
422
ADMINI6TKAT10X, AMEKICAN EXrEJ)lT10NAHV iOHCES
The ])ei!sonnel may be increased or decreased, as the needs of the service rccjuirc, upon
recommendation of the Surgeon General approved by the Secretary of War. The grades
and the ratios of grades authorized for the commissioned personnel are 7 veterinarians
with rank of major, to 20 veterinarians with rank of captain, to 36 assistant veterinarians
with rank of first lieutenant, to 37 assistant veterinarians with rank of second lieutenant.
The enhsted personnel is to consist of the following grades in the proportions indicated:
Sergeants, first class, per cent; sergeants, 5 per cent; corporals, 5 per cent; farriers,
20 per cent; horseshoers, 1 per cent; saddlers 3^ per cent; cooks, 13^ per cent; privates,
first class, 21}/^ per cent; and privates, 43 per cent.
3. In accordance with section 5 of Paragraph III of this order, the Surgeon General
has submitted tables of organization of the veterinary personnel, wiiich have been ai)proved
by the Secretary of War. Regulations for the government of the personnel have also been
submitted and approved by the same authority. The plan of organization upon which
these tables and regulations were based is as follows:
(a) Veterinary officers, to be attached to divisional organizations, whose duty it shall
be to closely observe the animals of their units for symptoms of communicable disease,
to discover and report to the commanding officer, with appropriate recommendations,
unsanitary or unhygienic conditions or practices wiiich are likely to affect the liealtli or
efficiency of the animals, to treat sick or injured animals, and to arrange for the evacuation
to a hospital of thos'e which may interfere with the mobility of the organization or which
may require a major surgical operation or prolonged treatment. With each veterinary
officer there are 2 farriers, 1 private, first class, and 2 privates, a detail of this character
constituting a veterinary field unit. One such unit is provided for each brigade of Infantry,
2 for each regiment of Field Artillery and 4 for the other organizations included in a
division. Veterinary units are provided in the same ratio for detached divisional units.
Two veterinary units are provided for each regiment of Cavalry.
(6) An organization which is called a mobile veterinary section is provided for each
division for the purpose of receiving animals from the divisional organizations, giving them
such treatment as they may require, aEd transferring them to a base hospital for treatment.
(c) A division veterinarian to coordinate and supervise the veterinary service of the
division.
. (d) A veterinary officer to act as meat and dairy inspector and render miscellaneous
veterinary service.
(e) Base veterinary hospitals, 1 unit of 1,250 capacity to each 12,500 animals, located
on line of communications, advance or intermediate section, to provide suitable quarters
and veterinary service for animals which may be affected with communicable disea.ses or
which may require a major surgical operation or prolonged treatment. All animals recover-
ing in veterinary hospitals to be delivered to a remount depot under the direction of the
remount service.
(/) Veterinary hospitals for remount depots which are not located convenient to a
base veterinary hospital and also to care for diseases or injured animals debarked from
transports.
(g) Veterinary units in remount depots, 1 unit to each 2,000 animals, to inspect
the animals in the depot for symptoms of disease, to discover and report to the commanding
officer unsanitary and unhygienic conditions, to treat minor injuries and ailments, and
to arrange for the removal to a hospital of animals affected with a communicable disease
and those requiring hospital care and treatment.
4. The personnel required for these various organizations is given in detail in Table
No. 1, which is attached. In this table personnel is included also for (a) the corps mobile
veterinary hospital, and (b) the army mobile veterinary hospital authorized by General
Orders, No. 39, paragraph 2 (H. A. E. F., September 18. 1917).
(a) The corps mobile veterinary hospital ovight to prove a valuable auxilary to the
division mobile veterinary sections, acting as a casualty clearing station and thus preventing
the congestion of the mobile sections during an action.
(6) The army mobile veterinary hospital will perform a valuable service by receiving
and providing treatment for animals who.se mobility is not affected and which mav require
OKCJAXIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 423
only several daws treatment, thus saving transportation to and from a base hospital and
at the same time relieving the divisional units and the corps mobile hospital of the encum-
brance of such animals. Animals recovering in the army mobile hospitals to be evacuated
to the army remount hospital.
5. In order to organize, ecjuip, and insure the proper functioning in the theater of
(iperations of the several elements of the veterinary organization described, and to provide
for their coordination and the cooperation with the other services of the Army, it is recom-
mended that a veterinary officer be appointed chief veterinarian, with authority, under
the immediate direction of the chief surgeon, to supervise and direct the veterinary service
of the American Expeditionary Forces; also that three veterinary officers be appointed
assistant chief veterinarians to assist in the administrative work, and that the necessary
office assistants be provided. It is further recommended that for each army corps a veter-
inary officer be designated as corps veterinarian to supervise and administer the veterinary
service of the corps.
6. The organization outlined is largely supplemental to that authorized for the American
Expeditionary Forces by General Orders, No. 39 (H. A. E. F., September 18, 1917). It
l)r()vides veterinary personnel for the mobile organizations as well as for veterinary hospitals
and remount depots on the line of communications. It differs from the latter organization
ill that it jjlaces the veterinary hospitals and the other parts of the veterinary service under
(MIC administrative head and also in the veterinary personnel provided for the hospitals
and remount depots, these latter changes being based upon the experience of veterinarians
ill remount depots and in the administration of veterinary hospitals. Nearly all of the
(luestions and problems arising in the conduct of a veterinary hospital refjuire a knowledge
(if veterinary matters for their decision. Moreover, the centralization of the administration
of the veterinary service is recommended because every element of the veterinary organiza-
tion has a definite function to perform and each must work in coordination with the other
at all times to obtain satisfactory results. This harmonious cooperation can only be secured
by placing the control of all parts of the organization under the control of one head. This
plan also has the effect of centralizing responsibility. Cooperation between the veterinary
service and the remount and other services can be arranged for between the administrative
heads of these services and can be insured, if considered advisable, by regulations.
7. On the basis of the organization outlined above, the veterinary personnel required
for the organization which have already joined the American Expeditionary Forces is 59
(ifficers and 338 enlisted men. For 3 base veterinary hospital units of 1,250 capacity each,
for 1 veterinary hospital for the remount depot at headquarters of base section No. 1, and
for 3 veterinary units for the advance remount depot, all of which are at present most urgently
needed, there will be required 25 officers and 1,184 enlisted men, making a total of 84 com-
missioned and 1,522 enlisted personnel for immediate requirements. The proportions of
tlie various grades and the organizations to which they are allotted are shown in detidl in
Tal)le No. 2, which is attached.,
S. The divisional organizations which have not yet joined the divisions now here will
reijiiire 11 commissioned and 85 enlisted personnel.
9. To provide the veterinary personnel for the other organizations included in the
first phase of the priority shipment schedule, 59 officers and 1,005 enlisted men will be required.
10. For the organizations included in the second phase of the priority shipment sched-
(lule, 139 commissioned and 2,519 enlisted personnel.
11. For the organizations included in the third phase of the priority shipment schedule,
137 commissioned and 2,545 enlisted personnel.
12. The projjortion of the several grades, together with the allotment to each organiza-
tion, is given in detail in Table No. 2, which is attached.
13. On information obtained from tables of organization and from other sources which
arc regarded as authoritative, it is estimated that the organizations included in the first three
liliases of the i)riority shipment schedule will be provided with approximately 195,901 horses
and nuiles. The veterinary personnel authorized for this number of animals by General
Orders, No. 130, AVar Department, October 4, 1917, is 489 officers and 7,824 enlisted men.
'I'lie total allotment of i)ersonnel on the basis of the organization described is 430 officers and
424
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
7,675 enlisted men. The proportions of the different grades authorized and allotted will be
found in the summary at the end of Table No. 2. The number of veterinarians with the
rank of major allotted is in excess of the proportion authorized because one major has been as-
signed to each base hospital, but the proportion allowed will not be exceeded because it is
intended that some of these hospitals will be placed in charge of a captain of the veterinary
corps. The slight excess of horseshoers and of privates, first class, allotted can be readily
adjusted. The veterinary personnel for the organizations which have not yet left the riiited
States can be organized there and trained in the cantonments.
At about this time the chief of the administrative section of the general
staff, general headquarters, notified the chief surgeon, A. E. F., that the com-
mander in chief had decided to suspend the application of so much of the
Veterinary Corps regulations (Special Regulations, No. 70, War Department,
1917) as was in conflict with the organization of the remount service, A. E. F.,
as outlined in General Orders, No. 39, H. A. E. F., and that while the personnel
of the Veterinary Corps would remain under the general supervision of the
Medical Department, the commander in chief directed that the assignment of
all veterinary personnel be made in accordance with recommendations suh-
mitted by the remount service." In consequence of these instructions, the
chief of the remount service, A. E. F., assumed the direction of all of the veter-
inary personnel on duty in the American Expeditionary Forces.
On January 2, one of the veterinary officers referred to above, in an inter-
view with the chief of the administrative section of the general staff, learned
that the general staff was opposed to organizing a separate veterinary service.'
Such a service would therefore have to be attached to the remount service, an
officer of the Veterinary Corps to be designated as chief veterinarian and detailed
as assistant to the chief of the remount service to exercise technical supervi-
sion over the veterinary hospitals on the line of communications. It was
pointed out that this would place the chief veterinarian and the veterinarians
in the hospitals at a great disadvantage; the results of the hospitals' work
would depend to a great degree upon how promptly sick and injured animals
were transferred to them, and the chief veterinarian would have no control
over this very important matter. Also it would be impossible for the chief
veterinarian to introduce and maintain any custom of inspection to guard
against the introduction of communicable disease or to provide for the dis-
covery and correction of conditions or practices which would impair the health
and efficiency of animals, although it was in this way that the Veterinary
Corps could render the greatest service. Because of the absence of any system
of inspection mange, glanders, and epizootic lymphangitis, three very infec-
tious diseases, had already appeared among the animals of the American Expedi-
tionary Forces. In view of these and other conditions, it was urged that a
veterinary service should be organized as promptly as possible.'
At the instance of the chief of the administrative section, general staff, the
following memorandum was prepared, January 4, 1918, describing a plan of
organization which corresponded as nearly as was considered practicable with
the requirements laid down by general headquarters, A. E. F. : ^
1. In order that the veterinary service, A. E. F., may be coordinated with the general
plans of organization and operation, as outlined by you, the following proposals are submitted
for your consideration:
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 425
I. Organization
ZONE OF THE ADVANCE
2. Divisional veterinary personnel. — One major, Veterinary Corps, National Arm\ , as
division veterinarian; 1 veterinary officer as meat inspector and for miscellaneous veter-
inary service; 4 enlisted men; 1 veterinary officer and 25 enlisted men, Veterinary Corps,
National Army, for a mobile veterinary section. One veterinary unit consisting of 1 veterinary
officer and 5 enlisted men. Veterinary Corps, National Army, with each brigade of Infantry;
2 veterinary units with each regiment of Artillery; and 4 to be detailed by the division vet-
erinarian to the other divisional organizations as required. Total for a division, 15 commis-
sioned and 89 enUsted personnel. Veterinary personnel to be detailed in same ratio to
detached divisional organizations.
3. Corps veterinary personnel. — One major. Veterinary Corps, National Army, as corps
veterinarian; 4 enlisted. Two veterinary officers, and 35 enlisted men. Veterinary Corps, Na-
tional Army, for a corps mobile veterinary hospital, one for each corps; 5 veterinary units —
2 with each regiment of Cavalry and 1 for the other corps troops. Total, 8 commissioned
and 04 enlisted personnel.
4. Army veterinary personnel. — One major, Veterinary Corps, National Army, as Army
veterinarian; 4 enlisted men. The veterinary officers, and 75 enlisted men. Veterinary Corps
National Army, for an Army mobile veterinary hospital, one for each Army; 27 veterinary
units — 2 for each regiment of Artillery and 3 for the other organizations included in the Army
troops. Four mobile veterinary sections, 1 veterinary officer and 26 enlisted men. Veterinary
Corps, National Army, in each section. Total, 35 commissioned and 314 enlisted personnel.
LINE OF COMMUNICATIONS
5. Evacuation hospitals, to conduct animals from the corps mobile hospital, and from
divisional mobile sections and Army mobile hospitals if necessary, to the railhead for trans-
portation to base veterinary hospitals, two for each corps; 1 veterinary officer and 30 enlisted
iHOii, Veterinary Corps, National Army.
6. Veterinary base hospital units of 1,250 capacity, 1 to each 12,500 animals in the Army;
I major or captain, Veterinary Corps, National Army, in charge, 5 additional veterinary
officers and 349 enlisted men, Veterinary Corps, National Army.
7. Veterinary personnel for remount depots. — One veterinary unit for each 2,000 animals
in the remount depot.
8. Veterinary hospitals, 500 capacity each, for remount depots and ports of embarkation
base sections; 5 veterinary officers and 122 enlisted men. Veterinary Corps National Army.
9. Veterinary sections of medical supply depots. — One veterinary officer and 5 enlisted
iiKMi for each section.
ADMINISTRATIVE OFFICERS
10. One veterinary officer. Veterinary Corps, National Army, as chief veterinarian; 3
voferiiiary officers. Veterinary Corps, National Army, as assistant chief veterinarians; and
II eidisted V^eterinary Corps, National Army; total, 4 commissioned and 11 enlisted.
II. Operation and Administration
11. Divisional. — (a) The veterinary officers attached or detailed to divisional organiza-
tions are to exercise close supervision over the animals in order that the presence of communi-
cal)le diseases may be promptly discovered, that ca.ses of noninfectious diseases and of injury
may be brouglit under treatment in their incipient stages, and that sanitary conditions and
unhygienic practice may be corrected before they can do great harm. These veterinary
officers should also provide immediate treatment for diseased and injured animals and arrange
for the evacuation of those animals which require hospital care.
(6) The function of the mobile veterinary section is to receive the animals of the latter
class, give them sucli attention as they may immediately require, and transfer them to the
corps niol)ile veterinary hospital.
(r) The veterinary service of the division shoidd be supervised and administered by
tlic division veterinarian, whose relation to the veterinary personnel of the division .should
426
ADMINISTRATION, A:MERICAN P:XPEDITI0N ARY FORCES
be the same as that existing between the division snrgoon and the medical i)ers<)nnel. Tlic
division veterinarian should also act in an advisory capacity to the division commander on
all matters pertaining to the health and efficiency of the division. If, for military reasons,
the office of the division veterinarian can not be at division headcuiarters, it can be located
with the mobile veterinary section, unless otherwise directed by the division commander.
12. Corps.— The corps veterinarian should exercise the .same function with regard to
the veterinary personnel of the corps troops as the division veterinarian does with that of
the division. In addition, he should direct the operation of the wrjjt; mobile veterinary
hospital. He should arrange with the veterinary officer in charge of the army mobile veteri-
nary hospital for the evacuation of animals to that organization and also notify the veterinai v
officer at headquarters of the advance section, line of communications, of animals to Ix'
transferred to the railhead in order that the latter may send forward from the evacuation
hospitals the necessary conducting parties and arrange for the transportation of the animals
to l^ase veterinary hospitals.
13. Army. — The army veterinarian should supervise and administer the veterinary
service of the army troops and direct the operation of the army mobile veterinary hospital.
He should keep the veterinary officer at hcadfiuarters of the advance section, line of com-
munications, advised of the state of this hospital in order that the latter may make any
necessary arrangements for the evacuation of animals.
14. Evacuation hospitals. — These should be under the direction of the veterina y officer
at headquarters of the advance section, line of communications. Their function should be
to bring animals from the corps mobile hospitals, and directly from the divisional mobile
veterinary sections and from the army mobile hospital, if necessary, and care for them luitii
they are transferred to base veterinary hospitals.
15. Base veterinary hospitals, located in advance and intermediate sections, line of com-
munications, are to receive and care for animals evacuated from the organizations in the zone
of the advance and from remount depots and other organizations on the line of communica-
tions. Recovered animals to be transferred to remount depots.
16. The chief veterinarian should exercise technical supervision over the veterinary serv-
ice, A. E. F. He should be given charge, under the chief surgeon, of the veterinary personnel,
A. E. F., and should have authority to detail officers and enUsted men of the veterinary corps,
National Army, for duty, and to coordinate the operation of the various elements of the
veterinary organization. The office of the chief veterinarian should l^e located as the com-
mander in chief may from time to time direct. One of the assistant chief veterinarians
should be stationed at the headquarters of the advance section, line of communications, to
supervise the evacuation of animals from the corps mobile veterinary hospitals, and directly
from the divisional mobile veterinary sections and from the army mobile hospital when
necessary, to base veterinary hospitals in the advance or intermediate section, line of com-
munications. One of the other assistant chief veterinarians should be located at headquar-
ters, line of communications, and should be authorized to supervise and direct the base
veterinary hospitals located on the line of communications and also the veterinary service
of the mobile organization operating on the line of communications. The other assi-stant
chief veterinarian should be in the office of the chief veterinarian to render him such assist-
ance as he may require and to act as an inspector of the veterinary service.
At the instance of the chief surgeon, A. E. F., a memorandum was prepared
by one of the veterinarians from the Surgeon General's Office, giving the reason
why the veterinary service should not be attached to the remount service,
A. E. F., and a plan for its organization. This, on January 26, met with the
approval of the chief of the remount service.'
On January 30, the chief surgeon invited the attention of the commander
in chief to the unsatisfactory state of the veterinary service in the American
Expeditionary Forces.^ His letter on the subject was accompanied by memo-
randa giving a thorough analysis of the needs of that service and included
recommendations, in detail, concerning its organization, official relationship?)
and operation.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 427
Meanwhile, the Surgeon General was endeavoring to exert his influence
on the organization of a separate veterinary service, A. E. F., as is evidenced
by the following extract from a letter written by him to the chief surgeon,
A. E. F., under date of January 5, 1918:^
The Medical Department is charged by law with the respoiisibihty for the administra-
tion of the veterinary service, and it is believed that this responsibility can not be evaded.
The department, therefore, does not approve, for the present, the amalgamation of the veteri-
nary service with any other branch of the military service. The department is endeavoring
to obtain good material for the commissioned personnel of the Veterinary Corps, and is trying
to place the whole service on a much higher plane than has been the case in the United States
Army heretofore. Until the per. onnel has had greater experience in administrative matters
it will need a great deal of assistance from medical officers of all grades and positions.
Furthermore, on January 21, 1918, the Surgeon General sent the following
cablegram to General Pershing on the same subject: ^
Veterinary service in United States reorganized and placed on independent, sound
working basis suitable to requirements modern warfare. Principle followed similar to
Uritish service, excepting it is under direction of Surgeon General, which change now recom-
mended by British. Suggest immediate steps be taken to similarly organize veterinary
service with American Expeditionary Forces, creating chief veterinarian, and vesting in him
direct control and responsibility to chief surgeon and commanding general. Lieutenant
Colonel Aitken, British veterinary service, sent here your request, has been material assist-
ance in afTccting reorganization. Would you consider his assignment to your headcpiarters
at early date, as veterinary adviser in coordinating veterinary service of interior and theater
operations? New rules and regulations this service approved, printed, and circulated.
Copies in sufficient number shipped France.
On February 6, 1918, the following cablegram w^as sent to War Department
in reply partly to the above-quoted message and in explanation of the adherence
to the plan of not having an independent veterinary service, A. E. F.: "
Subparagraph A. Not advisable to depart from our plans as given in service of rear
project, and put in effect by orders issued last September. Veterinary service here branch
of remount service; administrative matters at various headquarters handled through
remount divisions of chief quartermaster's offices in which veterinarians are detailed as
necessary. As far as possible veterinary officers given complete charge of veterinary hos-
pitals, but results so far are not satisfactory. Absolutely necessary here for the present
at least to keep veterinary service largely under supervision officers of mounted services
experienced in administrative work and not create another independent service with no
experienced jjersoiHiel. We have too many loose agencies already. At present it is clear
that veterinary persoiuiel will render most efficient service if not charged with extensive
administrative responsibility. The Medical Corps will liandle the supply of medicines and
other materials through medical supply depots; will handle personnel questions pertaining
to veterinary services and exercises supervision over professional phases of work. Veter-
inarians in the various headquarters offices will perform the inspection and supervise per-
formance of the professional work.
Subparagra|)h B. It will be satisfactory if you ship corps mobile veterinary hospitals
in accordance with paragraph 1 your caljlegram 622. We will reorganize in accordance
with our plans and necessities of .service here. The extra officers and soldiers in addition
to those called for in our service of the rear project will allow us to strengthen the veterinary
personnel assigned to divisional trains of Infantry divisions so that they will be able to
attend sick or wounded animals of Infantry regiments and other units not provided with
veterinary personnel. No changes in tables of organization with regard to this considered
desirable at present. .\ny changes found desirable will be recommended later. Do not
Jipprove of a.ssignnient 1 mobile section to each Infantry division for evacuating animals
to rear, whidi under our system is to be effected by corps veterinary units.
428
ADMINISTRATION, AMERICAN EXPETHTIONARV FORCER
Subparagraph C. Other veterinary units as given in your cablegram 022 satisfactory.
All should be sent accordance priority schedule.
Subparagraph D. Number of officers for all remount units as given in i)aragraph A,
your cablegram 673, except corps remount depots appears excessive. Provision otherwise
satisfactory.
Subparagraph E. Reference headquarters personnel for remount and veterinary service
following should govern. Necessary personnel will be part of chief quartermaster's offices
and medical supply depots. Unnecessary and undesirable to have this personnel separately
prescribed as present time. Sufficient personnel available here for all above assignments
provided you send all remount and veterinary units organized as indicated in preceding
paragraphs and supply replacement drafts in accordance with arrangements for automatic
replacements. If any additional personnel is required from United States for remount and
veterinary service you will be promptly advised.
No further efforts were made, for the time at least, to secure the detach-
ment of the veterinary service from the remoimt service, A. E. F. However,
because certain responsibilities of the Medical Department, in connection with
the veterinary service, could not be overlooked, and since these had not been
definitely covered in instructions promulgated by general headquarters, A. E. F.,
the chief surgeon, A. E. F., seeking a ruling in the matter, sent, on February
22, 1918, the following memorandum to the chief of staff, general headquarters."
1. From all that has been said and written and cabled during the last two months, I
gather that, so far as the veterinary service is concerned, it is the duty of the Medical Depart-
ment to furnish personnel and supplies for the veterinary service, A. E. F., and that the
remainder of the veterinary service will be handled by the remount service. Will you please
ndicate if my conclusion on this subject is correct.
2. I consider it most important that a definite answer shall be given in this matter
before the contemplated change is made. My only desire is that the Medical Department
shall meet the obligations expected of it in the organization which has been adopted.
The pronouncement from general headquarters, A. E. F., concerning the
above-quoted memorandum from the chief surgeon was to the effect that,
since the veterinary service was a part of the remount service, the chief surgeon,
after supplying needed personnel to the Medical Department, would report
other personnel to headquarters, Services of Supply, for assignment to the
remount service for veterinary purposes. In so far as veterinary supplies
were concerned, these were to be supplied by the Medical Department.'^
The officers who had been sent to France at the instance of the Surgeon
General in November, 1917, with a view of organizing a veterinary service,
continued their efforts until March 10, 1918, when they submitted a final
report.^
Believing that there was nothing further that they could do and that their
mission was a complete failure, they returned to the United States, leaving in
the hands of the assistant chief of staff, G-1, general headquarters, A. E. F., a
lengthy memorandum and a copy of a general order pertaining to the organi-
zation and administration of the veterinary service, A. E. F., which they had
proposed.'
On March 10, 1918, the chief quartermaster, A. E. F., was directed by the
commander in chief to appoint a chief veterinarian, A. E. F., and accordingly
a veterinary officer of the grade of major was assigned to that position. The
newly appointed chief veterinarian's duties were those of a technical adviser to
the chief of the remount service rather than those of an administrator. He was
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 429
not permitted to administer his department; he was subject to the control of
the chief of the remount service, the latter in turn to that of the chief quarter-
master. Consequently, in all matters affecting the advance area, the chief veter-
inarian had to communicate his instructions through, and subject to the approval
of, not only the officers mentioned but also of the general staff, general head-
(juarters.^^ The delay in transmitting instructions through these channels was
considerable, particularly where each successive head, being responsible for each
proposal submitted through him, wanted details before he would approve and
transmit any request. This situation was of most serious import when the out-
break of an epidemic was reported, for the chief veterinarian, being only a
technical adviser for his own branch of the service, was not permitted even to
exercise technical administrative duties over other veterinary officers.'^ Even-
tually, however, he was given authority to correspond with division veterina-
rians direct on technical subjects.
Neither the chief of the remount service nor chief veterinarian had any
direct authority in the zone of the advance, so that the administration of the
two services, remount and veterinary, in the armies had to be effected through
general headquarters.^^ As a result of this situation some 75,000 animals in the
advance area were practically outside of their administrative control.''^
Since animals on purchase were shipped direct to remount depots, and 70
per cent of the animals became sick on arrival, the remount depots became vir-
tual veterinary hospitals; consequently animals cured at veterinary hospitals
were issued direct to divisions. Veterinary units arriving in France from the
United States had to be sent to remount depots instead of to veterinary hospi-
tals because of the great numbers of sick animals there. Mange spread exten-
sively among all the animals of the American Expeditionary Forces, and in the
advance zone thousands of them had been treated by hand through lack of
properly constructed mange hospitals with hot sulphur baths.
A systematic method of remount and veterinary construction did not go
into effect until June, 1918.^^ All veterinary hospitals were crowded to the
utmost, and half of our sick animals were being treated either at remount depots
or with their organizations. At one time 600 animals of the 1st Division were
turned over to a French Cavalry regiment for treatment for the cure of mange,
as we had not sufficient hospital space to treat them.'^ Glanders broke out
frequently among the animals of combat divisions, and because it took five
(lays or more through the necessary channels of administration to reach the
outbreak, the disease naturally spread to a greater number of horses than would
have been the case with a more direct system of control.
On July 3, 1918, General Pershing requested the War Department to send
to France the best available senior veterinarian for administrative duty.^* The
officer selected sailed on July 30, 1918.
Reports received about this time showed an enormous amount of sickness
and disability among public animals. For weeks the noneffective rate was
above 30 per cent, and the prospects seemed excellent for a complete breakdown
(if the veterinary service and the practical immobihzation of animal organiza-
tions.
430 AD.MINISTUATIOX. AMERICAN' KXPKDITIOXAHV KOHCKS
The defects in service which had developed up to this time \ver<> attrihiittMl
by the officer who had been acting as chief veterinarian, to the followiii<; con-
ditions:
(1) Lack of technical adiniiiistratioii of the veterinary service by a chief veterinarian;
(2) mixing of diseased and healthy horses at remount depots; (3) slowness of construction of
both veterinary hospitals and remount depots; (4) the necessity of entire separation of a
service of supply such as was the remount service, and a service of salvage, such as was the
veterinary service; (5) the lack of a high ranking officer representing the veterinary service
as a separate organization.
General Orders, No. 122, general headquarters, A. E. F., July 26, 191<S,
revoked General Orders, No. 39, 1917, but the veterinary service remained
attached to the remount service and under its jurisdiction. The chief veteri-
narian retained technical supervision of the veterinary service, A. E. F., and the
necessary officers and personnel for this purpose were assigned to his office.
In a memorandum to the commander in chief, A. E. F., dated August 9,
1918, the chief surgeon. A- E. F., remarked that the existing organization in
veterinary service was as illogical as making the medical service of an army a
function of the recruiting and replacement service.'*' It prevented the develop-
ment of the veterinary service along professional and scientific lines and resulted
in the mingling, at all points along the line from rear to front, of serviceable
horses going forward with sick horses going back, thus resulting in a very high
mortality rate and a great deal of infectious disease. Seventy per cent of the
animals in the American Expeditionary Forces at the time were suffering from
sickness, whereas in the British service the proportion was only 7 per cent from
all causes.
At this time a veterinary officer and a remount officer of the British Army
were assigned to headquarters. Services of Supply, in response to a cabled
request for their services in order that they might give the American Expedi-
tionary Forces the benefit of their experiences.^^ These officers, through the
headquarters of the British mission, made certain recommendations for better-
ment in the remount and veterinary services, A. E. F. The British veterinary
officer, who had been of great assistance to the veterinary service in the United
States, obtained audiences with the chief of staff", A. E. F., and the chief
quartermaster, A. E. F., and recommended that the veterinary service, A. E.F.,
be made to conform to Special Regulations, No. 70, War Department, which
order he had assisted in formulating.'^ After the chief of staff, A. E. F., and
chief of the remount service had inspected several remount depots and veteri-
nary hospitals, this recommendation was approved and General Orders, No.
139, general headquarters, A. E. F., August 24, 1918, was issued, directing
that the veterinary service be transferred from G-1 to G-4, general headquarters,
that a veterinary division be established in the office of the chief surgeon, and
that the veterinary service, A. E. F., conform to Special Regulations, No. 70,
War Department, 1917. This order was the basis of the perfected organization
of the veterinary service, A. E. F.
AS PART OF MEDICAL DEPARTMENT
Under the chief surgeon the officer at the head of the veterinary division
of his office was now charged with the administration of the veterinary service,
A. E. F., whose relations with the remount service were to be those prescribed
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 431
by paragraph 138 of Special Regulations, No. 70.'^ The organization of
veterinary units was to continue as prescribed by the tables of organization
then in force.
On August 27, a Veterinary Corps officer was made chief veterinarian,
A. E. F., and was assigned to the chief surgeon's office, and, on August 29, a
veterinary division of that office was organized.'*^ It was through no fault of
its own that the veterinary service, A. E. F., had not been properly organized
at an earlier period of its history, but defects yet were such that they were
not overcome until March, 1919.'^
The adoption of Special Regulations, No. 70, War Department, 1917,
marked the real beginning of the veterinary service, A. E. F. This new organ-
ization provided a simple, direct, and efficient mechanism for the evacuation
of sick and inefficient animals from combatant forces to veterinary hospitals
in the Services of Supply, where organized and specially trained units cared
for them. From these Services of Supply hospitals the animals that were free
from disease were evacuated to remount depots and thence returned to service.
Animals which were not considered fit for treatment and eventual reissue
were sold to butchers and civilians or killed to terminate their suffering. Some
were employed in the Services of Supply.
The veterinary hospitals were placed under command of veterinary offi-
cers, and steps were taken immediately to collect scattered companies and
half companies of such hospitals into whole working organizations.^^ The
issue of convalescent animals from veterinary units back to organizations was
stopped, and the policy of passing all convalescent animals through remount
depots for reissue was instituted. The prompt rendition of weekly animal sick
reports and their accurate compilation was insisted upon. Requirements were
anticipated and reenforcements from the United States, already overdue, were
cabled for. Further hospital accommodation was sought, and, with difficulty,
an insufhcient amount procured.'*' These measures led to a material reduction
in animal morbidity.'^
The chief veterinarian, A. E. F., exercised direct jurisdiction over the
activities of the veterinary service onl}^ in the Services of Supply; in the zone
of the armies, administrative contact effected this through a veterinary officer
with the fourth section of the general staff, G. H. Q.^* Through arrangements
with the British and the French missions, an officer of the veterinary service
of the British and French Armies was secured for liaison work.'^ These officers
were assigned to the office of the chief veterinarian, A. E. F.'^
As finally organized, the office of the chief veterinarian comprised the
following: The chief veterinarian; executive officer; one inspector; an admin-
istrative branch ; a construction branch ; a personnel branch ; a statistical branch ;
liaison officers.
ORGANIZATION AND PERSONNEL
Tables of Organization, No. 331, December 31, 1917, prescribed for a
veterinary hospital (capacity 1,000 patients) 7 veterinary officers, 1 medical
officer, and 311 enlisted men. Tables of Organization, No. 109, February 12,
1918, fixed the strength of a corps mobile veterinary hospital at 2 officers, and
13901—27 28
432
ADMINISTRATION, AMERICAN EXPEDITIONAHV FORCES
35 enlisted men. Tables of Organization, No. 330, March 10, 1918, prescribed for
a mobile army (or for a base), veterinary hospital (capacity 500 animals) 4
officers and 144 enlisted men. Tables of Organization, No. 43, January 14, 191S,
provided for each Infantry division 3 veterinar}' field units and 1 mobile
veterinary section, the total personnel of this service for a division being placed
at 12 officers and 51 enlisted men. Each division leaving the United States
was to be accompanied by this contingent, part of whose members composed
the units above mentioned while the others were assigned to division head-
quarters, brigades, Artillery regiments and trains.
The veterinary hospitals authorized for the American Expeditionary Forces
were as follows : Corps mobile veterinarj^ hospital (evacuation) with 2
officers and 35 enlisted men; army mobile veterinary hospital (evacuation)
with 4 officers and 144 enlisted men, and designed for 500 patients with half
the equipment of a veterinary hospital; base veterinary hospital (stationary)
with the same allowance of personnel and equipment as the preceding; and
veterinary hospital (stationary) with 8 officers and 311 enlisted men. The
last mentioned, which was the typical hospital for the service of the rear,
had a normal capacity of 1,000 patients.
General Pershing's project for the rear called for the shipment of the
foregoing units as follows: Corps mobile veterinary hospitals, 5; army mobile
veterinary hospitals, 1; base veterinary hospitals, 2; veterinary hospitals, 26.
The phases under which the foregoing units were shipped are shown on
page 209, Volume I of this history. Other units organized which reached
France under an additional (October) phase consisted of corps mobile veterinary
hospitals Nos. 7, 8, and 9.^^
Veterinary personnel w^as also sent to France with 4 Cavalry regiments,
6 Engineer regiments, and 29 remount squadrons.
The 1st, 2d, 26th, 42d, 41st, and 32d Divisions left for overseas in the order
mentioned before the veterinary personnel was fully assigned or the mobile
sections organized, but the latter were assembled and sent over as a part of
the first phase.
With the foregoing exceptions, veterinary organization of the first eight
Regular Army, the National Guard, and the National Army divisions was
accomplished at the station when each division was organized, and the
veterinary units proceeded overseas with their respective divisions.
In April, 1918, the 132 veterinary officers available in France were quite
able to meet all needs, but the situation was quite different in so far as enlisted
men were concerned.'" The first two veterinary hospitals, comprising some
300 men each, arrived in France on April 4, 1918,'" the delay in their arrival
being due to the same cause that delayed other Medical Department organiza-
tions; that is to say, shortage of tonnage and the necessity for giving priority to
combatant troops.'" This shortage of men was somewhat refieved, however,
by detailing certain squadrons of the remount service to assist the veterinary
service.'"
With some minor changes veterinary units organized in the United States
in conformity with the project for services of the rear were sent to France
as called for in the priority schedule.'^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 433
The following tabulated statement shows the veterinary hospital units
and their enlisted strength which arrived in France between April 16, 1918,
and January 1, 1919, with dates of embarkation from the United States and
of demobilization:
Veterinary hospital:
1
2 - -
3 ----
4
5
6 ---- ----
7 -
8
9 - ---
10 -
n -
12 -
13
14
15
16 ---
17 ----
18 ---- --
19 --- ---
20 -
21
25 - - ----
Base veterinary hospital:
1
2 - --- ---
Mobile army veterinary hospital
IA
IB --
2
Corps mobile veterinary hospital:
1
2 ----
3
4
7 -
8
9
Veterinary replacement unit:
1
2
3 - --
4
Number
of veteri-
nary
officers
Number
of enlist-
ed men
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
141
144
144
72
72
144
35
35
35
35
35
35
35
200
200
200
195
Date of
embar-
kation
1918
Apr. 16
Mar. 28
May 15
Apr. 29
May 9
Mar. 28
Julv 26
._do
__do
._do_.,.
..do....
...do....
Oct. 4
Oct. 8
Oct. 14
Oct. 28
...do.
Oct. 29
Oct. 21
...do. ..
...do.-..
Oct. 27
Apr. 16
Oct. 28
July 26
Oct. 28
Nov. 19
Apr. 18
July 26
Oct. 28
...do.--.
Nov. 22
Nov. 23
Nov. 24
Oct. 14
...do..-.
...do..-,
.--do....
Date
of de-
mobili-
zation
1919
June 21
June 20
June 12
June 18
June 12
June 19
June 25
June 26
June 24
June 22
June 19
Do.
June 28
Do.
Juno 29
Juno 26
July 6
Juno 19
Do.
Do.
July 5
Jan. 26
June 20
July 5
(')
(»)
(°)
(>>)
July 5
(')
do
Aug. 15
Juno 30
July 1
(")
C)
(")
(")
» Absorbed in other units.
' Absorbed.
As shown in the foregoing statement, several of the units were absorbed by
other veterinary organizations in France, and never operated independently.
They were demobilized with the units of which they had become a part.^^
In addition to hospital groups above listed, other personnel was sent over
with divisions, corps, and army organizations, until the Veterinary Corps,
A. E. F., reached a maximum of 890 commissioned officers and 9,701 enlisted
luen.^^ The latter were augmented by 2,000 labor troops who were assigned to
this service, and at various times temporarily by several hundred men of the
remount service. There w^as no appreciable service diminution until April 1,
1919, when the veterinary service began to be gradually reduced and personnel
sent to the United States for demobilization and discharge.^^
434
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The following table shows the strength of the Veterinary Corps, A. E. F.,
as of various dates:
Date
1917
Dec. 15...
Officers
1918
Jan. 5
Feb. 2....
Mar. 2
Apr. 6
Apr. 20...
Apr. 27...
May 4
June 1
June 15...
June 29...
July 6....
July 20...
Aug. 3....
Aug. 24_..
Sept. "...
Sept. 21..
Oct. 5
Oct. 19...
106
105
113
115
141
191
203
214
262
326
353
380
421
443
523
555
642
678
719
Enlisted
men
18
18
596
597
626
1,042
1,635
2, 101
2,155
2,246
2,482
4, 256
4,413
4,450
4,612
5, 055
Date
1918
Nov. 2...
Nov. 16..
Nov. 30..
Dec. 7....
Dec. 28...
1919
Jan. 11...
Jan. 28...
Feb. 1.-..
Feb. 22...
Mar. 1_.-
Mar. 22..
Apr. 5
Apr. 19...
May 3._.
May 17.
May 31..
June 7
June 13. -
June 20..
Officers
Enlisted
men
728
5 166
802
.5, 505
854
8, 152
857
8, 275
890
8, 970
835
9,282
853
9,423
850
9! 458
839
9,701
832
9,661
819
9,583
778
9, 527
759
9, 430
700
9, 257
634
9, 104
551
8,560
523
8,285
451
6, 192
329
4, 819
HOSPITALS
No real veterinary hospitals were established in France in 1917.'^'^ Such
hospitals began to appear in the spring of 1918; so far as records go the first
establishments were as foUows:^^ No. 6, Neufchateau, April 16, 1918; No. 4,
Carbon Blanc, May 4, 1918; No. 4, Camp de Souge (detachment from hospital),
May 12, 1918; No. 10, Bourborme-les-Bains, July 8, 1918; No. 8, Claye
Souilly, August 8, 1918; No. 9, St. Nazaire, August 8, 1918; No. 7, Coetquidan,
August 8, 1918.
When the Medical Department took over the veterinary service on August
29, 1918, there were in operation 11 hospitals, with a total capacity of 11,580
animals. Fifteen had been established, but some had been abandoned.
On November 1, 1918, there were in operation 15 veterinary hospitals
throughout the different areas of the American Expeditionary Forces, but not
all construction had been completed. The total animal capacity then available
was approximately 12,000, but this was inadequate as many more cases than
this number had to be cared for, thus necessitating the use of picket lin^s,
corrals, paddocks, and other expedients.
After November 1, however, locations for veterinary hospitals were rapidly
secured at Verdun, Longuyon, and Commercy, in the advance section, and
construction was rushed to completion at Sougy and Lux, in the intermediate
section.^* Three thousand animals were turned in to the veterinary hospital
at Verdun within 24 hours after the personnel arrived there for station in Decem-
ber, though the accommodation of the veterinary hospital there was for les.s
than 1,700 animals.^*
A determined effort was made to locate new hospital sites and have more
labor troops assigned to Veterinary Corps to aid in evacuation and care of sick
animals until the veterinary hospital personnel which were on the water or
cabled for would arrive.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 435
On November 11, 1918, one army mobile veterinary hospital was in serv-
ice of the First Army, where it had been for several months,^^ and another in
that of the Second." At this time mobile veterinary hospitals which had been
provided for the First, Second, Third, Fourth, and Seventh Corps, were either
assigned or available; furthermore, a mobile-veterinary hospital for each of the
three other corps was on the shipping program." Twenty-one veterinary hos-
pitals and two base veterinary hospitals were provided in the Services of Supply,
and 10 other veterinary hospitals and 1 other base veterinary hospital were on
the shipping program or in process of organization in France when the armistice
was signed."
When the Third Army moved to the Rhine, locations were secured for
veterinary hospitals at Coblenz and Treves, and personnel to man them was
rapidly pushed forward. Stables of knock-down type for 10,000 animals were
held in readiness at Verdun for shipment to the Third Army if required.
Location of the principal veterinary hospitals, American Expeditionary
Forces, during operations, with the approximate animal capacity of each:^^
Location
St. Nazaire
Coetquidan
Carbon Blanc
Camp de Souge...
(lievres
Nevcrs
Neuilly L'Eveque
Triconville
Treveray
Valdahon
Animal
capacity
3,000
2, 160
950
1,000
2,000
1,000
1,200
1, 350
1,000
1,300
Location
Jeanne d'Arc.
Neufchateau-
Claye Souilly
Bourbonne-les Bains
Commercy
Lux-
Longuyon
Verdun
Orosrouvres
Woinvillc
Animal
capacity
1,000
1,700
1,200
1,250
750
700
1,200
2,000
300
300
Veterinary hospitals were established also at Toul, Meucon, Epinal, Sougy,
and Treves, in the zone of the armies.
The maximum number of veterinary hospitals, exclusive of those with
the armies, was 21. The total capacity of these hospitals was 27,614 animals.^*
On March 1, 1919, there were 20 veterinary hospitals in operation, exclu-
sive of army veterinary hospitals with an animal capacity of 26,664, and
containing about 20,000.^^
After April 1, 1919, the capacity of veterinary hospitals was gradually
reduced, and by May 1, 12 veterinary units had been placed on the priority
list for return to the United States, and all labor troops had been relieved from
duty with the veterinary service. Only 8 hospitals were then in operation,
containing about 4,000 animals. The hospitals could have been evacuated
more rapidly but for the fact that the remount depots were receiving animals
from troops that were returning home and were crowded to capacity.^'' There-
fore animals were held at hospitals until they were in a salable condition.
After June 20, 1919, demobilization proceeded very rapidly and by Septem-
ber practically all members of the veterinary service had been returned to the
United States except such as were designated for duty with the American
forces in Germ any.
436
ADMINLSTKATIOK, AMEHICAX EXPEDITIONARY FORCES
SUPPLY OF ANIMALS
Much of the embarrassment of the veterinary service was clue not only
to inadequate personnel but also to the overcrowded condition of the hospitals,
which in turn resulted from the fact that replacement animals were not avail-
able in sufficient numbers at any time prior to the armistice to permit early
evacuations of animals moderately incapacitated. This caused great numbers
to become totally incapacitated, required hurried evacuation, and necessitated
relatively prolonged treatment.
In July, 1917, the French agreed to furnish our forces with 7,000 animals
a month; accordingly, the War Department was requested to discontinue
shipments." However, on August 24, 1917, the French advised us that it
would be impossible to furnish the number of animals originally stated, and
the War Department was again asked to supply animals, but none could be
sent over until November, and then only a limited number.^''
Up to July, 1918, relatively few^ horses belonged to the American Expe-
ditionary Forces."* When it was decided to hasten the departure of American
troops to France, the prevailing shortage of ship tonnage made it impossible
to transport with troops their full complement of horses. As a result, in April,
1918, although there were six divisions of the American Expeditionary Forces
in France, they had (including all animals in remount depots) only 55,378
animals."* It had been hoped that horses could be obtained in Europe, but
the supply proved altogether insufficient, and consequently what horses the
American Expeditionary Forces had were overworked, contracted a large
amount of contagious diseases, and rapidly became inefficient through sickness,
with a high mortality. "*
Early in 1918, after General Pershing's personal intervention and much
delay, the French Government made requisition on their country and we were
able to obtain 50,000 animals. After many difficulties, the purchasing board
was successful in obtaining permission in the summer of 1918 to export animals
from Spain, but practically no animals w^ere received until after the armistice
was signed." Sound animals sent up from depots were soon infected in divi-
sional areas.
Because of the shortage of veterinary surgeons in the American Expedi-
tionary Forces, no officers of that corps were available for the inspection of
some 30,000 of the animals purchased; a result of this situation was the inclu-
sion of a great many diseased horses among those thus procured. Every
effort was made to reduce animal requirements by increased motorization of
artillery and by requiring mounted officers and men to walk, but in spite of all
these efforts the situation as to animals grew steadily worse. The shortage
by November 1, 1918, exceeded 106,000, or almost one-half of all our needs.
To relieve the crisis in this regard, during the Meuse-Argonne operation.
Marshal Foch requisitioned 13,000 animals from the French armies and placed
them at the disposal of the American Expeditionary Forces."
EVACUATION OF SICK AND WOUNDED ANIMALS
The system of animal evacuation adopted by the American Expeditionary
Forces, and promulgated in General Orders, No. 39, H. A. E. F., September 18,
1917, was similar to that employed by the British veterinary service. In
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 437
this order it was prescribed that the veterinary service should operate as
follows: Animals with organizations of the army that were wounded or had
become unserviceable were to be taken over by mobile veterinary units and
delivered to the nearest veterinary hospital. The organizations from which
these unserviceable animals were taken were to requisition on the nearest corps
remount depot for the animals needed to replace those turned over to the Veter-
inary Corps, and the corps depot was to deliver to the organizations the animals
asked for. The corps remount depots were to be kept filled by transfers of
animals from the Army depot which was to keep its quota of animals by requisi-
tion on the advance or base depots. All remount depots were to receive at
any time any animals that had been cured of disease or that had recovered
from wounds at veterinary hospitals. In short, the remount service was to
keep organizations supplied with serviceable animals and the veterinary
service was to relieve organizations of the care of all sick or unserviceable
animals.
There was no intrinsic reason why this plan should not have worked
successfully provided it was completely developed. It was merely an outline
of the plan of supply and evacuation, and since there was neither provision
for administrative veterinary officers nor for the close coordination of the
different parts of the veterinary service, inevitably there developed under
General Orders, No. 39, H. A. E. F., 1917, one veterinary service functioning
under the remount service, and one in each division, all operating quite inde-
pendently.^'^ Also, no corps or Army veterinary service was provided for in
connection with moving troops, nor was there any arrangement for coordination
of the services in the base, intermediate, and advance sections.
The need of an organized veterinary service in the army zone became
strikingly apparent during the Aisne-Marne operation in the summer of 1918.'®
In the First and Third Corps, which participated,^" no uniform system for the
evacuation of disabled animals had been provided for, and each of the con-
stituent divisions operated its veterinary service independently, caring for its
animals and disposing of them on its own initiative and as best it could.
This lack of coordination in these two corps entailed a great loss of animals.
In the First Corps a corps veterinarian was appointed who organized a corps
mobile hospital of 2 officers and 35 men, augmented by a troops of Cavalry.
It is noteworthy that this organization collected disabled animals from the
divisions of the corps and prepared plans for their subsequent shipment to
the rear, thus being our first attempt to carry out a systematic plan for the
evacuation of disabled animals.
FIRST ARMY
In the plans for the organization of the staff of army and corps. First
Army, no provision had been made for a veterinary staff service, but as the
necessity for such service was now recognized, an army veterinarian was
appointed for the First Army when that force was organized.^'' This officer
operated under the remount service until the veterinary service was transferred
to the Medical Department, August 27, 1918.
438
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
During the earlier operations evacuations of animals were effected in the
First Army as follows: Division mobile veterinary sections, located at the
most accessible points for receiving animals from divisional units, received and
prepared all cases for evacuation. Here first aid was given; the mallein test
was administered; if necessary, animals were shod; if in a hopeless condition,
they were destroyed to prevent suffering. From the divisional collecting
points they were transported overland by the mobile veterinary sections to
the receiving points of corps mobile veterinary hospitals where they were
classified, given first-aid treatment as at divisional points, and in turn evacuated
to the army mobile veterinary hospitals. These units were charged with the
temporary care of animals and their shipment to Services of Supply hospitals.
At first, the use of railheads for the evacuation of sick animals was refused
by the First Army, without reference to general headquarters, A. E. F.^' Thus
hundreds of animals debilitated and sick, often suffering from serious wounds,
were lost, through being evacuated long distances overland; literally thousands
were retained with divisions through the inability of the veterinary personnel
to cope with the requirements of long overland evacuation. Eventually, the
necessity for evacuating by railroad was conceded, but for a time another
difficulty obtained. ^3 Instead of the activity being considered a veterinary
one, it was placed directly under G-4 of the army; consequently, this portion
of the evacuating mechanism being out of the control of the army veterinarian,
adequate arrangements could not be made by him to send trainloads of sick
animals to the hospitals prepared to receive them.^^ Instead, animals to be
evacuated were sent to hospitals deemed most suitable by G-4 of the army,
the personnel of which did not always possess adequate knowledge of the
receiving capacity of such hospitals. Presently this obstacle was removed,
however, and veterinary evacuating hospitals (sections) commanded by veteri-
nary officers, took over the evacuated animals from divisions and moved them
by railroad to allotted hospitals.
About October 1, 1918, two army evacuating units were placed forward
near advanced railheads to carry on the work of receiving sick animals direct
from the divisional mobile veterinary sections and attend to their evacuation,
the corps units being taken over and consolidated with those of the army.^^
This proved of great advantage and was the means of saving the lives of many
animals that otherwise would have perished on the way to the rear under the
operation of the former system.
Because of the great shortage of replacements necessary to keep up the
animal strength of organizations, the evacuation of inefficient animals, unless
totally disabled, was impossible during active operations." This circumstance
in turn caused many animals to be returned which should have been evacuated
earlier.
Failure to provide animals for replacements during active operations was
a most important factor in the increase in the number of sick.^^ It happened
repeatedly that the recommendation of veterinarians concerning the evacuation
of unfit animals was opposed by unit commanders, who protested that sick and
emaciated animals were better than none and that the activities of their units
would be crippled or wholly suspended unless the sick aminals were retained or
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 439
replaced. Consequently, animals were worked until they starved to death,
(lied in harness or were in such condition that when evacuated they could not
be cured." Also under these conditions mange spread so rapidly that the entire
animal strength of some organizations was affected." Inevitably there were
groat losses which could have been averted had replacements been available.
The retention of inefficient animals within combatant units hindered in no small
measure the mobility and efficiency of organizations operating on the front line.
Not until after the armistice began did these units fail to show hesitancy in
evacuating incapacitated animals, and then sick animals long retained in divi-
sions were thrown in large numbers upon the veterinary service for evacuation
and treatment. Upon the removal of a great percentage of the sick, the effi-
ciency of the animals left was markedly increased.
Adequate provisions could not be made for the flow of evacuations that
ensued after the St. Mihiel and Meuse-Argonne operations, and, as a result,
the veterinary hospitals were greatly undermanned and overcrowded.'^ Sick
animals had been so long retained with divisions, that their evacuation in bulk,
although absolutely necessary, threw great strain on all veterinary hospitals,
and some of them perilously approached collapse.^'
The large number evacuated at this time is indicated by the fact that, in
24 hours, 3,000 animals were evacuated to the veterinary hospital at Verdun
where the stable capacity was only 1,625.^^ Fortunately, 10 veterinary hos-
pitals were at sea or under orders to embark, and until sufficient veterinary
personnel became available labor companies and remount squadrons were tem-
porarily detailed to assist these hospitals. However, even with this increase
of resources there was not sufficient personnel to meet the situation fully.
An efficient veterinary service which gradually brought the animal effici-
ency of the American Expeditionary Forces to a standard comparable with that
of the Allies was not reached until after the armistice was signed.
The following figures pertaining to the First Army indicate to a degree the
scope of its vetinary service Animals evacuated, 11,507; died, 2,037; de-
stroyed, 1,334; killed in action, 734. The highest number of animals of the
First Army was 93,032, while the average strength was 8,841. Mange and
debility caused the majority of the evacuations from the First Army.
SECOND ARMY
The Second Army evacuated its disabled animals to a vetinary hospital
established at Toul, whence some animals were sent to other veterinary hospi-
tals in the Services of Supply. When the Second Army was organized October
10, 1918,^^ it was not intended that it should at once undertake a vigorous
operation. It had a relatively quiet sector, and was preparing for an offensive
which began three days before the armistice was signed and was terminated by
that event. ^'
At this time advanced Veterinary Hospital No. 5 was stationed at Jeanne
d'Arc Caserene, near Toul.^^ This unit had been utilized by the First Army
during the St. Mihiel operation. It now passed to the control of the new army
and was used as a receiving station for all evacuations from the Second Army
area. From this point, after a rest, the animals were shipped to Services of
440
ADMINISTKATIOX, AMERICAN' EXPEDITIONAK V FCJRCES
Supply hospitals. Shortly before the armistice began the veterinary hospital
at Jeanne d'Arc Caserne was taken over by the advance section, and two army
mobile veterinary hospital units were assigned to take care of Second Army
evacuations. These were placed at the advanced railheads and were ready to
function in the military operation about to take place; however, owing to the
cessation of hostilities they did not operate in the manner planned excei)t to
receive and evacuate sick animals from organizations held in the area awaiting
orders for movement to the rear. These evacuating units were retained at the
points where they were originally located and were used for the establishment
of temporary hospitals until the Second Army as such passed out of existance.-'
As in the First Army, most of the losses and incapacity of animals in the
Second Army were due to the ravages of mange and to improper care.^' Re-
placements being difficult to procure, organizations were loathe to give their
animals up in the early stages of disease; consequently, they were held until
so emaciated and diseased as to be a constant menace to the other animals
of the command.
The following tabulation indicates the extent of veterinary operations of
the Second Army:^^
Greatest animal strength 30, 391
Average animal strength 12, 007
Number of animals evacuated 6, 219
Number killed in action 146
Number wounded by shrapnel and high explosives 385
Number died from debility and exhaustion 207
Number died from other causes 298
Number missing in action 27
Evacuation of animals from the Second Army was limited to a minimum
because the crowded condition of the Services of Supply veterinary hospitals
made imperative the treatment of large numbers of animals within their
organization. Approximately 30,000 animals were dipped between February 1
and April 10, 1919, and large numbers of others in divisional units were hand
treated by sprays.
THIRD ARMY
In order to provide sufficient animal strength for the Third Army, it was
ordered, before the march into Germany, that the divisions of the First and
Second Armies not designated as part of the Third Army turn over a suffi-
cient number of serviceable animals, free from disease, to units of the Third
Army, and evacuate all sick and unserviceable animals for transfer to veteri-
nary hospitals. 23 This naturally caused a great increase in the number of
animal evacuations and consequent congestion of veterinary hospitals.
On the march into Germany no adequate provisions were made for caring
for sick and disabled animals; therefore, animal losses were heavy.^'^
In this army also, mange became one of the most important diseases, and
it was not long before a large percentage of its animals were affected.-'^ The
seriousness of the situation was soon evident, however, and dipping vats were
established throughout the army area, clipping of the animals was instituted,
and all animals were dipped regularly. By pursuing this method of treatment.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 441
it was but a short time before the mange situation was well in hand. The
number of animals dipped exceeded the total number of animals, for many of
them were treated several times in this manner.-'*
Statistics concerning operations of the Third Arm}- from December 24,
1918, to June 1, 1919, are as follows:
Greatest animals strength 54 782
Number of animals evacuated 6, 504
Number admitted to Third Army hospitals 3, 326
Number sold from hospitals 1, 141
Number turned over to remount depots 862
Number died 1^ I99
Number destroyed (mostly for butchering) I^ 716
Greatest number of mange cases reported (Feb. 14, 1919) 9, 000
Number of animals dipped 54, 782
Subsequent to August 27, 1918, when such data became available, 317,690
animals were admitted to sick report.''* Of these, 105,019 were admitted for
mange, 21,153 for influenza, 2,079 for pneumonia, 549 for epizootic celluHtis.
Mallein tests for glanders numbered 948,065; 9,122 doubtful cases were
retested; 2,721 animals were destroyed by reason of glanders. The number
of animals transferred from one hospital to another was 71,043; 197,690
animals were restored to duty after treatment; 17,585 died after being taken
over by the veterinary service. Total losses to August 31, 1919, were 63,369,^^
The total losses from deaths and missing constituted practically 26 per
cent of all animals supplied the American Expeditionary Forces.^'* After the
Veterinary Corps was placed under the Medical Department the number of
deaths among animals amounted to 17,585, as contrasted with 41,373 deaths
which occurred while the corps operated under the remount service.
After April 1, 1919, when animals had been placed in salable condition,
they frequently were sold to French civilians, by some officer of the remount
service who visited the hospital in order to conduct this sale.^^ After that
date surplus animals were also disposed of under an agreement with the P^rench
Government by which those in good health were to be taken over and sold at
auction in the various French regions and the proceeds of sale, less 5 per cent,
were to be turned over to the American Government.^-*
In veterinary hospitals all animals w-hich would not be fit for service in
two months were inspected and condemned, and turned over to the French at
a fixed price of 450 francs. If too weak to be removed from hospital they
were sold for butchery purposes.
INFECTIOUS DISEASES
MANGE
Mange caused great havoc in the animal efficiency of the armies in western
Europe.^' Its eradication under war conditions was impossible, but the
i^ritish Army demonstrated that, with proper care, by the adoption of strict
sanitary precautions and the prompt evacuation and treatment of animals
affected, it could be kept well under control."^ In that army the number of
cases under treatment was reduced from 20,000 in July, 1916, to approximately
2,000, two 3^ears later.^^
442
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
On February 15, 1919, animal sickness in the American Expeditionary
Forces reached its maximum for the whole period of operations, 48,975, or
about 21 per cent of the total number of animals then on sick report.-' Of
this number, 30,756, or about 16 per cent, of our animals were suffering from
mange. Such energetic measures were taken to remedy the situation that the
number of cases rapidly diminished, and, on March 1, 1919, but few active
cases of mange were to be found.
In the First Army the method of treatment was by the use of sulphur
chambers, which proved effective.^^ The method of treatment in the Second
Army involved the use of dipping vats.^^ In addition to dipping, however,
great numbers were successfully treated in organizations by the use of hand
sprays. The standard lime and sulphur dip was the agent used for treatment
in either case.^^
INFLUENZA
Influenza took heavy toll of both animals and animal efficiency during
the early operations of the American Expeditionary Forces. This condition
was inevitable, for at this time all veterinary hospitals were operated in con-
junction with remount depots, and sick and well animals intermingled with
but little opportunity for segregation. Furthermore, fresh remounts purchased
from the civilian population were often sent direct to combat organizations
without preliminary training to harden them for active service. Therefore,
great numbers of these animals perished from influenza or its complications
and those which recovered were left in so weak and emaciated a condition
that, being of little value for service, they had to be evacuated at the earliest
opportunity.
GANGRENOUS DERMATITIS
Generally speaking, gangrenous dermatitis was the cause of the great
prevalence of such foot diseases, variously classed on sick report, as quitter,
canker, pododermatitis.^^ Caused by the Bacillus necrophorus, which existed
in the soil everywhere in France, it only became necessary for the standings
and roads to become muddy to cause its rapid spread. No records are avail-
able showing the number of cases of this infection, for such cases were classed
under diseases of locomotion; but it is beyond question that this disease caused
a large percentage of deaths and disabilities.^^
GLANDERS
In former wars glanders had been the disease most dreaded, and the most
reducing of animal strength, but in the World War its ravages were held at
a minimum.^^ This was due to the perfection of mallein and its practical
application in recent years, thus enabling veterinary officers to detect the
disease in its incipient stages. Three different practical field tests were avail-
able: The ophthalmic, thermal, and intradermic (termed the intrapalpebral
in the American Expeditionary Forces).
The intradermic test was the one adopted by the Veterinary Corps of our
own and the aUied armies, and it proved the most simple and efficacious for
field service when its technique was properly understood. Many of our
ORGANIZATION AND ADMINISTRATION OF CHIEF SUEGEON'S OFFICE 443
veterinary officers were not at first acquainted with its technique and, undoubt-
edly, some cases of glanders escaped their attention in the beginning of our
operations.
Following the appointment of a chief veterinarian, A. E. F., in July, 1918,^^
instructions were given to test all animals at least once a month. This test
was carried out to the extent required in so far as it was possible under existing
conditions, and no doubt was the means of reducing the spread of glanders to
a minimum. It is worthy of note that never was there any great outbreak
among the combat organizations at the front, although glanders gained con-
siderable headway in some of the veterinary hospitals.
The weekly report on glanders showed an average of six cases per week
up to November 23, 1918, when, for the week ending on this date it suddenly
increased to 34 cases. Early in 1919, the chief veterinarian, A. E. F., on
investigation, found that some veterinary officers did not understand the test
through lack of proper instruction in technique. Instructions were sent out
by him immediately, stating the manner of administering and reading the
test, and were later supplanted by a bulletin from general headquarters, A. E. F."
In addition to instructions being distributed, officers thoroughly familiar
with the test were sent to all units in the American Expeditionary Forces to
demonstrate the intradermic test to veterinarians.^^
Because of the prevalence of glanders in our veterinary hospitals, the
chief veterinarian, A. E. F., held at St. Nazaire on January 7, 1919, a confer-
ence of veterinarians to formulate rules for the administration of the intra-
dermal test and for the technique in reading reactions.
To confirm tests previously made, further tests, both intradermic and
laboratory, and post-mortem examinations were made in a large number of
reacting animals which had been killed. The results were noted to confirm
the reactions previously given. After a study of the results, recommendations
were submitted to general headquarters, A. E. F., on February 25, 1919. These
recommendations gave full instructions in administering tests, and in com-
bating outbreaks of glanders, together with sanitary precautions necessary
to prevent contraction of the infection by sound animals.
The more accurate tests required were followed by an immediate increase
in the number of cases reported, the report for the week ending January 18,
1919, showing 391 cases, but, from this date the number reported declined
rapidly. Only 44 cases were under treatment on March 1. The week ending
April 19, showed only 6 cases, and at this time the glanders situation was
believed to be well in hand. When the task performed by the Veterinary
Corps in controlling glanders and the difficulties confronting it are considered,
the number of cases destroyed does not appear excessive. Such cases w^ere
2,721, or approximately 1 per cent of all animals supplied to the American
Expeditionary Forces.
NONINFECTIOUS DISEASES
DEBILITY
Debility, while not properly classed as a specific disease, is worthy of
some consideration in connection with a study of the animal morbidity of the
American F^xpeditionary Forces. This condition was the result of various
444
ADMINISTRATION, AMERICAN EXPEDITION A in' FORCES
causes, such as the after effects of influenza, mange, overwork, lack of lood
and water, improper grooming, delayed evacuation.^'^ Wastage from this cause
alone figured largely in animal losses, but unfortunately no accurate data
can be formulated concerning it.^^
DIGESTIVE DISORDERS
The losses from digestive disorders, although not excessive, were consider-
able.^^ These maladies were usually due to conditions of the forage. Moldy
forage often had to be accepted because of the absence of other reliable feed.^^
QUARANTINE OF PUBLIC AND PRIVATE MOUNTS FOR RETURN TO THE
UNITED STATES
A quarantine for 66 private and 54 public mounts was established at Camp
de Souge (Gironde) on May 1, 1919, for animals designated for return to the
United States. The quarantine was to cover a period of 90 days in France
and to be continued for the same period in the United States. This was sub-
sequently changed to 30 days in France and 150 days in the United States,
including time in transit. On account of overcrowding on the transports bring-
ing the animals to the United States, the quarantine regulations unavoidably
were broken, and it became necessary to retain such animals for the full period
of 180 days from the date of arrival in this country. The quarantine in France
was to start on May 15, 1919, the date set for the receipt of the last animal, but
this was later changed upon request from the office of the chief surgeon, A. E. F.,
and the time limit fixed for August 20, 1919, although base section No. 2 was
officially closed before this date. For this work there were assigned 5 officers
and 144 enlisted men, Veterinary Corps.
The importance of this quarantine can not be fully realized unless it is taken
into consideration that the animals in question had been exposed to all classes of
infectious diseases incident to the war. Some of these diseases had never
existed in the United States and for this reason most careful and rigid quaran-
tine regulations were formulated by the veterinary division of the Surgeon
General's office in connection with and accordance with recommendations made
by the Department of Agriculture.^^
PERSONNEL"
(July 28, 1917, to July 15, 1919)
Col. Berkeley T. Merchant, Cav., chief.
Col. D. S. White, V. C, chief.
Lieut. Col. Harold E. Bemis, V. C.
Maj. George R. Powell, V. C.
Capt. Horace Z. Homer, V. C.
First Lieut. Theodora C. Beechwood, V. C.
First Lieut Will W. Korb, V. C.
Second Lieut. Maurice E. J. Evans, V. C.
° In this list have been included the names of those who at one time or another were assigned to the division during
the period July 28, 1917, to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names
have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 445
REFERENCES
(1) Bulletin No. 16, W. D., June 22, 1916.
(2) Cablegram from the Surgeon General to General Pershing. September 2, 1917. Copy
on file, Historical Division, S. G. O.
(3) Cablegram No. 177, par. 14, from General Pershing to The Adjutant General, for the
Surgeon General.
(4) G. O. No. 108, W. D., October 30, 1917.
(5) Memorandum froin Maj. L. A. Klein, V. C, for the chief surgeon, A. E. F., December
27, 1917. Subject: Organization of the veterinary service, A. E. F. Copy on file.
Historical Division, S. G. O.
(6) Memorandum for the chief surgeon, A. E. F., Col. J. A. Logan, chief of the administra-
tive section, general staff, G. H. Q., A. E. F. December 23, 1917. On file. Histori-
cal Division, S. G. O.
(7) Letter from Maj. L. A. Klein and A. L. Mason, V. C, to the Surgeon General, March
29, 1918. Subject: Veterinary service, A. E. F. Copv on file. Historical Division,
S. G. O.
(8) Letter from the Surgeon General to the chief surgeon, A. E. F., January 5, 1918. Sub-
ject: Organization of the veterinary service. Copy on file, Historical Division, S. G. O.
(9) Cablegram No. 677 from The Adjutant General to General Pershing, January 21, 1918.
(10) Cablegram No. 573-S, from General Pershing to The Adjutant General, February 6,
1918.
(11) Memorandum for the chief of staff, A. E. F., from the chief surgeon, A. E. F. Feb-
ruary 22, 1918. On file A. G. O., World War Division, chief surgeon's files, A. E. F.,
211.233.
(12) Memorandum for the chief surgeon, A. E. F., from the assistant chief of staff, G-1,
G. H. Q., A. E. F., February 27, 1918. On file, A. G. O., World War Division,
chief surgeon's files, A. E. F., 211.233.
(13) War diary, chief veterinarian, A. E. F., from March 10, 1918, to September 25, 1918.
Copy on file. Historical Division, S. G. O.
(,14) Cablegram No. 1410, from General Pershing to The Adjutant General, July 3, 1918.
(15) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1211.
(16) Report on the Medical Department, A. E. F., to November 11, 1918, prepared by
Capt. E. O. Foster, Sanitary Corps, and approved by the chief surgeon, A. E. F.
Copy on file. Historical Division, S. G. O.
(17) G. O. No. 139, G. H. Q., A. E. F., August 24, 1918.
(18) G. O. No. 31, G. H. Q., A. E. F., February 16, 1918.
(19) Report on the Veterinary Corps, A. E. F., made by the chief veterinarian, A. E. F.,
to the commanding general, S. O. S., March 1, 1919. Copy on file, Historical
Division, S. G. O.
(20) Tables of Organization, W. D., 1918, Nos. 43, 109, 330, and 331.
(21) Mobile veterinary units. On file. Record Room, S. G. O., 322.3-32. (Veterinary
Units, A. E. F.) (V) 322.3-23. (Veterinary Units, Camp Lee) (D).
(22) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. I, 1212.
(23) Report on the activities of the veterinary division, S. G. O., prepared by Maj. C. H.
Jewell, V. C, August 31, 1919, under the direction of the chief of the veterinary
division, S. G. O. On file, Historical Division, S. G. O.
(24) Report of the chief veterinarian, A. E. ¥., undated, made to the chief surgeon, A. E. F.
On file, A. G. O., World War Division, chief surgeon's files, 314.7.
(25) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1364.
(26) Report of the veterinarian, First Army, to the commanding general. First Army,
November 27, 1918. Copy on file, Historical Division, S. G. O.
(27) Final report of Gen. John J. Pershing, September 1, 1919.
(28) Organization of the Services of Supply, A. E. F. Monograph No. 7, prepared in the
Historical Branch, War Plans Division, General Staff, June, 1921.
446
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(29) Report on the activities of the chief surgeon's office, A. E. F., made to the Surgeon
General, May 1, 1919, by the chief surgeon, A. E. F. On file, Historical Division,
S. G. O.
(30) Summary history of the First Army Corps, from its creation, January 15, 1918, to the
cessation of hostilities, November 11, 1918, edited by G-2, First Army Corps,
November 15, 1918. On file. Historical Section, the Army War College, Also;
History of the Third Army Corps from April 1, 1918, to September 9, 1918, undated
Vol. I. On file. Historical Section, the Army War College.
(31) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. I, 1362.
(32) G. O. No. 175, G. H. Q., A. E. F., October 10, 1918.
(33) G. O. No. 122, G. H. Q., A. E. F., July 26, 1918.
(34) Bulletin No. 37, S. O. S., A. E. F., August 19, 1918.
(35) Bulletin No. 16, G. H. Q., A. E. F., February 25, 1919.
SECTION II
MEDICAL ACTIVITIES OF TERRITORIAL SECTIONS
The territorial sections, A. E. F., may be divided roughly into two classes:
Those built around the ports (or base sections), and the interior sections.
There were 11 territorial sections; however, for present purposes, 3 sections
only are considered the advance section (an interior section), and two base
sections (Nos. 1 and 5).
THE ADVANCE SECTION"
The advance section, located in the north and northeastern part of France,
embraced in a general way the territory north of Paris, and Dijon. Its
geographical limits, as prescribed by General Orders, No. 75, Headquarters,
A. E. F., December 14, 1917, included the Departments of Nord, Pas du Calais,
Somme, Oise, Aisne, Ardennes, Marne, Merthe et Moselle, Meuse, Haute
Marne, Cote d'Or, Vosges, Haute Saone, and Doubs. These limits were
somewhat changed from time to time.
At Chaumont, in this section, which was that immediately behind the
front, general headquarters of the American Expeditionary Forces were located
after September 1, 1918. The section also contained 22 training areas where
tactical divisions were billeted, either on their way to the front or for rest,
replacement, or refitting. In addition to these were the training area where
Medical Department troops were trained, the staff and line schools of all
branches of the service, the supply depots, and other installations of the tech-
nical services, including 63 hospitals and 10 veterinary hospitals. Despite
the fact that practically all of these areas and formations were under direct
control of either general headquarters of the American Expeditionary Forces,
or headquarters, Services of Supply, the number of troops under the juris-
diction of the section commander sometimes amounted to more than 200,000.
The section had been organized to extend the jurisdiction of the commanding
officer. Services of Supply, up to the points where supplies would be delivered
to the field transportation of combat forces, but in practice distribution was
made from regulating stations which were under the direct control of the
general staff, general headquarters.
Headquarters of the advance section were located at Neufchateau, where
the office of the section surgeon was opened on November 1, 1917.
The office of the section surgeon had three principal divisions: Adminis-
tration, sanitation, and dental service.
In respect to administration, the duties of the section surgeon were
analogous to those of a department surgeon, but were much greater, as they
included the sanitary service of many camps and the control of a number of
Medical Department units — ambulance companies, field, mobile, and evacua-
• The statements of fact appearing herein are based on: "Report of the surgeon, advance section, A. E. F.'
(undated), by Col. F. P. Reynolds, M. C. On file, Historical Division, S. G. O.
13901—27 29 447
448 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tion hospitals, medical supply depots, sanitary squads, and laboratories. The
frequent changes in these commands necessitated a corresponding increase in
the activity of the section surgeon's office. Another difficulty with which he
had to contend was the fact that, as a number of formations within the area
were exempted from control of the section commander, there was a certain
lack of coordination in the medical service of all the commands located within
its geographical limits. These exempted areas were schools, regulating sta-
tions, supply depots, base hospitals, roads, and other projects. On January
31, 1919, the number of Medical Department personnel carried on the records
of this office was as follows: Officers, 1,456; nurses, 500; enlisted men, 14,413.
Medical supplies were at first issued from the supply depot without the approval
of the office of the section surgeon. Shortly after the armistice began this
arrangement was modified so that requisitions for medical supplies required
his approval before issue from the depot was made.
For sanitary service the section was divided into areas, in each of which
a local sanitary officer was designated, all under the supervision of the section
sanitary inspector. To each divisional training area a sanitary squad was
assigned and its commanding officer was charged with the duties of sanitary
officer for the area. Each divisional training area included a sufficient number
of towns, usually a score or more, to accommodate a full tactical division, the
troops occupying houses, barns, or other outbuildings and newly constructed
barracks. For administrative purposes a zone major and three or four assist-
ants were assigned to each training area where they were under the direction
of the chief billeting officer of the advance section. The zone major assigned
brigades to groups of towns; in each occupied town a town major was appointed
by the commanding officer of the unit. The general instructions to the zone
major directed him to organize and administer his zone to accommodate the
unit assigned to it, his primary duty being to provide for the comfort of troops
occupying the towns of the zone.
The average towns with which this section was concerned had grown
from hamlets and villages without corresponding increase of wealth, for which
reason few streets were paved, lighting was most primitive, and sewerage
systems generally were lacking; pubHc bathhouses took the place of private
baths. Street filth was common in the village of eastern France because of
lack of labor and the fact that most of the villagers were farmers, who saved
all manure to spread on their lands. When the Americans first entered these
villages, with their long main streets lined with manure piles, they at once set
to work cleaning up. The result was often a misunderstanding. The rooms
used by our troops were paid for at an agreed rate, 2 square meters of floor
space being allowed for each man. The sanitary arrangements of the towns
were primitive and unsatisfactory to Americans, but were gradually inproved.
In the end, they were fairly good; at least the billets proved healthful to the
troops occupying them.
The general plan for sanitary work in a training area was: (1) To keep
the zone major constantly informed of sanitary conditions; (2) to estimate the
billeting capacity of each town in order that the troops might have proper
air space and comfort; (3) to work in conjunction with the central Medical De-
MEDICAL ACTIVITIES OF TERRITOEIAL SECTIONS
449
paitment laboratory in placarding water sources; (4) to assist incoming units in
preventing epidemics; (5) to assist in organizing and operating bathing and
disinfesting stations; and (6) to exercise a general supervision over the sanitary
conditions among the civilian population. When the training areas were not
occupied by divisions it proved desirable to assign trained men from sanitary
squads on duty in those areas to temporary duty elsewhere with organizations
recently arrived from the United States and whose medical personnel were
unfamiliar with special sanitary conditions and problems in France.
Following the signing of the armistice and the return of combat divisions
from the front to training areas, the work of the sanitary squads was mainly
that of assisting the divisional sanitary inspectors in promoting bathing and
disinfestation of troops and in improving the sanitary conditions in the towns.
Weekly reports of activities of the sanitary squads were rendered to the
zone majors and to the surgeon of the advance section.
The medical and sanitary services of troops in each training area were
handled by the surgeon and sanitary inspector of the division occupying it.
These officers were assisted by a sanitary squad of 26 men. A medical officer
was located in each town of any size but the sick requiring hospital treatment
were sent to the camp hospital of the area; the more seriously sick were
evacuated to base hospitals from the area railhead.
It was difficult and often impossible to maintain safe or satisfactory
standards of sanitation in camps and training areas. Overcrowding in bar-
racks and billets was the most serious defect, due chiefly to lack of buildings
and of building material, and transportation. This condition may be said to
have been the chief determining factor in the spread of respiratory infections,
notably influenza, pneumonia, diphtheria, meningitis and tonsillitis, which
prevailed at times, in many places.
Difficulties were experienced in providing adequate facilities for bathing
and for drying clothing, with ensuing hardship to the troops. Water supplies,
in many instances, were inadequate in quantity, while in quality they gener-
ally were unsafe for drinking purposes. Gross pollution was by no means
uncommon, and many outbreaks of diarrhea were traced to this cause. The
food of the men was ample in quantity and excellent in quality, so that com-
plaints on this subject were few and of minor importance. The same may
he said of clothing. A scarcity of blankets was reported in some organizations
in October and November, 1918, but this was soon corrected.
Investigations of outbreaks of communicable diseases were made by
special inspectors from the office of the advance section surgeon. Often these
investigations were carried on in connection with the central Medical Depart-
ment laboratory and Army laboratory No. 1, both of which were located in
the advance section. The facilities of these laboratories were also utilized
for the analysis of water supplies and for other chemical and bacteriological
work. They were supplemented especially for clinical purposes by the labora-
tories in camp and base hospitals.
Much difficulty was experienced in making effective measures for the
^supervision and control of the venereal diseases. The constant movement of
troops on their way to and from the front, the lack of control by headquarters
450
Anr^riXISTHATIOX, AMf^IUCAN EXPEDITIOXAHY FORC
of the advance section over many of the organizations, and the wide distribu-
tion of the troops under its command conspired to make difficult the prosecu-
tion of a comprehensive plan. The number of separate camps or stations of
troops was over 400. Many small detachments were located in isolated
localities, with which it was difficult, if not impossible, to communicate by
mail, telegraph, or telephone. Changes in stations of troops occurred so
frequently that headquarters of the section was never able to maintain an
accurate record in its weekly station list.
The great shortage of medical personnel and of transportation which
existed until some time after the signing of the armistice further interfered to
a serious degree in this as well as in other sanitary activities.
As a rule, the health of troops in billets was exceptionally good; better
than when they occupied crowded barracks, and on the whole was satisfactory.
The epidemic of influenza which prevailed during August, September, and
October, 1918, constituted the most serious outbreak of communicable disease,
for some organizations suffered very severely, and in certain camps, notably
at Valdahon, the epidemic assumed a grave aspect. Influenza continued to
constitute the principal cause of admission to hospitals to the end of 1918 and
isolated outbreaks occurred until March of 1919. After the autumn months
the cases of influenza were less severe and their complications, especially
pneumonia, were less frequent. Typhoid fever appeared in many places, and
in a number of combat organizations there were well-marked outbreaks.
Among troops properly pertaining to the advance section, the cases were
scattered, with a single exception, when 15 cases occurred in one camp. The
development of these cases occasioned a new administration of typhoid pro-
phylactic. Cases of cerebrospinal meningitis occurred in many organizations.
By January, 1919, 32 central reporting officers were collecting morbidity
reports from troops in their areas, which they sent in weekly by telephone or
telegraph.
A total of 26 camp, mobile, and evacuation hospitals were in operation in
this section, with approximately 9,000 beds. The personnel of camp hospitals
were assigned by the surgeon of the section approximately in the proportion of
10 medical officers, 10 nurses and 25 enlisted men to each of these units. Each
camp hospital served a division of from 25,000 to 30,000 men.
The following camp hospitals operated in this section: No. 1, Gondrecourt;
No. 3, Bourmont; No. 4, La Fauche; No. 6, Barisey-la-Cote; No. 7, Humes;
No. 8, Montigny-le-Koi; No. 9, Chateau-Viflain ; No. 10, Prauthoy; No. 12,
Valdahon; No. 13, Mailly; No. 18, Liffol-le-Grand; No. 21, Bourbonne-les-
Bains; No. 22, Langres; No. 23, Langres; No. 24, Langres; No. 38, Chatillon-
sur-Seine; No. 41, Is-sur-Tille ; No. 42, Bar-sur-Aube; No. 48, Recey-sur-
Ource; No. 49, Laigness; No. 50, Tonnerre; No. 64, Semur; No. 65, Semur;
No. 67, Moneteau; No: 97, St. Dizier; No. 100, Belfort. Evacuation hospitals
in the area were the following: No. 1, Toul; No. 2, Baccarat; No. 10, Froidos;
No. 114, Fleury-sur-Oise. Mobile hospitals were two in number; No. 10, Vitry;
No. 11, Donjeux.
On the breaking up of the First and Second Armies the following medical
units of these armies and unattached to divisions came under control of the
MEDICAL ACTIVITIES OF TEKEITORIAL SECTIONS
451
advance section — 4 evacuation hospitals, 3 field hospitals, 1 sanitary train, and
15 ambulance companies.
In the spring of 1919 disbandment of medical organizations in the advance
section went on rapidly. By April 1, Camp Hospitals Nos. 1, 3, 7, 8, 9, 10, 21,
38, 42, 49, 60, 67, and 97 had ceased to function. The evacuation hospitals,
field hospitals, and ambulance companies mentioned above were also ready to
move to the ports. Twenty-three sanitary squads had finished their labors.
BASE SECTION NO. 1 »
Base section No. 1 was located on the west coast of France, bordering the
Bay of Biscay and surrounding St. Nazaire. This was the first port used for
debarkation purposes. This section, after several changes, embraced the
departments of Morbihan, Loire Inferieure, Vendee, Maine et Loire, and Deux
Sevres. As St. Nazaire lay at the mouth of the Loire, the main route to the
American Army at the front led up the valley of this river. The port had
excellent wharves, with water deep enough for the majority of transports, but
its harbor was small and in consequence only a limited number of ships covild
be accommodated at one time.
The office of the surgeon of this section was established at St. Nazaire on
July 2, 1917, immediately after the arrival of the first convoy of troops. Among
the first of the duties of the base surgeon, whose office was an integral part of
that of the section commander, were the provision of infirmaries in and about
the city, the establishment of a base hospital (French Hospital No. 59), the
assignment of medical personnel, including those detailed to inspect incoming
transports, and the establishment of a warehouse for medical supplies. This
warehouse was to be a supply depot whence stores would be forwarded to the
medical supply depot at Cosne or to the various base hospitals then arriving.
Little could be accomplished in the development of the services of base section
No. 1 until after the receipt of additional personnel and supplies, but on August
4 several organizations arrived, including Base Hospital No. 8, which was
located at Savenay, about 20 miles from St. Nazaire. During the latter part
of August, Base Hospital No. 27 was established at Angers, somewhat farther
inland. By the end of August there were on duty with headquarters of the
section 2 medical officers and 9 enlisted men, 7 of whom were handling supplies.
The prevention of venereal diseases was one of the earliest medical problems
attacked, but its solution was made difficult by the lack of cooperation between
American and French officials, the methods of their respective services being
widely dissimilar. Numerous prophylaxis stations were established in the city,
instructions concerning their usage were sent to all troops in the section, a base
urologist was assigned, and the many venereal cases arriving on transports were
isolated and treated. Detailed instructions concerning venereal control were
later issued as provided in General Orders, No. 77, headquarters, A. E. F., 1917.
Early in September, 1917, the surgeon was instructed to establish a motor
ambulance assembly park, where all motor transport for the Medical Depart-
ment would be assembled and thence delivered to the proper organizations.
An officer of the Sanitary Corps and 35 enlisted men were assigned to duty with
this formation.
'' The statements of fact appearing herein are based on "Report of Medical Department activities, base section No. 1 "
(undated), made by Col. Charles L. Foster, M. C. On file, Historical Division, S. G. O.
452
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
By the 1st of October resources and responsibihties had so increased that
the section surgeon's office was divided into three departments, viz, central
office charged with administration, correspondence, records, and simdar duties;
motor transport branch, concerned with the receipt, assembly, and delivery of
motor vehicles; medical property branch, concerned with receipt, storage, and
shipment of general medical supplies.
The office of the surgeon of base section No. 1 remained an integral part
of the headquarters of that section until January 28, 1918, when in antici-
pation of the reorganization of the entire American Expeditionary Forces it
became a separate office of record in which the following departments were
established: (1) General correspondence, including selection of hospital sites,
establishment of hospitals and infirmaries, and issuance of instructions; (2)
personnel branch, including reports on personnel; (3) sick and wounded branch;
(4) property branch. Subsequently other departments were added, so that, as
finally organized, the surgeon's office comprised the following departments: (1)
personnel and motor transportation; (2) files, records, and general office branch;
(3) evacuation of sick and wounded; (4) property and accounts; (5) hospitaliza-
tion; (6) sanitation; (7) epidemiology; (8) base laboratory; (9) food and
nutrition; (10) urology, including venereal diseases; (11) dental service; (12)
professional consultants; (13) medical boarding service (of transports); (14)
attending surgeon's office; (15) attending dental surgeon's office; (16) embarka-
tion branch (concerned with troops returning to America).
The personnel and motor transportation branch acted on all reports con-
cerning commissioned and enlisted personnel, made assignments to duty, kept
personnel records and rendered reports concerning them to the chief surgeon,
A. E. F. It also kept a record of the number and location in the section of all
motor vehicles assigned to the Medical Department, requisitioned and assigned
such vehicles and rendered such reports on motor vehicles as were called for.
This branch was established on January 28, 1918, and did its maximum work
during the latter half of that year, when the medical personnel numbered
500 officers and 4,500 men.
The files, records, and general office branch dated from the reorganization
of the American Expeditionary Forces into sections on January 28, 1918. It
handled all mail, conducted correspondence, issued circulars and similar docu-
ments, maintained a decimal filing system, mailing lists, and the custody of the
office property. Pertaining to this branch were the commanding officer of the
medical detachment on duty in St. Nazaire and a separate mess conducted for
the men on duty in the office at the base laboratory, and at the supply depot.
The evacuation branch was charged with the movement of patients from
hospitals to ships and with duties incident thereto. Before August, 1918, the
number of patients evacuated to the United States through the port of St.
Nazaire was not large, and included chiefly personnel recommended for dis-
charge because of physical disabihty. During August and September, 1918,
wounded began to arrive in this section, and during September 3,190 of them
were evacuated to the United States.
An evacuation motor ambulance battalion was unofficially organized in
November, 1918. A little later Motor Ambulance Company No. 44 and Evac-
MEDICAL ACTIVITIES OF TERBITOEIAL SECTIONS
453
uation Ambulance Company No. 9 were organized as a battalion to transport
sick and wounded in the course of evacuation; later, Evacuation Ambulance
Company No. 22 was added to this organization.
The first evacuation of any importance was made on September 20, 1918.
From this time on the number of evacuations increased steadily, and by the
latter part of March, 1919, this organization had transported 33,500 sick and
wounded. The number of ambulances was increased to 38 Fords and 24 G. M.
C.'s. Later 10 White reconnaissance cars were added for long hauls, the total
vehicles now numbering 72.
These cars evacuated sick from all the base hospitals in the vicinity of the
port as far as Quiberon, Carnac, Muecon, Vannes, Coetquidan, Plouharnel,
Savenay, Nantes, La Croissic, and La Baule. The largest number transported
to one boat in one day was 1,476 on December 27, 1918. The record for rapid
evacuation was made on December 18, when 520 walking patients were unloaded
from trains and transported to the wharves in 28 minutes. The longest evacu-
ation, 78 miles, was made from Plouharnel. Patients evacuated through St.
Nazaire came from the hospital centers at Nantes, Savenay, and from the hos-
pitals at St. Nazaire. They were collected at Savenay for final examination,
assembly of records, and provision of equipment, clothing, and kits, including
toilet articles.
The property and accounts branch performed the duties indicated by its
name. When the first stores arrived in June, 1917, a part of warehouse F was
assigned to the Medical Department. Here stores were sorted and repairs
made, but the bulk of the stores were loaded on cars at once and shipped to
the supply depots in the interior. Later, warehouses E and G were assigned
to the Medical Department and used in the same manner.
It was apparent almost from the first that a medical supply depot was
necessary at the port for local issues. As an expedient, a small supply of extra
stores was kept at Base Hospital No. 101, St. Nazaire, for emergency issues.
On March 26, 1918, the section surgeon requested permission to keep on hand
the most necessary stores for issue to nearby units. This request was granted
and by July 1, 1918, a depot, though imperfect, was in operation. By Septem-
ber 1, warehouse E had been obtained, rebuilt, and stocked as a supply depot,
and was issuing general stores to base section No. 1 and to base section No. 5
(Brest).
The hospitalization branch of the section surgeon's office was established
in October, 1918, to have direct charge of hospital sites, buildings, adminis-
tration, inspections, records, supplies, and similar duties incident to the service
of such formations as were not under the direct control of the chief surgeon's
office, A. E. F.
The sanitary branch of the section surgeon's office was organized on
January 28, 1918. At first, this branch was concerned with reports and clas-
sifications of infectious diseases; isolation and treatment of cases of infectious
disease arriving on transports; correction of sick and wounded reports; weekly
sanitary reports; reports on evacuations; and reports on venereal diseases.
Upon the organization of separate departments for venereal diseases, epide-
miology, hospitalization, and evacuation, this branch controlled only purely
sanitary affairs.
454
ADMINISTRATION, AMERICAN EXPEDITIOXAK V FORCES
In August, 1918, base section No. 1 was divided into 12 sanitary districts
to each of which a sanitary inspector and a health officer were assigned. These
officers kept themselves informed concerning epidemic diseases in their respec-
tive districts, and reported them as occasion required.
An isolation camp with a capacity of 3,000 was established near Camp
Hospital No. 11, but when preparations were made for the return of troops to
the United States its capacity was increased to 4,000 and it was made a part
of the embarkation camp, except that barracks for 1,500 men and for a pro-
portional number of officers were reserved for isolation purposes. This group
of barracks was located in one corner of the camp, inclosed by barbed wire, and
so arranged as to permit its operation as a separate unit.
The epidemiological branch of the section surgeon's office was not made
a separate element until November, 1918. Its duties were: (1) To receive
and tabulate reports of epidemic diseases; (2) to direct measures for stamping
out epidemics; (3) to maintain charts and graphs of prevailing communicable
diseases; (4) to prepare the required reports for the chief surgeon.
From November 17, 1918, the epidemiological division issued a weekly
report of infectious diseases, showing the number of different diseases develop-
ing in each camp, the weekly rate per 100,000 for each disease, and the strength
of each camp or locality.
The base laboratory was opened at St. Nazaire on December 22, 1917, in
two rooms. The purposes of the laboratory were those of a base laboratory
for the section, viz, to distribute media and other laboratory articles to the
various hospitals, to do routine analyses for permanent troops of the port,
and to make Wassermann reactions for the whole base section. By July,
1918, the laboratory had enlarged its quarters, to a sufficient size and was pre-
pared to do all required work, several additions having also been made to the
personnel. During the summer of 1918, the unit received an 8-chest United
States Army transportable laboratory, which was used in emergencies at Camp
Hospitals Nos. 11 and 15.
One of the important duties of the base laboratory was to make water
analyses, for water supplies throughout the section generally proved unfit for
drinking purposes until purified. At first, St. Nazaire had a very small and
poor water supply, of about 660,000 gallons per day. This supply was increased
to 2,000,000 gallons per day by taking water from the Trignac Canal. Intensive
sedimentation and chlorination of the canal were necessary, but even with
these measures this water could not be made satisfactory, and a new system
was later installed by the Engineer Corps, taking water from the River Brivet.
This latter plant furnished 3,000,000 gallons per day, the water being coagu-
lated, filtered, and chlorinated. Another plant for the Montoir camps provided
1,000,000 gallons per day. These plants were not completed until February
1, 1919. A separate plant for Savenay which furnished 720,000 gallons daily
was in use by August, 1918. Other camps and billeting areas were supplied
in various ways. The laboratory checked and supervised all these water
plants and their output and published its findings.
1
MEDICAL ACTIVITIES OF TEEEITORIAL SECTIONS
455
The food and nutrition branch of the section surgeon's office was concerned
with improving troop messes and conserving food. It was organized on April
16, 1918.
The branch of the section surgeon's office, concerned with urology and
venereal diseases was organized on August 20, 1917. The general measures
instituted by it were: (1) Formulation of instructions to be given the men by
their officers; (2) the establishment of adequate prophylaxis stations; (3)
recommendations concerning passes; (4) inspection of restricted districts;
(5) supervision of the enforcement of general orders, A. E. F., relating to
venereal diseases.
It was the policy to maintain a station in each permanent organization, and
others at central points in the city, all being open day and night. For service
of stations in the various parts of the section, the sanitary inspectors were re-
sponsible. The success of these stations may be inferred from the fact that
during the last six months of 1918, only 1 case of venereal disease developed to
each 312 prophylactic treatments given.
The office of the supervising dental surgeon was established at St. Nazaire
on April 1, 1918. The supervising dental surgeon's duties at that time included
the supervision of the dental work in base sections Nos. 1, 2, 5, and 7. Since
organizations going through the section remained but a short time, the scope of
the work was limited, for each organization had its own dental surgeon and but
few were assigned to the base section.
On November 2, 1918, dental infirmaries were established at camp No. 1 and
at Montoir. On December 17, the scope of the service was enlarged to meet the
increased demands incident to the return of the troops to the United States;
infirmaries were opened at camps Nos. 4 and 5 and additional ones at both
Montoir and camp No. 1 ; more dental officers were assigned to the dental super-
visor and one was placed in charge of each district.
The attending dental surgeon's office was established April 17, 1918, at
section headquarters building in St. Nazaire, where 1,900 patients were treated
and 3,000 operations performed.
A system of reports was established so that the work done each day by each
dental office was tabulated and made of record. At the reception camp, dental
officers were on duty making inspections of all men arriving for embarkation.
Patients were listed according to the urgency of their needs for dental treatment
and were ordered to the infirmary accordingly.
Consultants for the base section were appointed in general surgery, ortho-
pedic surgery, and general medicine. These officers visited the various hospitals
from time to time, made special reports on personnel and equipment and
endeavored to remedy deficiencies. They were directed when necessary, to
remain at a hospital long enough to give special instruction and training to the
personnel, so as to insure the latest methods of treatment and uniform
procedure throughout the section. When better facilities for special cases were
known to exist at a particular hospital, recommendations were made for the
transfer thereto of selected cases, especially the wounded. The orthopedic
consultant also visited trains and transports to insure that the wounded were
comfortable and that the apparatus in each case was properly adjusted.
456
ADMINISTKATION, AMERICAN EXPEDITIONARY FORCES
The American and French health authorities agreed that our Medical
Department should execute the French quarantine regulations of the port, in so
far as these regulations applied to American transports. Consequently, a
quarantine office was established about December 1, 1917, and the officer in
charge was designated the medical boarding officer. His duties were defined as
follows: (1) Transmission of the instructions to transport surgeons; (2)
report of patients to be put ashore; (3) report of infectious diseases; (4) fur-
nishing correct hst of Medical Department personnel; (5) report of venereal
inspection of troops and crews; (6) venereal inspection on ships which were
without a transport surgeon. Later, the following duties were added: (7)
I^eport of typhoid and paratyphoid fever vaccinations; (8) report to French
authorities; (9) report on requirement that sera and vaccines be available on all
vessels clearing the port with the Government passengers; (10) distribution of
orders, letters, memoranda, etc., to transport surgeons. A bill of health was
issued to each vessel sailing.
The medical boarding officer also supervised the sanitary condition of the
wharves and transports at St. Nazaire and was a member of the board of inspec-
tors which reported on the accommodations for troops all returning ships.
Approximately 198,000 troops entered France through this port.
Following the signing of the armistice the section surgeon recommended that
all incoming troops destined for the United States be placed in a receiving camp,
where a thorough physical examination could be made, and where all officers
and men having infectious disease, including skin or venereal diseases, could be
separated and placed under treatment; that the remainder should be then
disinfested, equipped with a complete change of clothing, and placed in the clean
or embarkation camp proper.
The inspection and clearance of troops was placed under a special officer;
the embarkation surgeon and all disinfesting operations were under the Quar-
termaster Department. Embarkation Memorandum No. 1, laying down
regulations for the inspection of troops and the loading of transports, partic-
ularly stressed the subject of infectious diseases.
Troop trains were met by a medical officer, ambulances, and guides.
Inspection was made, acute surgical cases were sent to Base Hospital No. 101,
and medical, contagious, and venereal cases to Camp Hospital No. 11. Con-
tacts were placed in the isolation camp, and were detained there as long as
necessary.
At the gate of the embarkation camp, men stripped to the waist, dropped
their breeches and passed in line before the medical examiners. One officer
made examinations above the umbilicus and another below. Venereal cases
(or suspects) were sent to a special examiner. Those unfit to travel were
removed and diagnosis tags affixed to them. Vermin infested men were
marked with argyrol. In this manner 12,000 or more could be examined in
one day, 20 medical teams working at the same time.
After this examination the men who had passed secured their packs and
went on to the clean camp, which could be entered only by way of the bathing
and disinfesting plant. All took shower baths; the hair of those marked as
vermin infested was clipped and crude oil was applied to the head, to remain
MEDICAL ACTIVITIES OF TEREITORIAL SECTIONS
457
15 minutes. All then passed to a warm drying room where new underwear
and socks were issued, then to the clean side where they received their packs,
which had been heated for 20 minutes to 160°. From the clean camp the
men went directly to the ships; but another examination was required if 24
hours had elapsed since the previous one. A clearance certificate was prepared
for each organization or separate individual passed.
The hospital centers at Savenay and Nantes and Base Hospital No. 101,
at St. Nazaire, had authority to evacuate patients directly to the transports,
after their clothing, equipment, pay, and records had been inspected by the
base inspector and personnel adjutant.
BASE SECTION NO. 5
In August, 1917, when the line of communications, A. E. F., was organized,
base section No. 1, included the authorized facilities in the port of Brest.' It
was not until December 14, 1917, that base section No. 5 was organized.- At
that time it contained but one Department of France — Finistere. Eventually,
base section No. 5 embraced parts of Brittany and Normandy (viz, the Depart-
ments of Finistere, Cotes du Nord, Ille et Vilaine, and Manche).'*
Undesirable conditions which militated against the value of Brest for our
debarkation purposes were the heavy rainfall, a soil which soon became a deep
and tenacious mud, inability of large vessels to reach the piers, and the fact
that the French Government hesitated to transfer to the United States debar-
kation facilities, in large degree, until after the armistice was signed, for Brest
was the most important French naval base on the west coast. ^ All disadvan-
tages, however, were far outweighed by the situation, good harbor, and
railway facilities of Brest. How indispensable this port proved is evidenced
by the fact that approximately 791,000 of our officers and men here entered
France and that an almost equal number left through it on the return voyage.^
Prior to November 11, 1918, Brest, and to a much less degree Cherbourg, were
points of disembarkation in this base section and thereafter Brest was the
principal port of reembarkation of the American Expeditionary Forces.^
A very limited personnel for the operation of the section arrived in Brest
November 11, 1917, two days before the arrival there of the first convoy,
consisting of 4 transports carrying 11,000 troops.^ Of these troops, 3 companies
of the 301st Stevedore Regiment, with a detachment of 21 enlisted men of the
Medical Department, were assigned as permanent troops in this section.^ The
surgeon of this organization instituted the office of the section base surgeon
on November 13.^
During the period when troops were arriving from America no large
camps were established in this section, for no good sites existed in the immediate
vicinity of the port nor could such as were available be made suitable without
nuich time and labor; also the supply of building material was extremely
limited.^ Because of this lack of camp facilities the troops of the first and
many subsequent convoys were kept on board ship, where they could be
sheltered and fed, until trains were available, and thence were sent toward
the front or to other sections as quickly as possible after arrival.^ This
procedure prevented isolation of cases of infectious diseases and contacts, and
458 AD:^riNlSTRATIOX, AMERICAN EXPEDTTIONARV FORCES
permitted spread of such diseases along the hue of communications, a circum-
stance that was attended bv especially bad results, from a medical standpoint,
during the epidemic of influenza.^ Brest at first also lacked many sanitary
facilities and appliances for troops permanently assigned to this section. Budd-
ings used as barracks and latrines by the troops first serving in the section
were in poor condition and were very Umited in number. The water supply
was limited, and unsafe until chlorinated, but the limitation in its supply was
overcome in part bv collecting rain water. An adequate water supply, though
early recommended, was not installed until July, 1918. Fuel was scarce,
heating apparatus inadequate, and bathing facilities at first were lacking.^
For administrative purposes, base section No. 5 eventually was divided
into the following units Casemates Fautras Barracks; Fort Bouguen casual
camp; Fort Bouguen prisoners-of-war inclosure; Camp Federes; Penfield
prisoners-of-war inclosure; motor reception park; motor ambulance pool. Camp
President Lincoln; Camp Gainbetta; Camp de la Rampe; Camp Port Foye.
The surgeon at each of these was in charge of sanitation and of a sanitary
squad which each organized.
In addition to the section surgeon and section sanitary inspector, other
officers eventually on duty in the office of the section surgeon were his assistant,
an adjutant, a food and nutrition officer, and consultants in medicine, surgery,
urology, orthopedics, neurosurgery, and dentistry.^
When American activities began in this section the hospitals operating in
Brest were Navy Base Hospital No. 5, serving the personnel on American naval
transports based on that port, and the French marine hospital performing the
same duty for the French naval forces. ^ Arrangements were made with the
commanding officers of these hospitals for the care of such patients as might be
among the arriving troops. At this time the first mentioned unit had a capacity
of 40 beds, but was in process of moving to larger quarters where a capacity
of some 400 beds was provided. All of these were not available for the Army,
but as many as could be spared were freely allotted it. The number of beds
made available at the French marine hospital was between 100 and 150.
During the month of December, 1917, Navy Base Hospital No. 1, with a
capacity of 417 beds, expanded in times of stress to nearly 700, and staffed by
Navy personnel was established in the Petit Lycee at Brest. This unit was
loaned to the Army.^
On January 15, 1918, a formation first known as Pontanezen Barracks
Hospital and later (February, 1918) designated as Camp Hospital No. 33, was
opened in Pontanezen Barracks, its limited personnel being drawn from organi-
zations passing through the port and from other sources.^ No nurses arrived
until April. The bed capacity of this unit, at first 200, was increased in April,
1918, to 1,000 normal and 200 emergency. Later it was at one time increased
to 2,600 beds, but never cared for more than 1,900 patients at one time. It
occupied four barracks, 300 feet long, 13 Adrian barracks, and an old building
formerly used by the French as an infirmary. In May, 1918, a hospital for
contagious cases, under the jurisdiction of Camp Hospital No. 33, was built in
its vicinity. This unit, Camp Hospital No. 33, was used for troops located
permanently at or near Brest, but it also received patients from troops moving
MEDICAL ACTIVITIES OF TEEEITOEIAL SECTIONS
459
to the front, and later those belonging to troops being returned to the States.
During the period when influenza prevailed, August to December, 1918, the
admissions numbered 12,465. This unit experienced many difficulties, of which
the most serious were shortages in personnel, supplies, and equipment, and the
fact that it was required to supply with medicines transient organizations
temporarily in camp in this section. The base surgeon, in order to meet urgent
needs, was obliged to divert supplies en route to medical supply depots farther
inland. Sanitation of the hospital with the primitive facilities afforded was
very difficult, and methods employed in different elements of it were, because
of conditions encountered, somewhat diversified. Some latrines were pumped
out by tank wagons, while others of the can type were emptied by contractors.
Disinfectants were very scarce and it was impossible to render latrines fly proof.
Eventually large cement latrines were constructed, which were to have been
connected with the sewer system and flushed by waste water from the shower
baths, but these were never installed, and the pits therefor were emptied by
tank wagons or buckets.
Infectious cases were sent at first to the French marine hospital, but as
more beds were provided in American formations the usage of that unit by
Americans was gradually discontinued.^ Thereafter as far as possible infectious
cases were sent to Camp Hospital No. 33 and noninfectious cases to Naval
Hospital No. 1. It had been believed during the earlier period of activity in
this base area that the units mentioned above would prove adequate, for at that
time it was estimated that troop arrivals would average 20,000 per month.^
Later it was proposed to establish a hospital of 12,000 beds at Landerneau,
about 30 kilometers east of Brest, and as a nucleus Camp Hospital No. 46, with
a capacity of 260 beds, was established in June, 1918, in a convent at that
place. This hospital was not increased in size — orders for the construction of
a center there being canceled when the armistice was signed — and it was used
chiefly as a hospital for convalescent wounded, except that in the fall of 1918
(October and November) it accommodated influenza-pneumonia patients from
the transports.^
The most serious difficulties which the Medical Department encountered in
this section were those incident to hospitalization and transportation.^
In order to care for patients brought ashore from transports and for others
belonging to the troops permanently stationed here, hospital accommodations
were rapidly expanded.^ They proved adequate even during the influenza
epidemic when bed capacity rose to 6,200, though the Medical Department
personnel then available was very limited.^
Hospitalization at Cherbourg for Army troops was provided by the British
under an agreement whereby duplication of hospitalization facilities by the
Allies was avoided.^ The British personnel charged with care of American
patients there was assisted by 5 officers and 21 enlisted men of our Medical
Department. A total of 179,911 troops landed at that port, which was closed
December 27, 1918.
Though medical supplies for shipment elsewhere began to arrive at Brest
in Januaiy, 1918, it was not until December 6, 1918, that authority for the
establishment of an issue depot was obtained.^ On December 21, 1918, the
460
ADMINISTRATION", AMERICAN EXPEDITIONARY FORCES
base supply depot was stocked and prepared to make issues to hospital trains,
transports, dispensaries, troop organizations and, in emergencies, to base
hospitals.
The laboratory unit assigned to serve this section was organized in Washing-
ton in February, 1918, as stationary laboratory No. 2, but after its arrival at
Brest in the following May its designation was changed to base laboratory
No. 5.^ It was gradually equipped to do the necessary work for this base section.
Its greatest activities were the study and control of infectious diseases throughout
the section, but it also exercised supervision over the smaller laboratories in
and about Brest. Difficulty was experienced in securing supplies, but by
August, 1918, all necessary equipment had been received. Thorough studies
were made of all infectious diseases appearing in the section, from both bacterio-
logical and pathological viewpoints.^ Also the laboratory prepared antitoxic
sera and issued these and other supplies to hospitals in the section and to trans-
ports, and maintained close liaison with all units of the Medical Department,
especially in respect to infectious diseases, and with the Engineer Corps in matters
pertaining to water supply. Thorough examinations were made weekly of all
water supplies, and all American troops were instructed to use no water for
cleansing teeth, washing mess tins, or for drinking purposes unless drawn from
a faucet marked "potable." Faucets were marked under supervision of the
military officer commanding the area.
The only ambulances at first available were those furnished by the Navy,
and despite its difficulties the ambulance service of Naval Base Hospital No. 1
was especially satisfactory.^ Later a few ambulances from the Army were
received, but for several months after the port was opened the total number
available was very limited. Ambulance Company No. 105 reached Brest on
July 13, 1918, and was used to assemble ambulances and trucks at motor recep-
tion park No. 716.^ In August this company was also required to assist in the
transport of sick and wounded. There were then but 9 ambulances available,
4 belonging to Naval Base Hospital No. 1 and 5 to Camp Hospital No. 33,
but in September 5 more were assigned.^ Meanwhile trucks were used whenever
possible. On October 12 Ambulance Company No. 105 was ordered to rejoin
the 27th Division; affd on the 19th Evacuation Ambulance Company
No. 17, consisting of 1 officer and 31 enlisted men (later in the same month
augmented by 37 others), was assigned to the pool, though it was not actually
authorized in formal orders until November 12.^ On December 5, 1918, Evacua-
tion Ambulance Companies Nos. 28, 37, and 38 were also assigned to this pool,
with 3 officers and 110 enlisted men.^ The number of vehicles in and near Brest
gradually increased so that eventually there were 70 ambulances at the motor
ambulance pool, 16 ambulances at Camp Pontanezen, 5 ambulances at Camp
Hospital No. 118, and 1 ambulance at Camp President Lincoln.^ The personnel
consisted of 9 officers and 242 enlisted men.
Beginning with December, 1918, the pool took over the emergency ambu-
lance service of Brest and vicinity, excepting Camp Pontanezen. Ambulances
and men were always at call and requests were answered from points as far away
as Quimper and Morlaix. In four months these calls numbered 1,243, and the
number of patients carried was 2,920. This service, which operated under the
MEDICAL ACTIVITIES OF TERRITORIAL SECTIONS
461
direction of the surgeon of the base section, unloaded all hospital trains
either at the Kerhuon hospital center or at the Port du Commerce; transferred
all patients from other hospitals to those at Kerhuon and from that center to the
wharves and transports.
An officer of the food and nutrition section of the base surgeon's office
reported September 14, 1918, and about a month later was joined by two
noncommissioned officers especially qualified as instructors.^ Other officers
and enlisted men joined, until on December 24, 1918, the force consisted of 7
officers and 6 sergeant instructors, which number was gradually reduced by needs
elsewhere. This personnel, under general orders of this section, was directed to
investigate conditions of messes, the preparation, conservation, and handling of
food, instruction of mess sergeants and cooks. Improvements that could be
made by local commanders were recommended directly to them, if they were
able to effect them; otherwise to higher authority. Also messing conditions on
transports and commercial vessels were inspected from time to time and appro-
priate recommendations made. The food service of transient troops, perma-
nent troops, and hospitals presented many problems because of highly different
conditions constantly being encountered, which were aggravated by shortage
of material and labor and by unfavorable climatic conditions. Because of the
policy to ship to the front, as far as possible, all men and materials and retain the
barest necessities in building materials, as well as other assets, the base section for
a long time lived under primitive conditions. Camps were so widely scattered
throughout the vicinity of Brest and transportation was so limited that the
ration period, except for bread, meat, and vegetables, was made to be one month,
though storerooms were small and inconvenient.^ Water was scarce and its
points of supply poorly distributed, necessitating several messes carrying by
hand for long distances all water that they used.^ Mess service in hospitals was
rendered difficult by the lack for a considerable period of a number of the usual
ingredients of hospital diets and by the pressure of a number of patients greatly
in excess of those for whom normal accommodations were available.^ Messes
were operated by transients troops at the casual officers' camp. Camp Port Foye,
Fort Bouguen, Casual Camp, and Camp Pontanezen.
The company kitchens at Camp Pontanezen were replaced at about the time
the armistice was signed by others, each adequate to serve 5,000 men, some
feeding as many as 9,800 men in 70 minutes.^ This method afforded certain
advantages over that of company messes, but did not permit the preparation of
so diversified or elaborate a menu. Because of the difficulty in getting per-
manent personnel to operate these kitchens, the primitive mess halls, the scar-
city of fuel and water, and the inclement weather, mess service was at first dif-
ficult, but eventually satisfactory preparation and service of food were made
possible.^
The dental service of this section was generally inadequate, the number of
dental officers available being insufficient to meet the requirements of the troops
stationed in the section and of those passing through.^ The situation was met
as well as possible by shifting dental officers in accordance with the most emer-
gent needs.^
462
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
During 163^ months, 2,105 deaths occurred at Brest, of which 59 per cent
were among the troops who contracted their disease, or were injured, outside
the base section.^ Sixty-seven per cent of the total occurred during the last week
of September and the first three wrecks of October, 1918, when influenza was
epidemic. Of the latter percentage, 72 per cent occurred among patients who
had contracted disease outside this section. A total of about 70,000 patients
were cared for in the section.^
As the transports of the first convoy were obliged to anchor in the open
road, and heavy rains were falling, pneumonia cases at or near the crisis were
left on board, but other patients in that convoy were sent to Naval Base Hos-
pital No. 5 or to the French marine hospital in Brest. Most cases of sickness
among arriving troops was due to infectious disease, some cases of several
different kinds being found on every transport. Thus the sick in the first
convoy included men suffering from cerebrospinal meningitis, mumps, measles,
and pneumonia. The same infectious diseases were found in all subsequent
convoys, with also in some instances scarlet fever, diphtheria, and influenza.
At first mumps and, to a less degree, measles were the most common infectious
diseases, but on one transport an epidemic of scarlet fever developed.
The influenza epidemic began in a replacement draft from Camp Pike on
August 12, 1918. These men were so closely quartered in a wooden barracks
as to have but 129 cubic feet of air space each. By August 24, about 90 cases
had developed, with 17 deaths. The draft was removed to a tent camp, where
quarantine and other measures were enforced. Soon afterwards, influenza
appeared in the civilian population of Brest. On September 8, an order was
issued prohibiting troops entering places of public congregation. This local
epidemic spread but little and subsided in a short time.
Cases of influenza began to arrive again early in September, but were few
in number until September 12, w^hen the Kroonland brought 117 cases of influ-
enza and 6 of pneumonia.^ From this time on the number of cases rapidly
increased until the middle of October, after which they rapidly declined. Dur-
ing September and October, 4,187 cases of influenza and 913 of pneumonia were
disembarked.^ The transport surgeons on arrival often reported fewer cases of
influenza and pneumonia than were detected after the troops landed, the number
of influenza cases reported being about 50 per cent of those detected and the
number of pneumonia cases about 95 per cent.^ Conditions on board naturaUy
changed rapidly and records were made at the moment of anchorage, though
sometimes the transports were not unloaded for from 24 to 48 hours, during
which time cases developed in addition to those reported. Within five days
after the different bodies of troops arrived at Brest on transports there developed
among them 4,354 cases of influenza and 2,539 of pneumonia; i. e., 90 per
cent of the pneumonia and 88.7 per cent of the influenza admissions for base
section No. 5 developed among troops from transports. The number of deaths
from pneumonia among these troops after landing was 1,217; 497 patients had
died of that disease en route, making a total of 1,696 deaths among 218,000
troops transported.^
Sick were brought ashore by small launches, and as the larger transports
anchored in the open road, where they w^ere exposed to the rough sea, and as
MEDICAL ACTIVITIES OF TERRITOKIAL SECTIONS
463
there were frequent rains during the winter months, the transfer of patients to
shore was slow and attended by much discomfort to them. Recumbent cases
were transported in the Stokes Utter, and after the armistice began on a special
boat, for additional water transportation was then secured.^ Pneumonia
patients, except when on foreign ships, were not removed unless they were in the
first two or three days of their illness or had passed the crisis at least three days,
and were in transportable condition. Eventually it was ordered that no
pneumonia patients be transferred fromship toshore unless safelypastthe crisis. ^
Patients debarked at several piers, each of which offered some disadvantages,
until finally Pier 5 was used, though here there was no shelter and patients had
to be loaded direct from the tugs into ambulances, which at first were few in
number.^
This port, in addition to St. Nazaire and Bordeaux, was used for evacuating
sick and wounded to the United States from June, 1918.^ At first — ^that is, in
May and June, 1918 — patients arrived on hospital trains from the hospital center
at Savenay, usually at night. Since they were evacuated usually the following
day, all were fed and had their dressings changed. These requirements neces-
sitated an increase in the bed capacity of the local hospitals, especially of Navy
Base Hospital No. 1, the unit then principally used for this purpose because it
was nearest the docks. ^
Patients first began to arrive in appreciable numbers from hospitals farther
forward early in July, 1918, in small but numerous detachments, which had
been forwarded from Savenay.^ Soon a hospital car was added to the trains
from that point, and others were added until they were replaced by a hospital
train. As the sailing time and capacities of transports were uncertain a plan
was developed and applied to hold patients in considerable numbers until they
could be received on board the ships.^
With the exception of a few patients transferred direct from trains, patients
were evacuated to the United States principally through the hospital center
at Kerhuon, where shortages in equipment were made up, wounds dressed,
payments made, records completed, and classifications effected according to
naval requirements.^
As all transports coming to this port were under the direct supervision
of the Navy, liaison relative to patients was established through a represent-
ative of the Medical Corps of the Navy and one of the Army, the latter being
the evacuation officer.
Though evacuations were affected by an officer on duty in the office
of the base surgeon, the medical boarding officer superintended the embarkation,
and also received the sick from transports for transfer to hospital.
Patients were held at Kerhuon hospital center as short a time as possible,
dop(Miding on the quality and quantity of bed space available for them on
transports.^ Patients were classified as follows :
1. Bedridden: (a) Medical, (b) surgical.
2. Walking dressing: (a) Legless, (b) armless, (c) not needing assistance.
3. Tuberculous: (a) Bedridden, (&) requiring special attention, (c) requir-
ing no special attention.
4. Mental: (a) Requiring restraint, (6) not requiring restraint.
13901—27 30
464
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Immediately before departure patients were inspected by an officer from
headquarters, base section No. 5, who assured himself that all existing rejru-
lations had been comphed with.^ Other hospitals in this base section evacuated
through Kerhuon hospital center.^
Five hundred of the beds in the Kerhuon hospital center were set aside
for the accommodation of nurses about to sail to the United States. This
arrangement was made about February 14, 1919; prior to that time there
had been no systematic arrangement for their lodging when awaiting return
to the United States.^
The first hospital train from forward areas arrived in the base section
October 26, 1918, and the great difference in the character of the cases received
from this time forward required radical reorganization of the professional
services.^ From this time the Kerhuon hospital center acted as one of the evac-
uation hospitals of the American Expeditionary Forces.^ The vast majority
of patients arrived with very meager data. Several forward base hospitals
evacuated all their patients at one time, including some who needed daily
dressings, which were impracticable during the three or four days en route.^
This policy was soon corrected.^ Patients at Kerhuon constituted a group
whose members were given final preparation for their voyage to the United
States and could be held to meet, on short notice, calls from the Naval Transport
Service to fill such space as might be available for the several classes of patients
to be placed aboard.
After October 1, 1918, the carrying capacity of transports was increased
and the disposal of patients simplified. Thereafter hospital trains were loaded
in sections, each section being meant for a transport and having its passenger
list, which was made up in triplicate. One copy was used to check patients
on board, the other two filed in the base surgeons' office.^
Until November 15, 1918, 98 per cent of the casualties evacuated through
Brest came from Savenay, where passenger lists were made up, a copy of
which was given the transport service.^ From this the regular passenger
list required for each transport was made up and patients according to the
quota of each class on each transport were placed on board. A letter from the
commanding officer of the transport service to the base surgeon, prescribed
the quota for each transport and gave the following data concerning classi-
fication both of accommodations and of those w^ho would utilize them. ^ Num-
ber of beds, including those in the sick bay, for the bedridden; number of
beds for those who could walk and could occupy troop standees, though
requiring surgical dressings; number of nervous and mental cases, that could
be carried; number of tuberculosis cases that could be carried in isolation
or on open decks; beds available for those able to walk, requiring no attention,
in rooms for officers; beds for convalescents requiring no attention.
A Red Cross rest station was erected on Pier 5 in the autumn of 1918,
and later in the same year a larger and more modern building on Pier 6 was
used by that association for the same purpose. From their station the society
issued refreshments to patients awaiting transfer to the tugs that would take
them to their vessels.^
MEDICAL ACTIVITIES OF TEBKITORIAL SECTIONS
465
A replenishment depot for hospital trains, with a personnel of 1 officer
and 4 enlisted men, was established about December, 1918, in order to replenish
with medical and quartermaster supplies such of those units as entered the
base section.
The following tabulation shows the number of patients evacuated from
Brest to the United States from May, 1918, to July, 1919
Evacuation of sick and injured to the United States, base section No. -5, from May, 1918, to
July 31, 1919, inclusive
May
June
July.
August
September.
October
November.
December.
January. .
February.
March
April
May
June
July
Total -
1918
Medical
Surgical
2,646
4,922
1,824
1,656
5,190
2,215
4,546
2,804
5, 468
3,510
5, 338
2,925
5, 120
2.644
3,318
301
32,450
21,977
All others
831
350
250
1,431
Total
20
152
425
324
2,784
3. 220
5,807
8, 399
3, 830
7, 655
7, 350
8, 978
8, 263
7,764
3.619
68, 390
CAMP PONTANEZEN
From January to December, 1918, Camp Pontanezen functioned as a
debarkation and rest camp, with a small permanent garrison.^ From (and
including) December, 1918, it operated as an embarkation camp.^ The perma-
nent strength of this camp rose to about 15,000.^
In the spring of 1918 a board of officers examined Camp Pontanezen and
found it fairly satisfactory for about 10,000 men, provided certain improve-
ments were made.^ Some of the improvements recommended by the board
were effected, but during the summer and fall of 1918 the small permanent
garrison was straining every nerve to keep the tide of men and supplies moving
toward the front, and had but little time or resources wherewith to accomplish
iniich in the way of improvement.^
The camp consisted of an interior and an exterior area. The interior
area, covering approximately 15 acres, was inclosed by a wall and contained
six old and very large stone barracks and several other smaller buildings. This
area, known as Pontanezen Barracks, had long been used by the French as
a military garrison.^ The exterior area, comprising farm land surrounding the
inclosure, was gradually extended by requisitioning land from the French as it
was needed. It expanded from about 90 to approximately 1,000 acres when
the camp reached its maximum capacity in the spring of 1919.^
The final dimensions of the camp were approximately 1 mile wide by IH
miles long.^ It lay on a hillside, sloping toward the south, about a mile and
a half from the harbor. Though the slope afforded drainage, there was neither
good roads, walks, sewers, nor drainage ditches, and the clayey loam surface
466
AT:>]\riXISTRATION, AMERICAN EXPEDITIONARY FORCES
was cut up into small rectangles by dykes and hedges. Consequently, con-
ditions at first were very unsatisfactory, for not only was it necessary to utilize
the camp before it was ready, but also the weather was cold and inclement
and the soil such that it formed a deep and tenacious mud. The last mentioned
fact greatly interfered with both construction and service. Other defects were
insufficient kitchens, lack of mess halls, inadequate means of sterilizing mess
kits, poor latrines, limited bathing and disinfecting facilities, limited means
for washing hands, shortage of fuel, and an inadequate water supply, which
was polluted. These unsatisfactory conditions were intensified by the relative
lack of trained camp personnel and the great numbers of troops which arrived.^
At first there were only two roads, which ran north and south; however,
two east and west roads soon w^ere built, and a number of good thoroughfares
had been completed by April, 19 19.'^ Also by that time footways, largely
"duckboard," were provided.
In addition to Pontanezen Barracks, the only other shelter at first avail-
able consisted of several temporary barracks, which had been erected in No-
vember, 1918, and pyramidal tents for 5,000 men.^ Prior to this time, a
number of the troops had to occupy shelter tents. In the latter part of Decem-
ber, 1918, only 44 per cent of the pyramidal tents were floored; however, by
April, 1919, barracks and floored tents were adequate. At that time 450
barracks each accommodating 110 men, and 5,000 floored tents, each accom-
modating 6 men, were available.^
The activities of the camp surgeon's office were varied. Sections of it
were charged, respectively, with administration, records, statistics, sanitation,
and medical clearances.^ The camp hospital and segregation camp were
ultimately placed under control of the camp surgeon, thus promoting their
coordination.^ Weekly conferences of medical officers were held and health
and venereal bulletins were issued to acquaint line and medical officers with
prevafling local sanitary and health conditions. Although most organizations
passing through the camp were accompanied by their medical detachments,
some were not, and for these it was necessary to maintain six infirmaries,
besides the seven maintained for permanent organizations.^
For purposes of sanitary control Camp Pontanezen was divided into 17
sections, each supervised by a sanitary inspector.^ Senior surgeons of organi-
zations were held responsible for sanitation in their ow^n areas, to each of which
two men and a sufficient number of labor troops w^ere assigned.^ Under the
control of the camp sanitary inspector were 3 chief assistants, 2 sanitary squads,
and 265 men from a labor battalion. Three men from the labor battalion
were assigned to each kitchen, and six to every five latrines. Those on duty
at the kitchens were required to keep the garbage cans and surroundings clean;
those at the latrines washed the seats daily and sprayed the interiors twice
daily with cresol and crude oil.^ The sanitary squads (w^hich supervised the
work of the labor troops) were in addition to tw^o others w^hich operated the
disinfecting plants.^
Certain sanitary activities required special inspectors; for example, one
oflRcer was engaged solely in the inspection of troop kitchens, one had entire
charge of drainage problems, another supervised construction of latrines.^ The
MEDICAL ACTIVITIES OF TEEEITORIAL SECTIONS
467
officers concerned with drainage and latrines worked with the Engineer
Department.^
Every day the camp sanitary inspector held a meeting of his assistants ,
and each week the camp surgeon held a conference attended by all senior
surgeons and sanitary inspectors/
For a long time there was but one kitchen in Camp Pontanezen. This
was operated in an old stone building within the walls of the caserne.^ It
had 7 double field ranges and 41 French caldrons, but no mess hall. In
December, 1918, a mess hall was built, but since it accommodated only 400
men, the great majority ate in the open, although there was almost incessant
rain at this time.^ This kitchen fed about 7,000 men daily and operated day
and night until April, 1919.^
In December, 1918, seven kitchen buildings were constructed and tem-
porarily equipped with field equipment.^ These buildings were long and low,
each being divided into five separate kitchens, equipped with two double
field ranges and a number of caldrons for cofTee, stews, etc. At the end of
December, 1918, but three kitchens had mess halls. ^ These had high, wooden
tables, and dirt floors, which emitted a putrid odor from the trampling in and
decomposition of food particles. Since these kitchens had to prepare food for
from four to seven thousand men each, necessarily the menus were simple,
consisting chiefly of bread, beans, coffee, and stew.^ Subsequently, these
kitchens were properly equipped and were made permanent.^
Meanwhile, model kitchens were being constructed, one for each area into
which the camp was divided.^ These were called "troop kitchens." Each
was approximately 375 feet long and comprised six completely equipped unit
kitchens, with all necessary modern appliances, and had a concrete floor, water
supply, and sewer connections. Vegetable bins, made of wire netting and set
above the floor, were installed, and a room for meat was built in each kitchen.
The mess halls were about 300 feet long. Each could feed 5,000 men in 40
minutes. By a system of inspections and markings, a friendly competition
was brought about among the personnel of all kitchens; personal cleanliness
on the part of the kitchen force w^as a requirement especially stressed.^
The disposal of garbage was a constant problem.^ Early in 1918, part of
the garbage was taken by French civilians, but for sanitary reasons this had
to be discontinued. The garbage was then buried in great pits. After the
troop kitchens, referred to above, had been constructed and a less simple
ration became possible, the amount of garbage increased to such an extent as to
fill from 60 to 80 large cans per day at each of the 16 kitchens. This was too
large an amount to be constantly burying, so during March, April, and May,
1919, incinerators were constructed at the kitchens, each capable of disposing
of all the garbage, then averaging more than 45 cans per kitchen daily. These
cans were kept in a special concrete stand.
PVces were disposed of as follows:^ In the caserne a number of old
French latrines of the hopper type, with cesspools, w^ere utilized. In the
outside area latrines were constructed, use being made of galvanized cans. In
October, November, and December, 1918, about 25 cement-lined pit latrines,
with urinals, were constructed and their contents removed by odorless excava-
468
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tors. In January, February, and March, 1919, these were supplemented by a
large number of pit latrines of the box type. The contents of the latrines of
the can type and of the cement vault type were hauled away and buried in
two deep pits, or trenches, at the edge of the camp. These pits were frequently
burned out with crude oil and the contents covered with dirt. By April this
system was abandoned.
From November, 1918, to July 1, 1919, there were practically no flies at
Camp Pontanezen.^ One reason for this was that there were very few animals
in camp, as motor trucks were used instead of horse-drawn vehicles, and the
small amount of manure which required disposal was hauled away by French
farmers, or buried in the pit latrines with feces. ^
The sick at Camp Pontanezen were cared for usually at Camp Hospital
No. 33.^ Navy Base Hospital No. 1, Camp Hospital No. 46 at Landernau and
the Kerhuon hospital center were also available.^ During the influenza-
pneumonia epidemic of October, 1918, and at times soon after the armistice
was signed, the hospital facilities were taxed to their utmost capacity, but the
sick and wounded were always provided for.^
A quarantine camp, including a venereal segregation camp, was established
December 6, 1918, at the northern extremity of Camp Pontanezen in a tri-
angular area, bounded by three public roads. ^ The entire plant was termed
"the quarantine camp" until February 13, 1919, when the designation "Segre-
gation camp" was adopted. The men were quartered in floored tents, not
more than six men to a tent.
The segregation camp was divided into plots, to each of which was assigned
a certain class of cases. ^ The quarantine section proper had a capacity of
300 beds and received the contacts of communicable diseases from among
permanent troops at Brest and Camp Pontanezen and from transient troops
en route to the United States. The venereal section, divided into subsections
for white and colored, and with a total capacity of 700 beds, was used for all
uncomplicated cases of venereal disease in a communicable stage. Complicated
cases were sent to hospital. The stafl" of this section consisted of 10 officers
and 244 enhsted men, the officers including 3 genitourinary specialists, 1 skin
specialist, 1 dentist, and 1 laboratory officer. Negro venereal patients were
separated from the white men in this class; venereal suspects were also sepa-
rated from those with a definite diagnosis of such diseases. Patients with
definitely estabhshed venereal diseases were classified as A, B, and C. The
men in class A were those unable to do any duty. Those in class B performed
light duty, and those in class C full duty (or labor).
A hospital with 200 beds and a laboratory was maintained for this camp.
Patients with scabies were treated in an especially equipped building.
The capacity of the segregation camp was about 1,500 until June, 1919,
when all venereal cases in the vicinity of Brest were transferred to it.^ Early
in July, 1919, all the venereal cases from the Third Army were received, as well
as others from various parts of France, necessitating extensive additions.'^ All
patients were organized into battalions, of which there were six in July, form-
ing a provisional regiment. Extensive buildings for treatment were provided,
with faciUties for treating 4,000 cases of gonorrhea and 2,000 cases of chancroid
MEDICAL ACTIVITIES OF TERRITORIAL SECTIONS
469
in one-half hour. At this time the camp was largely a venereal camp; the
number of contacts being relatively small. The number of cases of venereal
disease segregated in it numbered about 1,200; and all contacts about 200.
This camp had a canteen and a Y. M. C. A. hut (with capacity of 2,000).
Educational classes were maintained, instruction was given in hygiene, citizen-
ship, and other subjects, and a generally friendly attitude was maintained.^
PREPARATION FOR EMBARKATION
The principal function of Camp Pontanezen was to prepare troops for
embarkation.^ The basic idea was a division of the entire camp into areas,
each receiving an entire organization. Within its own area each unit had its
kitchen, infirmary, prophylactic station, and welfare hut. From all these units
a communal segregation camp received venereal cases and infectious disease
contacts. Men, seriously sick, suspected of having an infectious disease, or
with fever, were sent to Camp Hospital No. 33.^ Sterilizing and disinfesting
plants were provided to eliminate vermin. The plan was not to pass men from
area to area but to hold them in one, retaining from each command the contacts
and patients with venereal disease.^
Organizations arrived from the interior at all hours of the day and night.
Data concerning the strength of each arriving organization were telephoned to
the billeting officer, and tents were assigned before troops reached their desig-
nated area. Preparations for embarkation of the organization were then begun
conformably to the following method.^ On arriving at the camp the organiza-
tion, as stated above, was assigned to a definite area, containing a kitchen,
infirmary, water supply, latrines, sewer connections, etc. Commanding officers
and medical officers reported at the main billeting office for instructions.
Instructions for medical officers dealt with: (1) Reports required; (2) disposi-
tion of sick and contacts; (3) physical examinations required; (4) infirmaries,
ambulances, and prophylactic stations; (5) medical supplies and dental treat-
ment; (6) general orders and memoranda of medical interest.
Within 24 hours after arrival, the transient organizations received orders
to report for physical examination at a specified time.^ These orders were so
issued as to call for 240 men every 10 minutes. The unit reported at a large
central building arranged for examination and bathing. This structure had
numbered scats (benches) for 480 men. The men stripped to their undershirts
and stood on benches, two rows facing each other. The medical inspector then
passed between each two rows examining for venereal disease and vermin, thus
making it unnecessary for the inspector to stoop. The men then stepped down
from the benches and pulled their undershirts over their heads and the inspector
passed along a second time examining for skin diseases, scabies, and body lice.
Men found to be diseased or infested with vermin were at once segregated in a
special room. The others placed their underwear and socks in bins for steriliza-
tion, leaving their outer clothing on the numbered seats. At a given signal, 120
men went to the shower-bath room, where they received a four-minute hot
bath. Each man was then given a clean towel, clean socks, and underwear,
whereupon all men returned to the numbered seats. Here they dressed quickly
in their old clothing and then passed out of the building. But one minute was
470
ADr^llXlSTKATIOX, AMERICAN EXPEDITIOXAHY FORCP:S
, allowed for a change of groups in the bathrooms, so that a continuous stream of
bathers was kept going at the rate of 120 men every 5 minutes, orderlies being
in charge to prevent talking and to maintain order. Lists of men cleared were
sent daily to the medical clearance officer/
Men found with lice or nits were sent with an officer of their organization
to their quarters to procure their blankets and other clothing and then to a
disinfesting plant. ^ There they undressed completely and placed all their
clothing in receptacles to be sterilized, themselves passing to a room where
the axillary and pubic regions were closely clipped and treated with vinegar.
They then went to a bathroom, where they rubbed the entire body with kero-
sene soap (1 pint of kerosene to 5 pounds of soap dissolved in hot water),
following this with a hot shower. While this process was going on, all the
men's clothing, except leather and rubber articles, was sterilized by steam
for a period of 20 minutes. On leaving the bath, men were given clean under-
wear and clean socks and their own outer clothing was returned to them. The
medical officer in charge then checked the list of men and receipted it by writing
"deloused" with date and signature. This list was then forwarded to the
medical clearance officer.
Though men with lice were sent to the disinfesting plant and treated as
detailed above, those found wdth scabies or venereal disease were sent to the
segregation camp for treatment.^
Before organizations could embark, they were required to have clearance
certificates covering all officers and men.^ Whereas each officer was required
to have a separate certificate, the clearance for an organization covered all
its enlisted men. A medical clearance officer received all lists of clearance
from the examining and bathing building, from the disinfesting plant, or from
the segregation camp, as the case might be. The certificates of examination
of an organization, certificates of examination of its oflScers, and lists of men
found with vermin, scabies, or venereal disease were clipped together and
marked "Uncleared." When the report of the disinfesting plant was received
this was added, as was also the report of admission of cases of scabies and
venereal disease to the segregation camp. When ah lists were checked and
balanced, ah men found to have been examined, all those with lice had been
dismfested, and all scabies and venereal cases sent to the segregation camp,
the papers were signed by the chief epidemiologist, and the organization con-
cerned was "cleared." Clearance certificates were then sent to the troops
movement office and to the base surgeon, one was filed, and one was furnished
to the organization when it received sailing orders. If the organization did
not sail within six days, it had to be reexamined. ^
One other, last certificate was required showing that each man's throat
had been examined daily and his temperature taken within 24 hours of sailing.*
Any man having a temperature 1° above normal was sent to hospital; any
with a suspiciously appearing throat was sent to the segregation camp.
If men in hospital became of duty status in time to sail wdth their organi-
zation, they were returned to it; if not until after the organization had sailed,
they were transferred to a casual company, which embarked as a unit ^ Per-
sonnel to be embarked as "sick" or "injured" were transferred to the embar-
MEDICAL ACTIVITIES OF TERRITOEIAL SECTIONS
471
katioii hospital at Kerhiion. Contacts in the segregation camp were treated
as ordinary sick.^
The camp surgeon received the following three troops lists dail,y:^ (1)
Billeting office, giving organization, strength, and location and date of arrival
(changes of location were also reported); (2) personnel office, strength for
statistical purposes; (3) camp headquarters, list of transient troops, preparing
for inspection, ready for inspection, and ready for embarkation.
SURGEONS OF TERRITORIAL SECTIONS
BASE SECTION NO. 1, FRANCE
Col. George P. Peed, M. C, July 2, 1917, to July 17, 1917.
Col. Clyde S. Ford, M. C, July 18, 1917, to December 29, 1917.
Col. Charles L. Foster, M. C, December 30, 1917, to June 28, 1919.
Lieut. Col. Felix Hill, M. C, June 29, 1919, to July 15, 1919.
BASE SECTION NO. 2, FRANCE
Col. Larry B. McAfee, M. C, August 30, 1917, to February 22, 1918.
Col. Henry A. Shaw, M. C, February 23, 1918, to October 13, 1918.
Col. IT. C. Coburn, jr., M. C, October 14, 1918, to October 28, 1918.
Maj. Gen. Robert E. Noble, M. C, October 29, 1918, to April 20, 1919.
Col. C. R. Reynolds, M. C, April 21, 1919, to July 13, 1919.
BASE SECTION NO. 3, ENGLAND
Col. W. J. L. Lyster, M. C, July 7, 1917, to January 13, 1918.
Lieut. Col. Robert M. Skelton, M. C, January 14, 1918, to January 24, 1918.
Col. Charles F. Mason, M. C, January 25, 1918, to April 15, 1918.
Col. Thomas U. Raymond, M. C, April 16, 1918, to May 16, 1918.
Brig. Gen. F. A. Winter, M. C, May 17, 1918, to October 17, 1918.
Col. F. A. Washburn, M. C, October 18, 1918, to March 10, 1919.
Col. A. M. Whaley, M. C, March 11, 1919, to June 15, 1919.
BASE SECTION NO. 4, FRANCE
Lieut. Col. Edward L. Napier, M. C, January 1, 1918, to July 12, 1918.
Lieut. Col. Ralph H. Goldthwaite, M. C, July 13, 1918, to May 10, 1919.
BASE SECTION NO. 5, FRANCE
Lieut. Col. William Denton, M. C, November 12, 1917, to May 11, 1918.
Col. Guy L. Edie, M. C, May 12, 1918, to May 10, 1919.
Maj. Gen. R. E. Noble, M. C, May 11, 1919, to July 15, 1919.
BASE SECTION NO. 6, FRANCE
Maj. Holland M. Tigert, M. C, June 2, 1918, to July 14, 1918.
Col. W. E. Vose, M. C, July 15, 1918, to January 15, 1919.
Col. C. E. Morrow, M. C. January 16, 1919, to April 9, 1919.
Col. Paul S. Halloran, M. C, April, 10, 1919, to June 18. 1919.
472
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE SECTION NO. 7, FRANCE
Lieut. Col. C. C. Demmer, M. C, July 1, 1918, to July 15, 1918.
Col. Herbert G. Shaw, M. C, July 16, 1918, to April 25, 1919.
BASE SECTION NO. 8, ITALY
Col. Elbert E. Persons, M. C, October 17, 1918, to April 7, 1919.
BASE SECTION NO. 9, BELGIUM
Col. Jacob M. Coffin, M. C, May 13, 1919, to July 15,. 1919.
DISTRICT OF PARIS
Col. E. G. Bingham, M. C, May 5, 1918, to September 21, 1918.
Col. Larry B. McAfee, M. C, September 22, 1918, to July 15, 1919.
REFERENCES
(1) G. O. No. 20, H. A. E. F., August 13, 1917.
(2) G. O. No. 75, H. A. E. F., December 14, 1917.
(3) Report of Medical Department activities, base section No. 5, undated, compiled under
the direction of the base surgeon from official records in his office. On file, His-
torical Division S. G. O.
(4) Ayres, Leonard P., Colonel, General Staff: The war with Germany. Washington,
Government Printing Office, 1919.
(5) Report of Medical Department activities, Camp Pontanezen, Brest, compiled under
the direction of the camp surgeon. On file, Historical Division S. G. O.
SECTION III
HOSPITALS
CHAPTER XXI
HOSPITAL CENTERS
How the hospital center came to be adopted by the Medical Department,
A. E. F., is set forth in Chapter XV, Section I. This need not be gone into
further here. Following soon upon the conception, the chief surgeon, A. E. F.,
recommended in September, 1917, after the layout and buildings for individual
type A (base) hospitals had been approved, that five such units be erected, to
form a hospital center at Bazoilles-sur-Meuse.^ This project was promptly
approved by the general staff, A. E. F. As the situation developed, larger and
larger centers were provided, the erection of new units and the utilization of
existing buildings for this purpose progressing rapidly.^ On December 12, 1917,
authority was given for the construction of 10 type A hospitals at Allerey,
Beaune, Mars, and Mesves.^ The next day a project for 3,000 beds at Nantes
was approved. By the end of December other centers had been authorized in
the following places: ^ Beau Desert (Bordeaux), 5,000 beds, to be expanded to
20,000; Langres, 2,000 beds; Rimaucourt, 2,000 beds, to be expanded to 9,000;
Limoges, number of beds to be determined; Perigueux, number of beds to be
determined.
Other centers were gradually added at Vittel-Contrexeville, Savcnay, Vichy,
Toul, Kerhuon, and on the Riviera, so that eventually 20 hospital centers were
operating before the armistice began, of which 5 were located in the advance
section, 8 in the intermediate section, and 7 in the base sections.^ A number of
others were being constructed and additional ones were projected when the
armistice was signed.^
SELECTION OF SITES AND CONSTRUCTION
Sites were selected by one or another member of the hospitalization division
of the chief surgeon's office, A. E. F. In some cases the sites had been suggested
by French authorities.^ Proposed sites were finally accepted or rejected by a
joint board, of American and French officers, on which were American represent-
atives of the general staff" (G-4), the chief surgeon's office, the Engineer Depart-
ment, and a railway transportation expert.^ The sites were leased by an officer
of the Quartermaster Department assigned to duty with the chief surgeon for
that purpose, but construction was in charge of the Engineer Department.^
Approval of a site was determined largely by conformity with the pro-
portion of beds authorized in the advance, intermediate, or base sections; and
by availability of railway facilities.^ This latter requirement took cognizance
of all matters affecting railway service, that is, distance from the front, prox-
imity to main railway lines, grade and condition of trackage, strength of bridges
473
474
ADMIXISTRATIOX, AMERICAN EXPEDITIOXARV FORCES
(whether sufficient to support American hospital trains), available rolhng stock,
existence or practicability of sidings, and similar considerations.-^ Smce the
French controlled the railways, their advice and cooperation were essential in
locating these centers.^
Buildings utilized by centers were of two general types — preexisting French
buildings and newly constructed barracks.^' The former consisted of groups of
hotels or miUtary barracks where from two to seven hospitals were operated,
and whose capacity varied from 1,000 to 16,000 beds.^ Prominent centers
of this type were those at Toul, Vittel-Contrexeville, Vichy, and on the Riveria,
the first mentioned utilizing barracks and the last three, hotels.^ Often these
buildings, especially the hotels, were poorly adapted to hospital purposes for
they required extensive alterations, additions — especially of plumbing— and
repairs. Also many of the hotels had no heating arrangements having been
constructed for occupancy during summer only.^ Rents of such structures also
were excessive.^ On the other hand, the military barracks utilized were obtained
from the French practically without cost.^ These, generally speaking, were
more desirable for hospital purposes than hotels for they were large, built of
stone or cement, and arranged in convenient groups.^ Each barrack accom-
modated about 1,500 patients in rooms larger than those in hotels, thus assuring
easier service to a given number of patients.^ Their disadvantages were lack
of water-carriage sewer systems, inadequate water supply, and absence of suit-
able artificial light.' When the armistice was signed six centers were operating
in French buildings with a normal capacity of 38,340 patients and an emergency
capacity of 51,523.^
Centers occupying barracks constructed for the purpose, consisted of a
number of type A hospital units (whose layout is given in Chapter XV),
together with some accessory, communal buildings.^
It was planned eventually that the constructed centers would consist of
from 2 to 20 complete type A base hospitals of 1,000 beds each, with facilities
for expansion to from 50 to 100 per cent additional.^ Each center was also
to include a convalescent camp whose capacity would be 20 per cent of the
"normal" beds in the center.^
The geometrical layout of the individual units was admirably suitable for
this arrangement, as exemplified by the ground plan of the center at Mars.^
When a site was selected capable of accommodating a number of type A units
the Engineer Department made an initial survey which had particular refer-
ence to contour lines, and units were disposed in a manner most adaptable to
them, thus saving considerable piering and excavation.
Representatives of the chief surgeon's office, A. E. F., and of the Engineer
Department, in charge of construction projects, worked out together the layout
for each center. Some of the more important items which they considered
in this matter were the location and adequacy of railway sidings, frontage of
units thereon, provision of such common buildings as offices, storehouse,
garage, bakery, and ice plant, post office, telegraph and telephone exchange,
fire engine house, chapel, laboratory, and morgue, for the service of the entire
center, the construction of roads and installation of drainage, water, sewerage
and lighting systems.^ The larger centers, some of which had a»projected
HOSPITALS
475
capacity of 20,000 beds, approximated veritable cities with all their accessory
public-utility requirements.^
When the armistice was signed, 14 centers were operating in newly con-
structed barracks, with a normal capacity of 69,059 and an emergency capacity
of 127,270 beds.^ Very few of these barracks hospitals, however, were fully
completed and it was necessary to occupy them while yet under construction.^
The personnel of the Medical Department locally on duty and convalescent
patients assisted materially in the completion of these projects. In many
respects service in them was easier than in centers w^hich occupied buildings
several stories in height.^
Special hospitals were features of all centers. In each, certain units were
specially equipped for the treatment of surgical, orthopedic, eye, ear, nose, and
throat, maxillofacial, psychiatric, neuropsychiatric and, in some centers, con-
tagious cases. ^ The center at Savenay had a special hospital for the treatment
of tuberculosis patients and that at Vichy had special facilities for maxillofacial
cases. ^
The following table shows not only the hospital capacity (normal and
crisis) but also the number of beds occupied, grouped by section, on November
28, 1918: ■*
Name
.Vdvance section:
Toul center
]Ja?,()illes
V'ittel-Contrexeville.
Rimaucourt
Langres _
Intermediate section:
Beaune
Allerey
Mars -
Mesves
Vichy
Clermont-Ferrand
Orleans
Tours _
Base section No. 1:
Angers _.
Nantes --.
Savenay (St. Nazaire)
Base section No. 2:
Beau Desert
Limoges
Perigueux _
Ba.se section No. .5: Kerhuon (Brest)
Normal
capacity
Crisis
Occupied
15, 250
7,000
5,951
5,000
2,000
15,250
13, 136
9,875
10,388
3,000
10, 963
2,094
3, 545
2,519
571
35, 201
51,649
19, 692
4,000
10. 000
11,468
10, 490
8,327
6,712
2,800
2,300
10, 200
14, 468
20, 000
21, 500
13, 000
6,712
2,800
2,850
4,934
10, 728
8, 098
16, 346
10, 250
3,017
1, 135
1,870
56, 097
91, 530
56, 378
3, 500
4,300
8,000
4,400
6. 278
8,316
2, 913
4,383
8,500
15,800
18,994
15, 796
6,924
4,528
1,000
11,000
6,000
1, 500
5,439
5,485
983
12, 452
18, 500
11,907
2,800
2,800
2,438
At this time these centers contained about two-thirds of all the hospital
beds (other than those in field units) in the American Expeditionary Forces.^
It had been planned that should the w^ar continue until April, 1919, the centers
would contain no less than half a million beds.' Hospital construction wdth
this end in view w^as well advanced, but inadequate personnel and equipment
were delaying progress. No centers were constructed in England or Italy.'
476
ADMINISTEATIOX, AMEEICAX EXPEDITIONARY FOECES
The center which attained the largest size was that at Mesves, which,
from November 11 to December 5, 1918, reported daily a capacity of 25,000
beds.^ On November 16 this center had a total of 20,186 patients and the
total strength of the command, including those on duty, was 28,828.^
On November 14, 1918, patients in hospital centers numbered 109,238,
with 22,191 men in their convalescent camps — a total of 131,429.^ The total
number of patients in all base and camp hospitals and of men in convalescent
camps numbered on that date 190,356. In other words, 69, per cent of men
then under treatment in fixed formations were occupants of these centers.
The total number of normal and emergency beds (including 29,284 in con-
valescent camps) then provided numbered 292,049. Of this number 182,045,
slightly less than 70 per cent, were in hospital centers.^
The following hospital centers were in existence December 1, 1918: ^
Kame of center
AUerey
Bazoilles
Beau Desert .
Beaune
Clermont Ferrand_
Commercy-Lerouville.
Kerhuon
Langres ._ _
Limoges
Mars _.
Mesves _ _
Nantes.
Pau-..-
Perigueux...
Rimaucourt.
Riviera
Savenay .
TouL..
Tours. .
Vannos .
Vichy..
Vlttel..
Hospitals comprising
25, 26, 49, 56, 70, 97, and E. H. 19
18, 42, 46, GO, 79, 81, 116
22, 104, 106, 111, 114, 121, Prov. B. 11.
No. 7.
47, 61, 77, 80, 96
20, 30, 103; includes Chatel Guvon and
Royat.
90, 91
63, 92, 105, 112, 120
53, 88
13, 24, 28.
14, 35, 48, 62, 68, 107, 110, 123, 131
50, 54, 67, 72, 86, 89, 108, 122, and E. JL
No. 24.
U, 34, 38, 216
71; includes Dax, Lourdes, Argeles
Gazost, Bagneres de Bigorre.
84, 95
52, 58, 59, 64 __.
99; includes St. Raphael, Cannes,
Nice, Menton.
8, 69, 100, 113, 119, 214, 118, and E. TI.
No. 29.
45, 51, 55, 78, 82, 87, 210....
7 and Prov. B. H. No. 1
136-236, Quiberon
1, 19, 76, 109, 115
23, 31, 32, 36
Type of building
Barrack construction.
do
do
do
French buildings.
.do.
Barrack construction .
....do
....do
....do
-...do
..-.do
French buildings.
Barrack construction .
do
French buildings
Barrack construction.
French buildings
Barrack construction.
French buildings
-...do
....do
Normal
bed ca-
pacity
10,000
7,000
6,924
5,500
5, 137
(-)
2,700
2. 000
4, 528
11, 468
10,490
4, 300
1.000
5,000
8,000
15, 250
( = )
1,400
8, 327
5, 951
91. B^rSual No^so'^^^^^^ ""^^'^ ^^"^'^'"^''^ "^^"'^ -'^^ -"^^'^'l ^y Base Hospital No.
"> Staffed, but never received patients. *
' Did not receive patients until after the armistice began.
The increase in bed capacity of all the centers is shown bv the following
table: 1
Normal
Emergency
Normal
Emergency
1918
July 1
Aug. 1
30, 890
70, 124
78, 371
33, 498
86, 252
102, 144
1918
Oct. 1
Nov. 1
109. 897
143, 869
163, 368
160,286
221, 421
282. 182
Sept. 1
Dec. 1
As an mdex of the extent of activities of the different centers, the following
table IS given. It shows the total number of patients passing through the
principal hospital centers to March 31,1919:^
HOSPITALS
477
Patients
Patients
Toul (nearest front)
Bazoilles
Savenay
Beau Desert
Vichy
Vittel-Contrexeville.
Mesves
Allerey
Mars
67, 866
66, 284
61, 973
47, 238
46, 297
44, 855
38, 765
33, 658
33, 256
Nantes. _
Kerhuon
Limoges.
Rimaucourt _ _
Joue-les-Tours
Perigueux
Riviera
Beaune
29, 538
24, 533
23, 818
21, 067
13, 701
13, 446
13, 500
4, 540
CONTROL
Hospital centers were under the direct control of the commanding general
of the Services of Supply, except in matters of discipline, guard, fire control,
supplies, and inspection.^ For all these excepted matters each center was
luider control of the commanding general of that section of the Services of
Supply in which it was located.^
In so far as subordination to the commanding general, Services of Supply,
was concerned, centers were more immediately under the jurisdiction of the
chief surgeon, A. E. F., who (after the promulgation of General Orders, No.
31, in March, 1918) was also the chief surgeon of the Services of Supply; with
yet greater particularity they were under the hospitalization division of his
office.^ After the armistice was signed and the Third Army advanced into
Germany, its hospitals functioned in the Coblenz area virtually as a center,
which also was under control of the hospitalization division. Eventually
commanding officers of centers were given full authority in many matters.
Thus, they were authorized to transfer and assign commissioned and enlisted
personnel from one unit to another within their command without reference
to higher authority, to promote or demote enlisted men up to and including
the grade of sergeants, first class. Medical Department, to direct the disposal
of all supplies received, to approve requisitions on the American Red Cross,
employ civilian labor (under certain limitations imposed) authorize expendi-
tures of Medical Department funds, convene special (but not general) courts-
martial and issue necessary travel orders for patients transferred.^ Bulletin
29, 1918, Services of Supply, A. E. F., conferred on center commanders ah
the authority of a post commander.^ They did not have authority to approve
for issue requisitions upon depots nor did they have jurisdiction over the
engineers constructing the center.^ On November 13, 1918, the judge advo-
cate general. Services of Supply, ruled in reference to this matter that "the
senior officer present of the department to which the formation belongs is the
commanding officer, regardless of what other officers, line or staff, are present.^
All sick and wounded records were forwarded direct to the chief surgeon 's
office by each hospital, but other documents from those units were required to
pass through the office of the center commander.^
478
ADMIXISTRATIOX, AMERICAN EXPEDITIOXAK V FORCES
STAFFS
As no orders from higher authority prescribed the staff organization of
hospital centers, each developed that organization which was most compatible
with its needs and resources. Inevitably this led to some minor differences
in such organization, but these were relatively few and unimportant. Thus
at Mars,^ and Mesves,*^ the commanding officer designated an executive officer,
while at Allerey'" and Beaune" because of the shortage of officers and nurses,
the commanding officers assumed the duties of that officer. At Allerey a
chief dietitian for the entire center was appointed — an assignment which
appears to have been unique.^"
At Mesves the staff organization, consisting of 40 members, was as follows:'
1 colonel, commanding officer; 1 major, executive officer; 1 captain, adjutant;
1 heutenant, statistical officer; 1 major, quartermaster; 8 first lieutenants,
assistants to the quartermaster; 1 captain, central purchasing agent; 1 captain,
salvage and burial officer; 1 captain, supervisor of buildings; 1 lieutenant,
medical supply officer; 1 lieutenant, motor transport officer; 1 lieutenant, assist-
ant to motor transport officer; 1 lieutenant, railway transport officer; 1 cap-
tain, provost marshal; 4 first lieutenants, assistants to provost marshal; 1 intel-
ligence officer; 1 captain, commanding headquarters detachment and band and
fire marshal; 1 major, evacuation officer; 1 captain, assistant to evacuation
officer; 1 captain, sanitary inspector; 1 major, medical inspector; 1 lieutenant
colonel, medical consultant; 4 majors, medical consultants; 1 major, labora-
tory officer; 2 captains, assistants to laboratory officer; 1 chief nurse.
PROFESSIONAL SERVICES
Medical officers who were consultants in their respective specialties were
designated as chief of their several services in each hospital center.^ These
officers were drawn habitually from the local personnel and, at first, performed
their duties as consultants in addition to personal attendance on patients; how-
ever, as the centers developed, these officers found it necessary to delegate more
and more of their personal practice to assistants.^ The consultants in general
medicine, general surgery, and orthopedics usually were members of the staff
of the center, together with the center laboratory officer who, as described
below, was in a somewhat different category. In some centers the consultants
for each of the special services prescribed by general orders, A. E. F., were
members of the staff. Whether on the center staff or not, designated consult-
ants supervised the urological. X-ray, neurological, ophthalmological, maxillo-
facial, and otolaryngological services, corresponding to the branches of the
professional services of the American Expeditionary Forces.^ Occasionally, in
some centers, certain officers w^ere designated who, to a degree at least, acted
as consultants in other specialties; e. g., cardiovascular and cutaneous diseases.
In general, the duties of consultants were as follows:^ To investigate and report
to the commanding officer on all professional matters within their jurisdiction,
control professional emergencies, keep themselves informed of the qualifications
and character of the service of their subordinates and of the equipment, service,
and acute needs of the several hospitals, recommend changes in assignments
and distribution of equipment, coordinate professional efforts, and disseminate
HOSPITALS
479
professional information.^ Their services were purely advisory. In each base
hospital the chief of a service performed the duties of a consultant for his spe-
cialty in so far as that unit was concerned, conforming his activities and policies
to those of the consultant for the center, who, in turn, conformed to the policies
of the chief consultant, in that specialty, of the American Expeditionary Forces.^
CONSULTANT IN GENERAL MEDICINE
The consultant in general medicine was essential at all times but especially
so in October and November, 1918, when the overcrowding in most centers
facilitated the spread of epidemic diseases. His most important duties were
the recommendation of assignment of personnel to the best advantage, recom-
mendations concerning the control of infectious diseases, and the dissemination
of professional information. He cooperated with other consultants in organiz-
ing the medical society of the center.^
CONSULTANT IN GENERAL SURGERY
In the field of general surgery, the surgical consultant exercised duties
altogether comparable to those of his colleague at the head of the medical serv-
ice.^ An important part of his work was checking and reporting to the chief
consultant in surgery, A. E. F., the results obtained by hospitals further forward
which cleared into the center.^ Other important duties were recommendations
for assignment of personnel, supervision and coordination of service, distribu-
tion of equipment to the best advantage, supervision of requisitions for supplies
and dissemination of information.^ Because of the limited quantity of instru-
ments and some other surgical supplies available, it was especially necessary
that patients requiring surgical or orthopedic treatment be concentrated in
certain hospitals, and here he was especially active.^ He also supervised
instruction in minor surgery given to nurses and enlisted men. The subjects
most considered in the classes organized for this purpose were anesthesia, prac-
tice in the application of dressings and splints and aftertreatment of battle
casualties.^ As the shortage of nurses in the American Expeditionary Forces
necessitated the employment of enlisted men to a very considerable degree to
perforin nurses' duties the training of selected men was an important, continu-
ing service.^
CONSULTANT IN ORTHOPEDICS
The orthopedic consultant cooperated with the consultant in surgery in
matters pertaining to instruction, assignment of personnel, obtainment and
distribution of supplies, and similar duties. In a number of centers the con-
sultant in surgery was also the consultant in orthopedics.^
CONSULTANT IN MAXILLOFACIAL SURGERY
The center consultant in maxillofacial surgery was instructed to keep in
view both the best possible treatment of the wounded and the early determi-
nation of those who would not be fit to return to duty within a reasonable
time. It was not practicable to assign a specialist in this subject to each
13901—27 31
480
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
center, but one most qualified among the general surgeons was in such cases
assigned to this duty.'- With him cooperated a specially qualified dental
surgeon who performed the splinting and prosthesis required and gave such
other care as came properly within his province.'^ He also consulted in a
number of cases with the center oculist and center otolaryngologist.'^ Habit-
ually, maxillofacial cases were concentrated in one hospital in each center,
but when their needs required and their condition permitted they were trans-
ferred to the hospital center at Vichy, which was designated as the organization
which would care for cases of this nature.'^ It was staffed and equipped accord-
ingly. A number of cases were sent to American Red Cross Hospital No. 1 at
Paris. Such patients as could not be transferred to the Vichy center or to
the hospital at Paris, or whose transfer was not indicated, were retained in the
center to which they had been admitted. It was not the policy to remove
cases from the care of those who had shown interest and competence, except
as the exigencies of hospital service demanded.'^
CONSULTANT IN ROENTGENOLOGY
The center consultant in Roentgenology supervised and coordinated all
activities in his specialty throughout the center.^ Habitually he was also a
member of the staff of some base hospital. Ordinarily only three hospitals
in a center were equipped with the Army base hospital outfit for X-ray work,
the other units being supplied with the Army portable machine and the bed-
side unit.^ Supplies pertaining to this specialty were handled in a different
manner from the others under control of the Medical Department, for requi-
sitions for them were sent to the chief consultant in this service. He modified
them if need be and sent them to the medical supply officer at Cosne for issue.'
Some centers had abundant supplies while others needed them very badly.
Electric current from French plants was utilized in some hospitals but in others
S-kilowatt generators were installed for each X-ray plant in operation.^
CONSULTANT IN UROLOGY
In most centers one officer was assigned to the staff as consultant in urology,
dermatology, and venereal diseases, but in others one officer was charged with
control of dermatology and another with the other specialties mentioned.' The
dermatological service was especially developed in the convalescent camp at
Mars. The consultant in urology, as the officer usually charged with these
collective duties was designated, supervised the establishment and operation
of prophylactic stations, both in the center and in nearby towns; he handled
all venereal reports and statistics, supervised, directed, and coordinated the activ-
ities pertaining to his specialty throughout the center, promoted compliance
with military orders concerning venereal disease, requested the personnel
necessary for practice of these specialties, and received all reports, returns, and
statistics pertaining to them.^
CONSULTANT IN OPHTHALMOLOGY
In one hospital in each center a department was organized to which all
cases in the center requiring ophthalmological treatment were sent.^ This
section was equipped as thoroughly as possible and staffed to the best advantage
HOSPITALS
481
])y personnel drawn from any hospital in the center. The consultant, who
was (at least nominally) assigned to this hospital, himself rendered professional
service so far as practicable.' This department conducted an out-patient
clinic to which patients, in such other hospitals as did not have proper equip-
ment, were sent for refractions and minor operations.' All personnel including
nurses and enlisted men on duty in this department were especially trained.
The consultant in ophthalmology supervised and coordinated the ophthal-
mological work of other units, for these, as rapidly as equipment was received,
organized their own departments where such cases were cared for.'
CONSULTANT IN OTOLARYNGOLOGY
In the otolaryngological service, the consultant's duties were similar to
those just mentioned.' Usually this service was conducted in some hospital
other than that in which the center ophthalmological service was operated
because of the limits of available space in any one unit for operating room bed
capacity and other facilities.' The hospital designated for each of these clinics
was adequately equipped in other respects as well, that is. X-ray, surgical, and
isolation facilities, in order that these also could be used if necessary.'
CONSULTANT IN NEUROLOGY
Psychiatric and neuropsychiatric cases were clearly differentiated, and
habitually were segregated in different groups in respective hospitals.' Plans
for hospital centers provided for a separate hospital unit, located at a quiet
point on its outskirts, where psychiatric cases would be cared for, but in a
lumiber of centers this was never completed. The two classes of patients
above mentioned were habitually cared for by different groups of specialists,
both of which were under the general supervision of the neurologist for the
center.' As resources improved, reconstruction facilities, such as those afforded
by shop and art work for the rehabilitation of the neuropsychiatric cases, were
rapidly developed, especially in the centers at Beau Desert and Kerhuon.'
SENIOR DENTAL OFFICER
One or more dental officers were assigned to each hospital where minor and
emergency work were performed.' Much of the more elaborate work of these
specialists was performed at a central clinic, which was more thoroughly equipped
than were the others, and was under the direct supervision of the senior dental
officer, who was also in general control of the dental service throughout the
center.' Like the laboratory officer, the senior dental officer was not a local
representative of any member of the staff of consultants for the American
E.xpeditionary Forces.' In professional matters he was directly under the
senior dental officer of the American Expeditionary Forces.' As consultant
he performed duties similar to those of other chiefs of service, but in a number
of centers no consultant in this service was designated.'
SPECIALISTS IN CARDIOVASCULAR AND DERMATOLOGICAL DISEASES
Specialists in cardiovascular and dermatological diseases were not, gener-
ally speaking, designated as consultants in all centers.' They were of special
value in the convalescent camp, through which, in many centers, all patients
482 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
were made to pass before they were sent to replacement camps or depots.'
Here medical officers examined all patients to determine the presence of the
effort syndrome, and in this service cardiovascular specialists proved of essen-
tial value. ^ At Mars, all patients, before they were returned to full class A
duty, were required to march 12 miles, after which they were examined.' At
the same center a dermatologist examined all patients when they entered the
camp and, when called in consultation, he also examined patients in other for-
mations.' By his systematic methods he discovered that an unexpectedly
large number of patients was suffering from cutaneous diseases, some of which
were rarely found in civil practice.'
LABORATORY SERVICE
The laboratories of the several centers were under the jurisdiction of the
central laboratory of the American Expeditionary Forces at Dijon, which in
turn was under the sanitation division of the chief surgeon's office.' The
center laboratory officer was therefore in a somewhat different category, though
in the same status as a consultant, as were the chiefs of the other professional
services.' The general plan for the laboratory service of the centers was pre-
scribed in Memorandum No. 8, from the director of laboratories, dated July 23,
1918, but the degree of centralization developed under that plan, varied among
the different centers according to circumstances.' A center laboratory and
usually a morgue were provided which supplemented the similar small installa-
tions operated in the several hospitals.' Autopsies usually were performed at
the center morgue. In general, all work requiring use of animals, serology,
water analysis, inoculations, and special pathological or chemical study was
carried out at the center laboratory, and all other laboratory work was performed
in the plants of the several hospitals.' The laboratory officer coordinated this
service throughout the center and made appropriate recommendations con-
cerning distribution of personnel, supplies, and duties.' At Mesves he was a
member of a permanent board which, as stated above, was organized for the
control of infectious diseases.^
NURSING SERVICE
Each of the several centers had about 40 nurses to each 1,000 patients,
distributed as most needed throughout the several hospitals.^ The plan des-
ignating a chief nurse for a center, which developed in November, 1918, was
soon applied in most of these formations. She was elected from among the
nurses on duty in the center and exercised over their service a general super-
vision comparable in some respects to that of the consultants.' One of her
most important duties was the distribution of the nursing personnel to the best
advantage to meet the shifting needs among the different units. ^ Other duties
were the following:' To meet incoming nurses and provide for their reception,
systematize the rules and regulations governing the nurses, carry out the policies
of the chief nurse, A. E. F., keep informed concerning the nurses' quarters, sub-
sistence, social activities, and the care they received when sick, recommend
assignments and transfers, keep a file of nurses' qualifications, act on all papers
pertaining strictly to the Nurse Corps, and keep the commanding officer of thfi
HOSPITALS
483
center fully informed concerning the nursing personnel.* Nurses' hom-s were
long and the strain on them severe, for their number was insufficient and for
a long time their recreational facilities were almost nil, but after the armistice ,
when tension lessened somewhat, it was possible for them to enjoy recreation to
a much greater degree than formerly. Small social affairs such as dances were
very frequent and of great value in promoting morale.* Until March, 1919,
social relations between nurses and enlisted men were forbidden, but in that
month a circular from the chief surgeon's office directed that in social matters
there would be no distinction between officers and enlisted men when off duty.*
This circular was in conformity with a law recently enacted by Congress.*
Centers located near cities sometimes furnished for nurses' use a limited
amount of automobile transportation between the two communities.*
SANITARY SQUADS
A number of sanitary squads, each consisting of 1 officer and 25 enlisted
men, had been withdrawn from divisions which had been assigned to replace-
ment duty and which for this reason no longer needed them, and were
distributed among the hospital centers.* Some centers such as Mars, Mesves,
Beau-Desert, Allerey, and Savenay had two of them.*^ Usually, but not invari-
ably, the commanding officer of a squad was assigned as the sanitary inspector of
a center. * In certain centers, because of shortage in personnel, these squads
were absorbed by other organizations and assigned to miscellaneous duties, but
in others they retained their autonomy and were used for purely sanitary
services — e. g., construction, repair, and direction of operation of sanitary
appliances, such as incinerators, latrines, grease traps, etc.; inspection of water
supply and sewer systems and of alterations in the same; operation of disin-
festing plants; inspection and direction of proper sanitary operation of laun-
dries and bathhouses; inspection of bakeries, butchers, kitchens, barracks, and
provision of men as superintendents over details of special sanitary or police
work; and preparation of all necessary reports in connection with the above
services. *
CIVILIAN LABOR
Without civilian labor the operation of hospital centers would have been
very difficult* to a large degree, the only labor of this character available for the
Medical Department consisted of French women, about 50 of whom were em-
ployed by each hospital.* It was found they could be hired, controlled, and
distributed most efficiently by a central employment bureau which generally was
operated by the quartermaster, but in some centers was conducted by other
offices.* These employees served in various capacities, such as interpreters,
cooks, waitresses, laundry workers, and scrub women, and were paid upon civilian
rolls by the Quartermaster Department. * Their pay averaged about 5 francs
a day when they were not furnished subsistence, or 33^ francs when furnished it.
Some male labor also was employed by the Quartermaster Department in some
centers to perform such labor as removal of garbage.*
484
AD:\riXISTHATIOX, AMERICAN EXPEDITIONARY FORCES
MEDICAL SUPPLY DEPOT
The personnel of a hospital center depot usually consisted of an officer of
the Sanitary Corps, assisted by a chief clerk, returns clerk, and stenographer, and
a warehouse force consisting of a noncommissioned officer and some 20 other
enlisted men, among whom were the receiving clerk, who received, checked, and
arranged supplies and checked cars, and the issue clerk, who made issues on
approved requisitions.^ The chief clerk kept the office records, which included
a correspondence book, a requisition book, and a car book. The first contained
records of letters received and sent. The second contained captions giving the
number of each requisition, the date and place from which it w^as received, class
of supplies called for, date requisition was filled, date shipped, voucher number,
and name of checker.^ In the car or receiving book were recorded the initials
and number of each car received, by whom and when shipped, when received,
contents as actually inventoried on receipt, date emptied, date goods were
placed in warehouse, and the name of the checker.^
From the medical supply depot of the hospital center articles were distrib-
uted locally among the several units, each of which had its own depot. ^ Because
of the important and teclmical nature of this service, the medical depot at each
center required exceptionally competent personnel. Eventually a number of
men from each center were sent to the medical supply depot at Cosne or
Gievres for a brief period of training.^
Other records maintained in this office were a file of warehouse receipts, a
special order book for emergency issues only, a file of retained copies of orders for
supplies purchased, depot property returns, warehouse records (which included
a copy of warehouse receipts), a special issue book and separate stock lists.
Surgical instruments, poisons, alcoholic liquors were kept in a locked closet.^
Medical supplies usually were classified and sorted in the following cate-
gories: Medicines, antiseptics, and disinfectants, surgical (including splints and
dressings), dental, laboratory. X-ray, identification, furniture, and miscel-
laneous.^
One of the most difficult problems connected with the administration of
centers was obtaining medical supplies. Particularly was this true of those
units which began to operate between July and October, 1918. Usually a
base hospital unit had asked for initial equipment before leaving the United
States and of its own efforts often had procured considerable material.^ After
the unit reached France its equipment did not arrive until one or more months
later, and equipment received from depots was inadequate for the complete
outfitting of all hospitals so that each could serve all clases of patients. Largely
because of the restrictions on shipping space, to which all departments were
subjected, and the lack of many articles in European markets, the chief sur-
geon, A. E. F., urged that the organization of these centers be made in such
a manner that deficiencies could be compensated for by providing special
equipment for only a fraction of the hospitals present. ^ Supplies that could
not be procured from A. E. F. depots were obtained to a limited degree by
purchased in the open market or from the American Red Cross.^
HOSPITALS
485
MOTOR TRANSPORTATION
In each of the large centers an officer of the Motor Transport Corps was
assigned to duty with personnel which usually was insufficient.' At no time
before the armistice was motor transportation adequate.^
All motor transportation at centers was pooled and vehicles were fur-
nished only on signed requests of the commanding officers of units. ^ Supplies
were delivered from the depot by trucks assigned to that duty and much
hauhng was done at night. Experience led to the conclusion that a center of
15,000 beds with the most favorable arrangement of buildings, railway spurs,
depots, and roads would require 15 trucks of from 3 to 5 tons, 15 fight trucks
of three-fourth ton, 12 G. M. C. ambulances, 2 touring cars (7-passenger)
5 touring cars (fight type), and 12 motor cycles with side cars.^
It became fully apparent that for several reasons all motor equipment
should be standardized.^
After the armistice was signed, evacuation ambulance companies became
available for the purpose and were stationed at a number of centers.^ Each
of these companies consisted of 1 officer, 39 enlisted men, and 12 G. M. C.
ambulances, in some centers operating under the evacuation officer.^ They
answered local calls as well as calls from outlying organizations which had no
transportation, served in the evacuation and loading of hospital trains, and,
in emergencies, carried supplies. Their vehicles were also used to convey the
remains of the dead.'
A central garage and repair shop was provided in each center.^
DISINFESTING PLANT
Central disinfestfng plants were established in most centers for there were
not available in France enough mobile disinfestors to serve all units individually.^
In some centers this communal plant was assigned for one day each week to
each unit. One plant at Mesves, for example, by operating day and night
did all the work of the center for almost a month. In some other centers
portable disinfestors were furnished the units caring for the most serious cases,
other units employing a central disinfestor of the Canadian hot-air type in the
convalescent camp.'
FIRE DEPARTxMENT
Fire control at hospital centers was under the general jurisdiction of the
bureau of fire prevention, Services of Supply.^ Fire fighting apparatus, includ-
ing chemical engines, ladders, hose, buckets, barrels, and extinguishers were
obtained through it. Fire regulations were promulgated in each center. Each
hospital and other unit organized its fire-fighting force and conducted drills
under the general supervision of the fire marshal of the center.' Fire risks in
barrack hospitals were very great; fortunately, however, no serious conflagra-
tion occurred in any center.^
SALVAGE OF PROPERTY
The salvaging of property of whatever character was an important and
extensive undertaking.' Each center provided a salvage dump where material
coming for the separate hospital units was sorted, cleaned, renovated if pos-
486 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
sible, and either redistributed locally or shipped to a central salvage depot.^
The principal classes of supplies salvaged were: Clothing, ordinance, boxes,
bags, crates, paper, metal scraps, tin cans, grease, garbage, and writing paper.'
Clothing was disinfected, laundered, repaired, renovated, and, if possible,
reissued; otherwise it was sent to a central salvage depot. Mess kits were
assembled and placed in stock for reissue.' Gas masks, helmets, and rifles
were cleaned and transferred to any neighboring replacement camp or were
shipped to a large salvage depot.' Boxes, crates, etc., except such as were
needed for use at the center, were shipped in returning cars to large salvage
depots. Tin cans were cleaned in boiling water at each hospital, flattened at
the center salvage dump, and then shipped to a local salvage depot. Grease
was saved by the units and generally used for making soap; several centers
had eflicient soap factories.^ Garbage was reduced to a minimum by food
saving; one hospital with 540 ambulant patients had less than half a can of
garbage daily. That remaining was disposed of either by a central incinerator,
by sale to French civilians (an arrangment which gave very different degrees
of satisfaction), or at the center's pig farms.'
FARMS
At several of the centers, especially that at Savenay, farms and gardens were
operated successively and arrangements were under way for their provision at
almost all centers when the armistice was signed.' Land for this purpose was
procured through the American Expeditionary Forces garden service, and
whenever possible animals and manure were provided from neighboring veteri-
nary hospitals. Implements were procured through the garden service, the
American Red Cross, or from hospital funds. Seeds and plants were supplied by
garden service; labor was performed by volunteers from the convalescent
camp. Farms that were most highly developed were equipped with a small
barracks and appurtenances for 100 men and a dispensary, the convalescent
camp exercising medical and disciplinary supervision over the personnel.'
Pig farms proved especially lucrative, the animals being subsisted on
garbage from the center.'
CEMETERIES
On request of the Medical Department, land for cemeteries was acquired in
the vicinity of all large centers, or permission obtained to make interments in
French cemeteries.' Laws in France were such that new locations for cemeteries
could be obtained only after compliance with a number of requirements, but
through the graves registration service these were complied with, sites ob-
tained, and arrangements made for their control and maintenance, and for the
proper marking and preservation of graves.' Graves were dug by personnel
assigned to the quartermaster. The chaplain of the unit in which a death
occurred conducted funeral services, except when the deceased belonged to
another denomination, in which case, if at all available, a chaplain of the same
faith oflBciated.'
HOSPITALS
487
CHAPLAINS
A chaplain was to be assigned to each base hospital unit, primarily to min-
ister to both patients and personnel. There was never a full quota of these
officers in the American Expeditionary Forces, in so far as hospital units are
concerned, for which reason each chaplain habitually performed duties in several
hospital units, including that to which he was specifically assigned.^ All
chaplains in a center were under the supervision of the senior chaplain present,
who distributed the services of his colleagues to the best advantage.^ The
senior chaplain supervised recreational and entertainment activities, conducted
services for the group weekly, was responsible for the proper conduct of funerals,
and in some centers was liaison officer between the hospital center and the graves
registration service, reporting to that organization all interments and supervising
the proper marking of graves. The last-mentioned duties were sometimes dele-
gated to a junior chaplain.^
AMERICAN RED CROSS ACTIVITIES
American Red Cross activities in the center were supervised and coordinated
by the representative of that service on the staff of the commanding officer.
They were concerned chiefly with home and hospital service, recreation, and
procurement of hospital supplies. The home and hospital service had one or
more workers in every hospital who assisted in tracing the missing, distributed
chocolates, cigarettes, and other articles of this kind, to incoming patients and
throughout the wards. An important part of their service was the writing of
letters for disabled patients.^ As mentioned above. Red Cross activities in
promoting recreation were coordinated with those of the chaplains and were
under their general control but more immediately under the direction of the Red
Cross worker in charge of the Red Cross hut.^ Here a library, reading and
writing rooms were provided, a piano or phonograph installed, and space was
available for presentation of vaudeville or moving-picture shows, and such
social diversions as dancing and receptions. In the provision of medical
supphes the American Red Cross supplemented the Medical Department,
sometimes furnishing articles in very large quantities.^ Requisitions from units
habitually passed through the center commander before being referred to the
American Red Cross. This organization maintained in many centers a small
depot where there was a rapid turnover of the delicacies, stationery, toilet
articles, and similar supplies which it distributed to personnel and patients.^
RECREATIONAL ACTIVITIES
Even before the armistice, entertainment of patients and personnel was
an important element of center service, which was under the general supervision
and control of the senior chaplain.^ In the several units the chaplains organized
recreational activities, promoted sports, provided moving picture and other
shows and organized similar diversions, but it was not until after the armistice
was signed, when pressure of other duties relaxed, that this service attained its
488
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
highest development.' There was a general exchange between units through-
out each center of entertainers drawn from the personnel or patients. A num-
ber of others, including many professional entertainers sent overseas to serve
the troops in this capacity and volunteer companies organized by other units,
greatly promoted this service during the armistice.' If a band was not assigned
to a center by higher authority, one usually was organized in its convalescent
camp, and orchestras were developed in a number of units. The orchestra
developed by the center at Mars, comprising over 70 pieces, was a remarkably
fine organization. Instruments for bands and orchestras usually were furnished
by the American Red Cross, which cooperated with the chaplains in furnishing
diversion and were in immediate charge of a number of details connected there-
with. The recreation huts provided, so far as possible, for each base hospital
were erected at the expense of the American Red Cross, and a Red Cross worker
was immediately in charge of the social and recreational activities in each.'
REFERENCES
1. Report on organization of hospital centers, A. E. F. (undated), prepared under the direc-
tion of the chief surgeon, A. E. F., by Col. H. C. Maddux, M. C. On file, Historical
Division, S. G. O.
2. Report from the chief of the medical group, fourtli section, general staff, G. H. Q., A. E. F.,
to the chief of G-4, general staff, G. H. Q., A. E. F., December 31, 1918, on activities
of G-4 B, for the period embracing the beginning and end of American participation
in hostilities: Appendix E. On file Historical Division, S. G. O.
3. Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919, on the activities of the chief surgeon's office, A. E. F., to May 1, 1919. On file,
Historical Division, S. G. O.
4. Consolidated weekly bed reports, A. E. F., office of the chief surgeon, A. E. F., November
28, 1918. On file, Historical Division, S. G. O.
5. Consolidated weekly bed report, office of the chief surgeon, A. E. F., November 14, 1918.
6. Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., AprillT,
1919, on the activities of the Medical Department, A. E. F., to November 11, 1918.
On file. Historical Division, S. G. O.
7. Report of activities of the hospital center at Bazoilles, undated, prepared under the direc-
tion of the commanding officer. On file, Historical Division, S. G. O.
8. Report of the activities of the hospital center at Mars, undated, prepared under the direc-
tion of the commanding officer. On file. Historical Division, S. G. O.
9. Report of the activities of the hospital center at Mesves, undated, prepared under the
direction of the commanding officer. On file. Historical Division, S. G. O.
10. Report of the activities of the hospital center at Allerey, undated, prepared under the
direction of the commanding officer. On file, Historical Division, S. G. O.
11. Report of the activities of the hospital center at Beaune, undated, prepared under the
direction of the commanding officer. On file. Historical Division, S. G. O.
12. Letter from the senior consultant in maxillofacial surgery, A. E. F., to local consultant in
maxillofacial surgery, September 24, 1918. Subject: Information. On file, A. G. 0.,
World War Division, chief surgeon's file, 321,624.
13. Based on reports of activities of hospital centers A. E. F. On file. Historical Division,
S. G. O.
CHAPTER XXII
A TYPICAL HOSPITAL CENTER
HOSPITAL CENTER, ALLEREY«
PHYSICAL CHARACTERISTICS
The hospital center at Allerey was on the outskirts of the town whence it
took its name. Allerey, at the time, was a town of some 800 inhabitants on
the Paris, Lyon, & Mediterranean Railroad, in the Department of Saone-et-
Loire, approximately 11 miles north of Chalons-sur-Saone, the largest town
(population, 30,000) of the department. The center was about three-quarters
of a mile from the Saone River, which was at once, in effect, the source of its
water supply, and a line of communication over which fuel and other supplies
were brought to the center when access by rail was obstructed.
The site of the reservation covered an area of 172.3 acres, which consisted
chiefly of farmland, but included some swampland at the eastern end and
some woodland at the western. The site was low, and generally very level,
most of it (e. g., section 4) being lower than the edge, so that proper drainage
was difficult.
The soil consisted of a layer of loam, from 6 inches to 2 feet in thickness,
superimposed on clay; and though rainfall readily percolated to the clay
stratum protracted rains soon saturated the upper layer.
Climatic conditions during the existence of the center offered nothing
unusual for this region. The summer of 1918 was hot, dry, and at times windy;
spring, autumn, and winter were rainy, with almost constant cloudiness during
the last-mentioned season, and marked by cold of a penetrating character, but
without very low temperature. Rainfall averaged 840 mm. per annum; the
mean temperature was 10.52° C.
HOSPITAL CONSTRUCTION
The outlay of the hospital center comprised 13 sections and a cemetery;
10 of the sections were to accommodate 1 base hospital each, 1 a convalescent
camp, 1 the quartermaster and motor transport departments, and 1, secluded
from the rest, a psychiatric unit. Each base hospital was to accommodate
1,000 patients with attendant personnel and to supplement its capacity by
tentage for 1,000 beds — more if need be. These tents were to be pitched in
the "crisis expansion" areas provided in the rear of the wards. Each hos-
pital was to be a unit complete in itself, except for transportation and certain
other communal elements. Such a unit consisted of 55 buildings apportioned
as follows: Administration; reception and evacuation; dining rooms; kitchens;
bathhouses and latrines for patients, nurses, and officers; wards; recreation
hall; laboratory and morgue; X ray and clinic; operating; quartermaster and
" The statements of fact appearing herein are based on "History of the Allerey hospital center, A. E. F.," by
Col. J. n. Ford, M. C, commanding officer. On file, Historical Division, S. O. O.
489
490
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
medical supplies; garage, shop, and disinfection; fuel house and incinorator.
The convalescent camp consisted of a similar layout, except that ward buildmgs
were replaced by tents for 2,000 patients, and the following were eliminated:
Nurses' quarters and appurtenances, receiving ward, laboratory and morgue,
operating pavilion, garage and shop.
The areas of the base hospital units extended in juxtaposition along both
sides of a broad central highway, down whose center ran a double-track spur
of the railway line. From this highway, the backbone of the camp, two branch
roads ran the depth of each unit area and were connected by several crossroads
passing in front of the receiving ward, kitchen, storerooms, and garage. The
convalescent camp, located north of the blocks of base hospitals, was reached
by the roads which traversed one of them. Roads were also in service along
the back line of each block of five base hospital areas.
Fig. 87. — Map of Allerey hospital center and vicinity
The psychiatric unit, consisting of quarters, dining rooms, kitchens, bath-
houses, and latrines for 200 patients and attendant personnel, faced the broad
central highway beyond the end of the railway spur. It was never completed,
but was occupied by the military police during the period of greatest over-
crowding.
The quartermaster and motor transport section nearest the proximal end
of the railway spur at the east of the reservation included the storehouse,
bakery, ice plant, barrack for civilian laborers, garage, motor park, work shops,
gasoline station, etc. The cemetery immediately north of this was on the
reservation, so that it was readily accessible and could be cared for the best
advantage.
Housing facilities were of two kinds, portable buildings and tents. The
types of buildings selected for the center were known as the "Cavanair and
Majoram" types, more commonly as type I. These were of knockdown con-
struction, built by securing together uniform sections made up of double thick-
nesses of ^-inch tongue-and-groove lumber, inclosing an intervening air space
4 inches in thickness. These sections, which were assembled at distant fac-
HOSPITALS
491
tories, formed the exterior walls. Koofs and floors were formed of l-inch boards,
the former covered with tar paper. Partitions to form rooms were made of 2 by
4 studding and beaver board. Practically all buildings were 6 meters wide, but
varied in length from 10 to 50 meters. This type of building was constructed
very rapidly, but in many instances settling occurred because of the softness of
saturated ground, and cracks in exterior walls developed. The tents employed
were of the marquee type and of French manufacture. Their floor dimensions
were 17 by 35 feet, so that three tents, connected end to end, accommodated
50 beds. Such sets of tents to accommodate 500 patients were erected back of
alternate wards in most but not all of the hospitals, there being an insufficiency
of tents thus to equip the entire center. Though location back of alternate
wards caused some lack of uniformity and balance in ward service, this method
was adopted to lessen fire risk.
On February 16, 1918, the Engineer Corps began to lay out the site of the
center and to supervise the activities of the civilians who had contracted for its
construction. In the latter part of that month the wall sections of the portable
buildings arrived in such quantities that the freight house at Allerey station
was soon filled and 109 cars were unloaded at St. Loup, a neighboring village.
Bad weather hampered the work to such an extent that by March 23 only 10
buildings had been erected, and the roads were in such condition that only slow-
moving ox teams could force their way through.
From the outset the labor problem was difficult. Old men, boys, and those
unfit for military service were the only French laborers available, so that it was
necessary to recruit workmen for the project in other countries, especially in
Spain. For this purpose agencies were maintained by the French and American
Governments and in some instances by the contractors themselves. Labor pro-
cured in this manner, however, was of a very inferior quality, requiring constant
supervision. Also the practice of contractors of padding their pay rolls required
a constant check by the constructing engineer. Company C of the Twenty-
sixth Regiment of Engineers arrived on May 19, and from that date construc-
tion proceded much more rapidly. Eventually a labor company was assigned
to the center, and its number augmented by 40 German prisoners and 20 Rus-
sians. These last had been sent to France as part of a military force in the
early months of the war. Highly important work in construction was per-
formed by enlisted men of the Medical Department and by convalescent
patients. As fast as base hospital units arrived, their personnel was engaged
in completing the construction in the areas to which they had been assigned,
and continued on this duty even after they received patients. Throughout
the life of the center, selected men were detafled for special work such as electric
installations, motor repair, operation of stationary engines, etc. Similarly
convalescent patients were employed in large numbers for work of every kind
according to their strength and ability, and this practice expedited greatly the
construction of the center. However, as orders required that patients be
returned to duty as promptly as possible, a very rapid overturn of such per-
sonnel was necessary, and completion of technical work, especially, was delayed
to a considerable degree by the constant necessity for finding replacements for
skilled workmen transferred.
492
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Temporary roads were early laid out by the engineers and graded, but on
account of lack of road material many became quite imsatisfactory after rains
commenced. At first cinders were used as surfacing material, but because of
wet weather and constant passage of heavily laden vehicles the roads were
soon cut to pieces and some became impassable. Later crushed rock was
received in quantities and distributed where most needed. A steam roller was
operated in some sections of the camp. After the armistice was signed, 10,000
feet of duck board were procured and laid in those parts of camp which needed
it most; and after January 1, 1919, some corduroy roads of railway ties were
laid.
Fig. 88.— Reservoir, Allerey hospital center
The water supply was drawn by pumps, driven by gasoline motors, from
three wells averaging 55 feet in depth sunk 200 yards from the bank of the
Saone at the east end of the camp. A booster pump then forced the water
through an 8-inch main into the supply system of the several units, and the
surplus into a reservoir containing 100,000 gallons at the west end of camp.
The capacity of the pumping plant varied from 20,000 gallons daily in August
to 50,000 gallons in December, depending on the rate of inflow into the wells.
A 4-inch pipe which could be cut off at its point of junction with the main line
supplied each unit, and eventual distribution in them was effected through pipes
from ^ to 2 inches in diameter. As the central chlorinating apparatus was never
satisfactorily installed, w^ater was sterilized by the Lyster bag method in all
units.
A sewerage system for liquid waste was installed. It consisted of a main
12 inches in diameter, with ramifications 4 to 6 inches in diameter, reaching
HOSPITALS
493
the ]-eceiving wards, operating rooms, kitchens, and laboratory of each unit.
The system was not originally intended for the reception of mine, but even-
tually it was used for that purpose. The sewage was discharged into a concrete
sedimentation tank one-quarter of a mile north of the center. Here it was
chlorinated in accordance with the requirements of the French regulations on
this subject and the clarified effluent discharged through an open ditch into the
Saone.
Before this system was installed, liquid waste was removed by barrels
carried in a motor truck, and later by a steel tank wagon. Because of inability
to procure pipe installation the sewer system was long delayed and removal
of liquid waste continued to be a grave problem for some elements of the
camp even after the tank wagon service was effected.
Original plans had called for a high-tension line from Chalons to furnish
electric light and power, but this project was abandoned. Instead, five small
25-kilowatt electric light and power sets, each to serve two sections, were
gradually installed, but as their output was small and each required constant,
skilled attention, this arrangement was never satisfactory. It was particularly
inadequate when later required to serve 12 sections instead of 10. Illumina-
tion was never brilliant, and when patients arrived at night, as they often
did, current was not sufficient to illuminate properly the receiving stations,
wards, and operating rooms, and to actuate the X-ray plant. Despite fire
risk, it was necessary to supplement the electric light by lanterns in various
parts of the center and at all times to exercise the most meticulous care in the
proper usage of current. Exterior lights had not been provided in plans for
the center, but these were authorized when their need became manifest.
Throughout the operation of the center, until toward its close, there were
frequent interruptions in construction and in the operation of certain utilities.
At times, for various reasons, the output of the pumps was limited or discon-
tinued. Reception of building materials or other supplies was interrupted by
embargoes, railway delays, or nonavailablity at depots. The electric-light
output was at times reduced or perhaps suspended. In the original plans no
provisions had been made for offices or quarters for the headquarters group,
post office, and certain other elements, but these were promptly authorized
and constructed.
As the center developed, and as the pressure of essential work decreased,
certain public-spirited individuals in every unit charged themselves with the
beautification of grounds and improvement of buildings. As a rule, the com-
manding officers of these units, while encouraging this, left plans and work
of this character to those who were interested, believing that thereby they
would secure greater enthusiasm. Rivalry in the beautification of wards,
recreation halls, dining rooms, etc., was evidenced even at the period of great-
est pressure. In the convalescent camp decoration of grounds was carried to
a high point and a number of artistic effects secured, in differently colored
stones, evergreen plants, etc. Especial care was given the cemetery. Many
floral offerings from French citizens and inmates of the center, as well as the
painstaking attention to paths, turf, shrubbery, and the markings of graves
and boundaries attested the reverent remembrance of the dead.
494
ADMIXISTRATION, AMERICAN EXPEDITIONARY FORCES
ORGANIZATION
Organization of the hospital center at Allerey was commenced June 23, 1918.
On June 20, Base Hospital No. 26 had joined, being the first organization of this
character to arrive. Its commanding officer, relieved from further duty with
the hospital and assigned to command of the center, organized the headquarters
staff from the personnel of Base Hospital No. 26, but for several weeks the staff
continued to function to a diminishing degree in the positions which they had
occupied in the hospital until understudies could be trained. This initial staff
comprised the following departments: Adjutant, quartermaster, medical supply,
receiving and evacuating, sanitary, and railway transportation. A few days
later representatives of the American Red Cross and of the statistical branch,
Adjutant General's Department, arrived and joined this stafT.
As in other hospital centers, each staff officer at first had several positions.
Thus at Allerey the commanding officer performed the duties of executive
officer and, at first, inspector; the adjutant was also judge advocate, personnel
and statistical officer; the quartermaster was charged with motor transport
duties and immediate responsibility for those activities which were later assumed
by subordinates under his general direction. The sanitary inspector was also
laundry officer, fire marshal, supervisor of buildings and grounds, etc. No
detailed instructions covering the administrative organization of the center were
received, and development progressed as determined by force of circumstances
and existing resources. Throughout this formative period staff duties were
clearly delimited so that as occasion arose they could readily be distributed among
individuals who could give them their undivided attention. Until the close of
the center, however, a number of officers continued to exercise the duties of sev-
eral positions. Assignments to the headquarters staff were a continuing problem,
for only a few staff officers arrived from extraneous sources, and officers already
on duty in the center who possessed administrative ability were needed in their
• several units to meet the great expansion which these underwent through the
establishment of provisional hospitals, overcrowding, etc. Pressure was such
that the loss by any unit of one or two good administrators was felt at once locally,
and the local deficencies in service arising therefrom had to be met by increased
activities at headquarters. The situation was ameliorated to a degree by the
assignment to the center from other points of officers for service with the con-
valescent camp, motor transport, engineer, military police, statistical bureau,
medical supply, and the quartermaster department. Also a number of officers
undergoing treatment in the convalescent camp assumed some very important
duties — e. g., commanding officer of the interior guard and assistants to the
receiving and evacuating officer — so that during their stay in the center they pro-
moted greatly its staff activities.
The specialization of headquarters, developed to its final organization, was
as follows :
Commanding officer.
Adjutant.
Personnel officer.
Statistical officer.
Civilian employment officer.
Commanding officer, headquarters detachment.
Post-office service.
Banking service.
HOSPITALS
495
Quartermaster.
Subsistence.
Center purchasing agent
Sales commissary.
Bakery.
Butchery.
Ice-plant farm.
Clothing, equipage, etc.
Finance.
Laundry.
Animal-drawn transportation.
Utilities.
Salvage.
Commanding officer labor battalion, etc.
Cemetery.
Interment.
Motor transport officer.
Ambulance company.
Truck company.
Repair shop.
Medical supply officer.
Receiving and evacuating officer.
Inspector.
Sanitary inspector.
Inspection of buildings and grounds.
Fire marshal.
Signal officer.
Engineer officer.
Assistant judge advocate.
Assistant provost marshal.
Commanding officer of the interior guard.
Intelligence officer.
Ecclesiastical officer.
Railway transportation officer.
Center laboratory officer.
Consultants in professional services:
General medicine.
Psychiatry and neuropsychiatry, cardiovascular.
General surgery.
Orthopedics.
Ophthalmology.
Otology, rhinology, and laryngology.
Roentgenology.
Neurolog}-.
Urology.
Laboratory officer.
Consultant in dentistry.
Chief nurse.
Chief dietitian.
Red Cross officer.
This oflScer was one who had been selected from the patients in the convalescent camp,
who constructed this center v/as never a member of the staff of its commanding officer.
13901—27 32
As noted below the engineer
496
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
After SeptoDiber 20 a center officer of the day, cliosen by roster from among
the available captains, was detailed to inspect patients' messes, assist the
receiving and evacuating officer, if required, inspect the guard, and meet
emergencies.
An executive officer was never detailed as in the hospital centers at Mars
and Mesves. The duties of his office were divided between the commanding
officer and adjutant, the former charging himself with all executive adminis-
tration, the coordination of the activities of the staff departments, direct
supervision of units, important correspondence, and leaves of officers.
ACTIVITIES
COMMANDING OFFICER
The commanding officer held conferences at 1 p. m. daily, except Sunday,
which were attended by heads of staff departments and commanding officers
of units. The constructing engineer, who was not under the jurisdiction of
the commanding officer of the center, was invited to attend either in person
or by representative and habitually did so. At these staff meetings the
fullest discussion was invited and suggestions and recommendations sought
on all subjects relevant either to the interior service of the center or to its
external relationships. Most written orders were emitted only after their
purport had been fully considered at these conferences by all parties concerned,
their scope and limitations determined and, if necessary, their provisions
clarified. By this means several ends were attained, the most important
being the engendering of a spirit of cooperation, the formulation of orders in
such a manner that they seldom had to be revised, despite the mutations
incident to the growth of the center, and the avoidance of misinterpretations.
Each officer concerned was encouraged to feel that he had an important influ-
ence in the formulation of orders concerning activities of his department;
and this was believed to have promoted the solidarity of the center and smooth-
ness of cooperation much more than could have been effected by autocratic
methods. In some instances, however, as need arose orders were issued with-
out consulting subordinates. Most orders, instructions, etc., that w^ere of
temporary or individual interest were given verbally by the commanding
officer at these meetings to those concerned, who made record of them in their
notebooks at this time; but orders affecting communal service or of more
permanent interest, whether from higher authority or of local origin, were
issued in the form of special orders or memoranda.
Similarly, staff meetings were held by the several chiefs of professional
services. At these sessions professional activities w^ere coordinated, and, so far
as was feasible and reasonable, standardized throughout the center. In this
field, however, individualism in methods of treatment was encouraged rather
than restricted, provided results achieved were satisfactory, except that in
some fields of endeavor (e. g., control of infectious diseases, debridement of
wounds, etc.) orders issued were mandatory.
A stenographer attended all staff meetings and made of record discussions,
verbal orders, etc. These notes were read at the next staff meeting like the
HOSPITALS
497
minutes of a board of directors, and were open to inspection of any person
concerned who later wished to refresh his memory on any point. »
The commanding officers of units also held conferences with their sub-
ordinates daily except Sunday, when in a manner comparable to that at
headquarters all items of interest, whether administrative or professional, were
discussed and appropriate orders given.
The commanding officer of the center and those of the several units were
accessible to any member of their commands daily during hours set aside for
that purpose. The object of all these measures was to have the center and the
several units respectively as highly centralized as was reasonable without in-
fringing unduly, in the first instance, upon the prerogatives of unit commanders,
and in the second upon that of individual officers on duty in the units, and
that in determining the manner and degree of centralization officers con-
cerned should have a constructive share. Apparently centralization was
carried further at Allerey than at other centers for the reason that in pro-
portion to its resources it cared for more patients during a certain period than
(lid any other. In order to secure the fullest coordination a corresponding
degree of centralization was imperative.
Each unit was allowed the fullest possible freedom in interior organization
and administration, subject to existing general regulations. In order that
each unit might have the benefit of acquaintance with methods evolved in others,
the commanding officer of the center and his staff, accompanied by the com-
manding officers and staffs of the several units, visited each hospital in turn,
in order that all concerned might acquaint themselves with respective methods
of service. There was thus promoted mutual acquaintanceship and a free
exchange of ideas throughout the center. The result was an amiable rivalry
extending to every element of each unit and prompt application of new ideas
wherever found. It was interesting to note, however, that many of the ideas
thus exchanged were modified in greater or less degree when applied in hos-
pitals other than that in which they had their inception. Sometimes this
was due to differences in local requirements or resources; more frequently to
differences in the personal coefficient of the administrator or other personnel
concerned, who founa that they secured better results with methods to a degree
individualized. The results showed the advisability of leaving to unit com-
manders and to the members of their staffs the largest latitude possible in the
discharge of their respective duties.
ADJUTANT
"The adjutant promulgated orders, acted on furloughs of enlisted men,
and on charges preferred, reviewed court-martial proceedings and acted for
the commanding oflficer on questions which did not demand the latter's atten-
tion. In addition, he was charged with routine administration and correspond-
ence, preparation and issue of all court-martial orders and those affecting
audits of public vouchers, examination of requisitions and ration returns,
command of the headquarters detachment and supervision of the sergeant
major's office. Under his supervision units longest in the center instructed
newly arrived units in orders, customs of the service, use of blank forms with
498
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
which they were unfamiliar, etc. Instruction in some subjects, however, was
given by selected officers, usually those more immediately charged with then-
execution; e. g., receiving and evacuating officer, fire marshal, sanitary inspec-
tor, the chiefs of professional services, and others. The three base hospitals
which first arrived were employed as schools for the instruction of later arrivals.
As soon as a new hospital reported, its adjutant, registrar, mess officer, sanitary
officer, sergeants (first-class), and clerks, were distributed for instruction to one
or the other of these hospitals, and remained there until they became fairly
familiar with the records and their own hospitals were ready to receive patients-
Usually this was a period of about two weeks. Similarly, at the direction of
the commanding officer of the center, the adjutant directed the professional
personnel, in conformity wdth the recommendations of chiefs of services to
visit these hospitals and familiarize themselves with both professional and
official standards required. The adjutant apportioned numerous duties among
his assistants. One of these was an officer from the statistical department of
the adjutant general's office who joined in July, 1918.
The sergeant major's office, under the adjutant's jurisdiction, was divided
into the several sections noted below. The reports prepared and foi warded
by it are mentioned in the preceding chapter, which discussed hospital centers
generally. The personnel section of the sergeant major's office consolidated
all data pertaining to personnel on duty in the center, other than those serving
with the engineers, forwarded appropriate reports concerning them, except
that the daily and weekly numerical reports were formulated by the statistical
section, and kept up rosters of officers, nurses and enlisted personnel. Those
for officers and nurses were entered on file cards, which carried notations con-
cerning military status, professional and administrative aptitudes, etc., while
the roster for enlisted men was kept up by appropriate entries on a copy of the
muster roll of the organizations to which men belonged. The preparation
of a card index for enlisted personnel, though its desirability was recognized,
was not feasible with the clerical resources available. These rosters, especially
that of the officers, proved of great value in making details to meet the ever-
shifting needs of the center.
The statistical section checked the accuracy of all reports received from
units concerning patients, consolidated these for transmission to higher author-
ity (except those noted below under the receiving and evacuating section),
formulated the daily bed reports and collective numerical reports of patients
and personnel, consolidated daily reports of all cases of infectious diseases,
whether among duty personnel or patients, and placed these last-mentioned
data at the disposal of the sanitary officer. The head of this section was charged
with the engagement, supervision and discharge of all French civilians employed
in the center by the Medical Department. Such female employees to the num-
ber of 50 for each hospital were authorized by the chief surgeon, A. E. F., sub-
ject to rates of pay and terms of service required by him and the civil require-
ments of the French Government. These women were assigned to duty under
the supervision of the chief nurses of the hospitals and by them distributed to
best advantage. In order to promote prompt reply to the many queries
received from outside points concerning individual patients, the statistical
HOSPITALS
499
bureau maintained a card-index file for all patients, showing name, serial num-
ber, official designation, location in center (with notes of all transfers, even
from ward to ward), date of evacuation, classification (A, B, C, or D) and desti-
nation, or date and cause of death and number of grave. This index was in
constant use. In order to expedite the delivery of mail until the post office
prepared its own card index, that office consulted it during the night.
The receiving and evacuating section was closely associated with the statis-
tical section. It prepared all the reports concerning the reception, distribution,
classification, and evacuation of patients other than the daily and weekly statis-
tical (numerical) reports. It was responsible for the service records of outgoing
patients and for the completion of their records.
The order and record section received the orders from higher authority,
as well as those of local origin, recorded and promulgated them. It checked,
consolidated, and forwarded the records of the various activities of the center
not covered by other sections of the adjutant's office. Thus, it handled requi-
sitions for medical supplies and blank forms, reports of progress of construction,
of transportation facilities, pay rolls of marines and of civilian employees, state-
ments of hospital fund, reports of purchases from funds allotted the command-
ing officer of the center and the commanding officers of units, ration returns,
reports of fire marshal, etc. This section eventually had custody of all docu-
ments as they found their way into the files.
The filing, distributing and mailing section was charged with the upkeep
of the index of all orders, reports and correspondence, the proper filing of papers,
delivery of all documents throughout the center and obtainment of receipts for
same, verification of addresses on envelopes of outgoing official mail and on
telegrams, recording date when such were sent. The officer in charge of this
bureau supervised the post-office activities in the center.
As commanding officer of the headquarters detachment, the adjutant super-
vised the assignment of its personnel and kept in the detachment office all
records concerning them. His duties also included supervision of the proper t}^
officer for the headquarters office, of the courier service of the post-office service
and of the activities and protection of a branch bank which was established in
the center.
COURIER SERVICE
Important papers, destined for headquarters, intermediate section, Nevers,
and for the office of the chief surgeon, A. E. F., at Tours, usually were sent by
courier, and were received from these offices in the same manner.
POST OFFICE
Post-office activities in the center began July 6, 1918, but not until August
25 was the center given its post-office number, viz, A. P. O. 785. At this time
the office was moved into a building provided for it near headquarters. In
September, 1918, money order and registered mail departments were organized,
service in both increasing rapidly. By December, 1918, the value of the money
orders handled monthly was $20,000. By November, 1918, the service handled
daily approximately 40 pouches of incoming mail and 10,000 outgoing letters.
At this time the service was reorganized and a card-index file was formulated
500
ADMINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
similar to that at headquarters, carrying the names of all personnel in the center
so that prompt delivery of mail was feasible. The eventual success of this
service had a very important influence on morale.
BANK
In November, 1918, at the invitation of the center commanding officer,
the Chalons branch of the Societe Generale opened a branch bank in the center.
The military police furnished guards for the movement of funds back and forth
between the center and Chalons, and the motor transport park furnished trans-
portation for funds and personnel. The bank proved to be a great conven-
ience; in addition to cashing checks, it sold bonds of the fourth French loan.
Banking hours were from 10 a. m. to 4 p. m. on Mondays, Wednesdays, and
Fridays.
QUARTERMASTER
The group quartermaster had general charge of the activities of that
department.
The subsistence branch of his service was charged with those duties which
its name implies. For several weeks after the first hospital arrived, bread and
fresh meat were hauled from Dijon by truck, but after patients began to arrive
in considerable numbers motor transport proved inadequate and a shuttle
railway car convoyed by an enlisted man was put in operation. This shuttle
service was continued for this purpose for about six months, until a bakery
was established in the center and fresh meat was shipped in direct from depots.
It was used for the transportation of soiled linen to a civilian plant in Dijon.
Subsistence supplies, other than bread, were eventually received by automatic
supply from the base stations and distributed by the quartermaster of the
group to quartermaster units. This method of supply required about 10
cars daily but at one period (November and December, 1918), when the center
was operating at its maximum and about 23,000 rations were required daily,
as many as 27 cars were received in one day.
In order to meet increasing needs, a group purchasing agent was detailed.
His office consolidated the requisitions of the several units for the procurement
of fresh vegetables, eggs, milk, etc., not obtainable from depots. Such an
arrangement was necessary in order to prevent the several hospitals from
bidding against one another in local markets, to effect savings by purchasing
in large quantities, to prorate available supplies according to needs, and to
extend the radius of purchases beyond points accessible to the units them-
selves. These supplies were often bought in distant markets; e. g., potatoes
in Brittany, eggs in Algiers.
To relieve congestion in the group warehouse and to meet needs that
might arise because of unexpected expansion, unit commanders were required
to keep on hand nonperishable comestibles to the limit of their facilities,
viz, about two months' supply. This measure proved fortunate when the
center expanded rapidly in October, 1918, for neither condition of roads nor
available transportation would have permitted satisfactory commissary service
if unit warehouses had not been well stocked.
HOSPITALS
501
When fresh meat began to arrive in quantities, it was at first stored in
a coohng room erected in the warehouse after plans furnished by the chief
quartermaster, Services of Supply. This room was simply a box 20 feet
square and 12 feet high, with walls and roof 1 foot thick. These walls were
filled with packed sawdust and provided with very carefully fitted doors.
The frozen meat soon brought the temperature of this room down to a point
which permitted one week's supply to be kept on hand without ice. Later
an ice plant was built, with an output of 1 ton of ice daily, and in conjunction
therewith a cooHng room where 50 tons of meat, fresh vegetables, etc., could
be stored.
I'l'r. ^'1. —Exterior view of warehouse, Allerey hospital center
A sales commissary was organized promptly after the organization of
the center, but it was soon found that direct sales by it alone could not meet
requirements. Many patients were physically unable to visit the salesroom
and attendants often did not have time to do so. The American Red Cross
workers in units purchased articles in greatest demand (e. g., tobacco, con-
fectionei-y, etc.) to the limit of their storage facilities, and resold these at
cost to enlisted men, whether patients or duty personnel; articles for similar
resale to officers and nurses were handled by the unit mess officers. All such
sales were in addition to those made direct to individuals, whether commis-
sioned or enlisted, by the sales commissary itself, and were in effect an extension
of its service throughout the center.
A bakery was established by Bakery Company No. 357 in August and
thereafter was gradually expanded to 7 ovens. By October, it was turning
502
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
out 27,000 pounds of bread daily, and continued this output for several months,
though less than half the bakery company had joined. This output, made
possible by day and night shifts, was not quite equal to demands, however,
at the high-water mark of the center, and several shipments from the bakery
at Dijon were necessary to meet requirements.
Butchery Company No. 331, assigned to duty in the center, was distrib-
uted among the several hospitals, where its personnel gave instruction to
cooks in the care and cutting of meats.
The property branch of the Quartermaster Department supplied fuel,
forage, gasoline, clothing, equipage, ordnance, etc. Wood and forage were
purchased locally, coal was shipped in from base ports, and other articles
handled by this department were drawn from depots. It was necessary to
keep on hand a large supply of clothing and equipment, because of the rapid
overturn of patients, whose average stay in hospital was but 17 days, and who,
on evacuation, had to be fully clothed and equipped. The quantity on hand
at one period was sufficient for 40,000 men and approximated in value $1,000,-
000. As no buildings were available for the storage of such a quantity, the
bulkiest articles were stored. without injury under paulins, on platforms built
for this purpose. No shortage of fuel or clothing occurred at any time.
The finance section disbursed all funds other than those allotted to the
commanding officers of units by the chief surgeon, A. E. F. Commutation of
rations and liquid-coffee money were paid by the group disbursing officer, but
unit quartermasters made monthly payments of patients and personnel of their
respective organizations. The monthly disbursements usually approximated
$500,000, but for several months were 20 per cent greater than that figure.
The laundry service of the center was a grave problem from the opening
of the center until toward its close. Some of the laundry was done under
contract at Dijon, 34 miles distant, linen being sent back and forth, first by
truck and later, as mentioned above, by shuttle railway car. All resources in
that city soon proving inadequate, a hand laundry was organized at Verdun-
sur-Doubs, 23^ miles from the center. A laundry barge was hired, 30 French
washerwomen employed and 15 marmites erected. Later two portable laun-
dries were received and operated by day and night shifts. The output of
these establishments was about 200,000 pieces per month. During September,
1918, several truck loads of hospital linen were handled by the portable
laundries at Beaune, when circumstances permitted that they give this assis-
tance. In October, the steam laundry at Beaune, designed to serve both
that center and Allerey, began operations, and as soon as it was able to meet
demands of both centers all other service of this utility was discontinued.
The laundry at Beaune was operated on day and night shifts, but its output
never reached that at Mesves, which had been designed to handle 600,000
pounds monthly. The largest number of pieces done for Allerey in any month
was 300,000 pieces during December, 1918. During the period of greatest
pressure, female civilian employees in the several hospitals laundered the linen
used in the operating rooms, but despite their efforts and the utilization of
all available resources, as many as 100,000 pieces were awaiting laundry at
that time. An exchange was established in the warehouse where issues were
HOSPITALS
503
made against articles turned in and appropriate records kept, including num-
bers of all cars in which laundry was shipped.
The animal-drawn transportation at Allerey never assumed very large
proportions, but several teams were kept in service until near the closure of
the center. They were used chiefly to supply units inaccessible by auto trucks.
After the establishment of an auto park, the only other transportation
which remained under the charge of the quartermaster were the shuttle rail-
way freight cars, and the others which operated on the railway spur within
the center. These latter cars were loaded at the warehouse and then drawn
by truck, which moved on the road beside the track. It was soon found that
more supplies could be delivered in this manner than by this truck alone and
that this expedient released a number of vehicles that would have been neces-
sary to move many small shipments. The quartermaster had supervision over
this spur and the unloading of the cars bringing freight to the center.
Coincident with the construction work of the engineers, the quartermaster
took over maintenance and the service of utihties. He effected repairs and
operated cobbler, carpenter, and plumbing shops, the lighting plants, pumps,
etc. So far as possible, maintenance was effected by the quartermasters of
the several units, but communal service of this character was carried on by the
group quartermaster, as well as that requiring large resources or technical
skill not available in the units concerned.
Land was rented for a farm, to be cultivated by convalescent patients,
and considerable work was done to prepare it for seeding; but it was never
further developed by the center, which was closed before seeding was practicable.
This farm, however, was emploj^ed to good advantage by the agriculture
department of Beaune University when it took over the hospital center at
Allerey.
The salvage service of the center was under the general supervision of the
group quartermaster, but in fact was largely carried on in the several units. He
consolidated their results. The articles receiving the greatest general attention
were fats, burlap, paper, tin cans, bottles, bones, rubber, and wire. Fats col-
lected in the several units were clarified by boiling and straining before ship-
ment; burlap and paper were baled, and a few carloads of tin cans were shipped
to salvage depots. Unsuccessful attempts were made to sell the remainder of
them locally. Bottles were turned in for reissue or shipment if not needed in
the center. Nails, wire, rubber, and bones were shipped to the depots desig-
nated. Salvage operations extended far beyond these simpler items, however,
for all articles that could be employed to some alternative use or could be reno-
vated were turned in for local repair or cleaned, and shipped to appropriate
depots; e. g., instruments, appliances, clothing, ordnance, utensils, etc. Closely
associated with salvage was prevention of waste, whether of comestibles or
other supplies, especially dressings. Per capita wastage of foodstuffs, includ-
ing liquids, was about 3 ounces per day, but this wastage was made to show
some return through its sale to the contractors who removed garbage.
Another duty of the group quartermaster was the command of the labor
battalion assigned to this center, the bakery and butchery companies, the field
hiundry detachment, details from the convalescent camp, civilian clerks, labor-
504
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
eis, and other employees in his department. Proper performance of this duty
was difficult because of the wide dispersion of such personnel on different tasks,
and could be met only by the detail of convalescent officers to supervise the
work of the larger groups. One minor but constant duty in which the labor
battalion was of especial service was that of unloading all railway cars within
12 hours and their notification, for removal, to the railway transport officer.
The cemetery for the center (A. E. F. Cemetery No. 84), was under the
care of the quartermaster, in all that pertained to its physical care, such as
preparation, filling, and marking of graves, provision of caskets and crosses,
maintenance of roads, paths, shrubbery, etc. This office also kept a register
of all burials and serial numbers of graves. In order that interments might be
made with due reverence and with proper religious and military ceremonies,
the first chaplain who arrived in the center was charged with making arrange-
ments for all funerals. He also made the reports called for to the central
records office and to the graves registration service, cared for all correspondence
relative to interments, including the notification of relatives, and kept records
of the name, rank, organization, religion, nearest relative, and cause of death
and number of grave of each decedent. His records thus confirmed some of
those of the quartermaster, but were more extended. He made appropriate
notifications to other chaplains of the same faith as that of the deceased in
order that they might officiate. Prior to the arrival of a chaplain of the Cath-
olic faith, the parish priest at Verdun was requested to visit the center, to
administer extreme unction and conduct funeral services for Catholic patients.
If no chaplain of the same faith as the decedent (e. g., Jewish) was present, the
services held by the officiating chaplain were as nearly as possible in harmony
with those prescribed by his church. Remains were removed by ambulances.
Firing squads, which attended all funerals, were detailed by the military police,
and pallbearers were selected by the commanding officer of the hospital in
which the patient died. Because of lack of lumber, it was at first necessary to
mark graves by pegs instead of crosses. Each peg showed the notation later
made on the cross which marked each grave, viz, name, rank, organization,
and date of death of the deceased. To this peg, and later the cross, was fastened
one of the decedent's identification tags, the other being buried with the remains.
A monument to the memory of Private Paul H. Burton, Base Hospital No.
25, the first soldier buried in the cemetery, was erected by the citizens of Allerey.
A resident, whose chateau was located on the outskirts of that village, later
offered to donate an elaborate monument to the cemetery, but as orders had
been received in the interim that no monuments were to be erected, the offer
was declined. A number of floral and other offerings were made by the French
citizens of the neighborhood as well as by the occupants of the center.
MOTOR TRANSPORT
The motor transport service was charged with the procurement, main-
tenance, and operation of all motor vehicles assigned to the center, procurement
of spare parts, provision of adequate transportation for all units, control of
personnel assigned to this service, and preparation of appropriate reports,
returns, etc. This service at Allerey was at first under the supervision of the
HOSPITALS
505
quartermaster, but in July, 1918, a separate department was organized by
which all transportation belonging to the medical service of the center was pooled
and repair shops operated. In the early period of occupancy no trucks were
available for the service of hospitals, but needs were met to a degree bv bor-
rowing from the constructing engineer after 6 p. m., and at other times to meet
emergencies. The motor park grew gradually and was placed on a much better
footing after the arrival of Truck Company No. 554, with 72 men and adequate
transportation. Truck and ambulance companies were formed, but service
frequently was impaired by nonreceipt of spare parts or lack of gasoline. The
automatic supply of 4,000 gallons per month authorized for the center proved
quite inadequate and was increased from time to time until double the amount
was being furnished. Much of this was used to operate pumps and the station-
ery engines, for lighting plants, etc. On several occasions, when grave diffi-
culties arose because of nonreceipt of spare parts and of gasoline, it proved
necessary to send trucks that could hardly be spared to Nevers and Dijon for
enough of these to tide over an emergency. By November, however, shops were
well equipped; the gasoline station had been established and these shortages
had ceased; expert auto mechanics had been found among the personnel on duty
in the center and in the convalescent camp and had been attached to the truck
company. Usually not more than 1 vehicle of the 50 then in the center was in
the shop at one time; rarely more that 2, though work was normally carried
late into the night. Orders required that the drivers should not leave for the
day until they had cleaned and oiled their vehicles, filled the gasoline tanks,
performed necessary minor repairs, or reported these to the shop if unable to
effect them themselves. One of the greatest handicaps to the motor service was
the poor condition of the roads, which not only obstructed operation of
vehicles but was responsible for many damages to them.
The three hospitals in the center which had been organized as American
Ked Cross units had each collected certain motor transportation in the United
States, but these never reached their units in France, because of pooling and
redistribution of motor equipment at base ports. The American Red Cross pro-
vided four Ford cars, which were put at the disposal of the several units by roster.
MEDICAL SUPPLY SERVICE
A depot for medical supplies was established at Allerey, as at other centers,
for the following purposes: (1) To have on hand supplies to meet immediate
needs, (2) to lessen fire risk at central depots, and (3) to facilitate shipments
by enabling these to be made in bulk and when cars were available. To further
reduce fire risk, storehouses were also established in all units in the centers.
The medical supply personnel at Allerey consisted at first of but 1 officer and
3 enlisted men, but this force was later augmented as need arose to 2 officers, 8
noncommissioned officers, and clerks and laborers as required. Valuable
additions were officers and enlisted men who had seen service in larger depots.
Duties were divided as follows:
Record section. — The sergeant in charge of the record section supervised all
other personnel and had immediate custody of records, correspondence and
reports, requisitions and returns of the depot. "jj
506 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Receiving and storage section .—This section checked in all supplies, received
and arranged in the storehouse those not issued to units direct from cars, and
was in charge of the storehouse. Its personnel checked the unloading of all
cars, whether unloaded into the storeroom or direct to units, and made record
of contents of each car, with number of same.
Issuing section. — This section modified requisitions as needs required and
made issues from the depot to units. It also received notations from the receiv-
ing section of such issues as it had made direct from cars. Such issues com-
prised chiefly beds, cots, bedding, and the supplies belonging to certain units
which they had had shipped from the United States.
The first duty of the medical supply officer at Allerey was to inventory
the considerable quantity of property already there when the center was organ-
ized and for which no packers' lists or invoices had been received. Supplies
accumulated in the United States by the unit which first joined the center
were not received until some two months after it arrived, so that meanwhile
articles were drawn to meet its needs. An acute emergency which arose at
the outset of the service at AUerey before all needed supplies had been received
was met by securing supplies by truck from the depot at Is-sur-Tille instead
of awaiting their arrival by train from the more distant depot at Cosnes, which
normally supplied the center; also, by shipments from the American Red
Cross depot at Dijon and by purchase in open market of some articles not
obtainable from either of these sources. After this initial deficiency, supplies
secured were, generally speaking, adequate, though sometimes very limited
and in a few items, insufficient. Often, supplies sent from the depot at Cosne
were from two to four weeks in transit, for one reason or another, such as an
embargo. Hence, constant provision was required of all concerned and
responsibility clearly fixed for any deficiency through lack of timely requisition.
Whenever less than 10 days' supply of needed articles were on hand in a unit
depot the fact was reported to the officer in charge of the center depot, who
took appropriate measures to prevent shortages becoming deficiencies. Simi-
larly this depot sought to keep a month's supply in stock. It had been planned
to keep on hand supplies for 20,000 men for three months, but quantities for
such reserves were not available at the depots.
As no separate storeroom had been provided for medical supplies, the
quartermaster allotted half of his warehouse to that purpose. This w^as sup-
plemented by the medical storehouses in all units which were kept filled to
capacity, with the result that storage facilities proved adequate. Whenever
possible, cars were unloaded at the unit needing their contents, so that much
bulky property did not pass through the warehouse, being checked direct
from the cars to the units. In October, on account of the sudden demand for
beds because of the influenza epidemic and the Meuse-Argonne operation, each
of the best-equipped hospitals in the center established a provisional hospital
of 1,000 beds, for whose supplies the parent unit assumed accountability. In
order to reduce paper work, these slenderly staffed provisional hospitals carried
all property on memo, receipt, and issues made to them were taken up and
accounted for by the parent unit.
HOSPITALS
507
The quantity of medical supplies reaching the center is indicated by the
following figures:
Cars received 280 | Sheets 65, 000
Beds 13, 000 Pillow cases 62, 000
Cots 7, 000 , Hand towels 87, 000
Mattresses 15, 334 ' Cotton, pounds 33, 000
Blankets 100, 000 Gauze, yards 600, 000
Ether, -pound tins 32, 000
RECEIVING AND EVACUATING OFFICER
The receiving and evacuating officer was responsible for the proper recep-
tion and distribution of patients and their evacuation as soon as their condition
permitted, with proper records and equipment, to stations designated by higher
authority. He received from the statistical officer daily abstracts showing the
number of patients and empty beds in each hospital and in the convalescent
camp, the number of officers and enlisted men ready for transfer to the camp
and from the camp to depots. His office maintained graphic charts showing
these data. Usually, but not always, the arrival of trains would be previously
reported by telegram to the center by the regulating station at Is-sur-Tille,
giving the number of the train, time of arrival, and number of medical and
surgical cases. The receiving and evacuating officer then determined where
these patients should be distributed, taking into consideration not only the num-
ber of empty beds in each hospital but also the respective facilities of each
hospital. The most serious surgical cases including all litter surgical cases were
sent to the hospitals which had first reached the center, as these were best
equipped to handle them. Incoming patients with influenza were sent to one
hospital; other infectious diseases, including venereal, to another, etc. Having
decided upon numerical distribution so far as possible, the receiving officer
made appropriate notification to the hospitals concerned and to the motor
transport and sanitary officers. The receiving officer furnished details to remove
patients and prepared for their reception, the motor transport officer furnished
ambulances at the time and place specified, and the sanitary officer arranged
for the cleaning and disinfection of trains and the police of the railroad spur.
Triage was effected in the train by the receiving and evacuating officer, his
assistant, the center officer of the day, and officers detailed from each hospital.
This method delayed somewhat the cleaning of the train, but 600 cases could
thus be classified and removed in three hours. During a certain period more
than 2,000 patients a day were distributed in this manner, with a minimum of
inconvenience both present and subsequent to all concerned. When necessary
to release trains more promptly triage was expedited and effected in from one-
half to three-quarters of an hour, but it was always found that this required
some subsequent transfer of patients between hospitals. During the removal
of contagious respiratory cases the hospital personnel discharging this duty
wore masks.
The receiving and evacuating officer also supervised the activity of the
disability boards in the several hospitals meeting with them frequently to assist
in the classification of patients. When it appeared from daily morning reports
that any hospital was not evacuating its patients as rapidly as it should — i. e.,
508
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
was allowing patients to remain an undue time on sick report — he visited its
wards and, by personal examination of patients and service with its board,
expedited their transfer to the convalescent camp.
These boards classified patients into four categories: A, fit for combat serv-
ice; B, temporarily unfit for combat service but retained for early reclassifi-
cation; C, permanently unfit for combat but fit for service in the rear; D,
unfit for further service in France.
At first all patients of whatever class were evacuated direct from the several
hospitals to the depots designated by higher authority, but later all except
Fn;. 90.— Interior of receiving ward, Allerey hospital center
those in class D, and a few special cases, were evacuated only through the con-
valescent camp . Class D patients, including those seriously w^ounded who could
be moved, psychiatric cases, etc., were evacuated directly from the several
hospitals by special trains, which, on request of the center commander, were
sent by the chief surgeon, A. E. F., from time to time for this purpose. Lists
of these patients submitted by the several hospitals were consolidated and
appropriate orders made when notice was received of the prospective arrival
of a train. Each hospital evacuating class D patients w^as furnished a list with
date, time, and place of entraining. It checked its patients into the train under
the direction of the receiving and evacuating officer, and transmitted their com-
pleted records. Special cases requiring hospital treatment elsewhere — e. g.,
those requiring fitting with artificial eyes— were sent direct from the hospital
in which they were being treated. They, like class B and D cases, were trans-
ported on ordinary passenger trains.
HOSPITALS
509
Patients were tentatively classified by their ward surgeons, then examined
hy the chief of service, and finally by the disability board of the hospital where
they were undergoing treatment. Patients suitable for transfer to the conva-
lescent camp were moved at a specified hour daily under a noncommissioned
officer on order of the receiving and evacuating oflficer, who also notified the
camp of the number to be expected from each hospital. With these men was
sent a nominal roll, giving names, serial numbers, military status, age, race,
religion, civil occupation, diagnosis in full, and classification, together with a
certificate signed by the chief of service of the hospital w^hence they came, to
the effect that they w^ere free from vermin and infectious disease, were fully
equipped and accompanied by complete records. All inmates of the conva-
lescent camp were reexamined at frequent intervals, and when fit for transfer
were paraded, their equipment was inspected, and those who did not feel fit
for duty were ordered to fall out for reexamination. All these last-mentioned
measures, including the preparation of proper orders, lists, etc., were in efl'ect
part of the evacuation service, but were performed under the commanding
officer of the convalescent camp.
Several advantages were secured by evacuating all patients except class D
and special patients through the camp. The most important of these were
verification of patients' physical condition, frequent examination by trained
physicians who specialized in this duty to determine progress, coordination, and
verification of records, provision of a depot whence men could be drawn for
needed service in the center while awaiting transfer, collective supervision by
specialists of graded calesthenic exercises, and reestablishment of military
discipline which may have been lost to a degree by patients while undergoingl
treatment in hospital.
Outgoing men had to be gi'ouped according to destinations, for the several
arms of the service had individual replacement depot or regulating stations
to which class A patients were sent and, similarly, B and C patients were
evacuated to designated points. It was found to be much simpler to evacuate
one consolidated convoy than to notify all hospitals concerned and move a
number of small detachments, the method that would have been necessary
had evacuations taken place direct from hospitals and which had been practiced
(luring the early days of the center.
Patients were transferred from unit to unit in the center as occasion re-
(juired — e. g., transfer of infectious cases — by mutual arrangement between
the respective commanding officers, and such transfers were then reported
to headciuarters of the center.
Arrangements for transportation of troops were made by the local railway
transportation officer (on notification from the evacuating officer) who, in turn,
made arrangements with the troop movement bureau headquarters. Services
of Supply. It was sometimes difficult to get the reservations desired. Space
allotted on local trains was often usurped by other organizations before they
arrived at AUerey, and very frequently trains were many hours late. To
diminish discomfort of men scheduled to leave during the night, they were
transferred after the evening meal to quarters nearest the railroad station and
not moved until the railway transport officer telephoned the near arrival of
510 ADMIXISTRATIOX, AMERICAN f:XPKI)lTI()NAKV FORCES
the train. This measure, not available until overcrowding diminished, was
important, for it saved many hundred patients the necessity of marching to
the station, three-quarters of a mile distant, and then waiting through the night
in cold and rain for transport, which occasionally did not arrive. Special
trains, which were sometimes necessary, were available as a rule after three
or four days' notice. Class B and C cases were evacuated on ordinary trains.
Outgoing convoys, if their size warranted, were under charge of an officer.
Sometimes several officers were detailed for this duty, as when, in one convoy,
more than 1,200 men were transferred.
INSPECTOR
The duties of an inspector for the center never received undivided atten-
tion of an officer, for there was none available for this duty exclusively. To
meet as well as possible a very evident need, the commanding officer directed
the only other officer of the Regular Army who was present for any consider-
able period to assume these duties in addition to those of the commanding
officer of Base Hospital No. 49. This hospital functioned so well that this
officer was able to devote most of his time to inspections which took cogni-
zance of both conditions within the center and its external relationships with
French communities and individuals. He followed no routine, but inspected
all elements of the command as need arose, recommending appropriate changes
of method, transfers of personnel and equipment, investigated complaints,
reported defects in service of units and individuals, etc. An important duty
was the investigation and rectification, if just, of any complaint arising from
misconduct of occupants of the center while on pass, and his activities in this
field promoted amicable relations between the Americans and the French.
SANITARY INSPECTOR
The sanitary inspector supervised the sanitation of the center and was
authorized to give orders on this subject. More specifically he was charged
with making suitable arrangements for the disposal of excreta, waste, and
refuse, disinfection of clothing, bedding, buildings, and hospital trains, super-
vision of measures ordered effected for the control of infectious diseases, inspec-
tion and report on the sanitation of units, coordination of the efforts of the
sanitary officers of units, and report on progress of construction of buildings
and grounds. Sanitary problems were numerous, and w^ere intensified by
overcrowding, shortage of equipment, and poor condition of roads.
The sanitary officer of the camp was assisted by the officers holding similar
positions in the respective units. Also, in each unit there was a small, per-
manent detail of enlisted men engaged in sanitary work. At first, these
enlisted men were selected from the units concerned; however, when sanitary
squads No. 23 and No. 77 joined, personnel from these squads were distributed
among the several units, thus permitting the release of the unit personnel.
Members of the sanitary squads inspected and reported to the center sanitary
officer upon all matters affecting sanitation therein; e. g., quantity and removal
of garbage, collection and disposal of other refuse, ventilation, and water
purification. Defects reported were corrected by the sanitary officers of the
HOSPITALS
511
center and of the unit concerned. Another section of the sanitary squads
supervised general police duty, such as that of the railway spur, the cleansing
and disinfection of hospital trains, operation of the center incinerator, and
cleansing of the settling tanks of the sewer system.
The condition of buildings and grounds and of water, food, and clothing
supplies of the center have been discussed above under the construction and
the quartermaster service, respectively. No further reference need be made
to these subjects here, except that milk was purchased from neighboring
dairies, but it was so heavily contaminated that local orders required its
Pasteurization before use.
Garbage was removed under contract twice a day by a nearby farmer
who, under supervision, performed this service very satisfactorily.
The pail latrine system was employed. As to the final disposal of excreta,
this was buried in a pit north of the center, until an extemporized incinerator
was built of salvaged material. The pails were emptied into covered barrels
which were hauled by truck to this point. Unsatisfactory as was this method,
it had to be employed from time to time until toward the close of the center.
No excavator wagon was obtainable. Five Horsfall incinerators were
received from time to time, but these proved quite inadequate for the needs
of the maximum population in the center, so that recourse was had, with satis-
factory results, to the use of the center incinerator. Pits were dug to collect
mine and waste water, but because of the impermeable soil these soon filled
and their contents were removed in barrels to a disposal tank on the outskn-ts
of center. Eventually these fluids were removed largely through the sewer,
though by the end of October, 1918, not more than half of the sewerage system
had been completed. Urine pits were never connected with the sewer, but
their contents were pumped into it by hand pumps.
Disinfection was effected at first in Serbian barrels, but later four portable
disinfectors, American type, were installed from time to time. These, together
with a Canadian hot-air disinfector built in the convalescent camp, met most
needs, but during periods of stress were supplemented by the Serbian barrels
until toward the end of the center's existence. The portable appliances were
distributed, and their use by neighboring units regulated, accordmg to roster.
Mess utensils were disinfected after each meal by immersion m boilmg soapy
water and boiling clean water successively.
The sanitary officer inspected all parts of the camp at least twice monthly
and dailv any part of it which required especial attention (e. g., wards for
infectious diseases). He kept a blue print of the camp, marked each day with
colored pins, which indicated the location and character of sanitary defects
reported by the sanitary squads or the sanitary officers of umts, or discovered
on his inspections. He graded on a percentage basis the samtary condition ot
wards, kitchens, latrines, food wastage, and general police of the several units.
These gradings of all units, published twice a month to the command, proved a
stimulus to amiable rivalry . r j f .
An important duty of the sanitary officer was the enforcement of orders for
the control of infectious diseases. Such orders, in so far as professional measures
13901—27 33
512
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
were concerned, were initiated by the chiefs of the medical and laboratory
services; methods of their application w^ere determined by the sanitary officer
in conjunction with them.
The sanitary officer kept up graphic charts showing the number of cases of
each infectious disease in the center. The occurrence of each case of diphtheria,
meningitis, mumps, and measles in each building in the center was shown on a
diagram of the center, by the appropriate insertion of pins with differently
colored heads — one color for each disease.
In November, 1918, the center at Allerey was housing over 22,000 in
addition to about 600 troops and employees of the engineers and was severely
Fig. 91.— Delousing apparatus, Allerey hospital center
overcrowded. A number of cases of influenza and pneumonia had been received
during October, together with many gassed cases who were very susceptible to
respiratory infections. The greatest number of influenza cases w^as 1,002 on
November 4, when the total number of patients in the center was 16,063; and
the greatest number of pneumonia cases, 291, was reached four days later.
By January 1, 1919, the number of cases of each of these infections had fallen to
100 and 51, respectively. Influenza and pneumonia cases developing in the
center were transferred so far as practicable to appropriate wards in the same
hospital in which they arose, but all other infectious cases were transferred to
appropriate wards in Base Hospital No. 56. Though other infectious diseases —
diphtheria, cerebrospinal meningitis, mumps, measles, German measles, erysip-
elas, typhoid, paratyphoid, and scarlet fevers — were introduced into the center,
HOSPITALS
513
only diphtheria occurred in any alarming number. It had been introduced by
chronic carriers, especially those who had been gassed, these latter being highly
susceptible to the disease. The number of cases rose gradually to 95, on
December 2, the most important factors in its spread being overcrowding,
contaminating hands, and fomites (indirect droplet infection), and, at first,
delayed diagnosis in laryngeal cases. Clinically these cases often were very
similar to membranous laryngitis caused by "mustard" gas. Measures for
control adopted were :
(1) Inspection of all throats daily and prompt segregation of positive cases,
carriers, and suspects. These were transferred to cubicled wards and wore
masks when out of their cubicles.
Fig. 92.— Clothing preparatory to delousing process, Allerey hospital center
(2) Quarantine of wards in which a case developed until the throats of all
therein were cultured, inmates meanwhile wearing masks.
(3) Contacts, including those occupying, or working in, the same building
were given the Shick test, and if this proved positive they were given antitoxin.
(4) Carriers and contacts were quarantined until two negative cultures
were obtained, at 48-hour intervals, from the nose and throat.
When five or less positive atypical cases were found in a ward when a case
of diphtheria had appeared, they were sent to the quarantine wards in Base
Hospital No. 56; when more than that number were found in a ward, the ward
was quarantined. The throats of all its inmates were treated for 3 days and,
after 24 hours' respite, were recultured. Quarantine, though rigorous, was made
as brief as possible, in order to insure cooperation of those affected by it.
514
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Similarly, meningococcus carriers were quarantined until after two negative
cultures were obtained at one-week intervals. Eighteen cases of this disease
developed, between no two of which could close contact be established. Ten
cases appeared at the time of greatest crowding, but epidemic developed.
Observation wards were provided in each unit for the segregation of sus-
pected cases of infectious disease. All these beds, as well as in the contagious
wards, were cubicled and attendants were masked. The sanitary officer in each
hospital made frequent day and night inspections of the wards for contagious
cases, and exemplary punishments were inflicted for violation of quarantine.
Proper ventilation and head-to-foot sleeping arrangements were enforced.
Fig. 93.— Interior of one of the quarters for enlisted men, Allerey hospital center
Public gatherings were forbidden for a few weeks during the height of the influ-
enza epidemic.
Buildings were heated by coal and wood stoves, but a sufficiency of these to
make all structures comfortable never was received. Proper heating of tents
was especially difficult.
French shower baths, provided in adequate number, proved very satis-
factory. Personnel and ambulant patients were required to bathe twice weekly
at least, and permitted to do so more frequently if they did not interfere with
the use of these baths by roster.
Very few venereal cases developed. Preventive measures were those
usually employed.
HOSPITALS
515
FIRE MARSHAL
The fact that the housing facilities in the center were constructed entirely
of pine or were canvas caused the fire hazards to be exceptionally great, though
these were minimized as far as possible by the spacing of units and tents and
by the installation of spark arrestors on all smokestacks or chimneys.
The fire marshal of the center was charged with the formulation of fire
regulations, procurement and distribution of fire-fighting material, instruction
of the fire marshals and squads of the several units, supervision of their drills,
inspection of apparatus at least twice monthly, etc. The fire marshal being also
sanitary officer, he added the duties of firemen to those of the sanitary squads
Fig. 94. — Heating apparntus for jiaiiiTits' liaths, Allerey hospital center
and required that, when making sanitary inspections, the members of these
squads were to note the condition of buildings and grounds and of fire-fighting
apparatus. Such apparatus was rather delayed on delivery. When received,
much of it was placed in those units treating the greatest number of bed patients
and the remainder as equitably as might be throughout the center. At first
the only facilities were fire buckets (which were used for no other purpose), 45
fire barrels, and 2 hand pumps to each unit. Eventually all units were equipped
with Pyrene and Hardin extinguishers, 10 pumps of 5-gallon capacity, and 640
feet of 2-inch hose. A central fire department, consisting of 12 men on day
and night duty who were in charge of a 90-gallon chemical fire engine, was soon
expanded to operate three other such engines, which were distributed through
the center. Detailed regulations covering fire service were posted in all wards,
barracks, etc., and fire drills in accordance therewith were held weekly in each
516
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
unit and by the fire department of the center. Notwithstanding all precautions
a number of small fires occurred, of which about 90 per cent were attributed to
cigarette stubs; the only one that was at all serious was caused by an explosion
of a small gasoline tank. Because of the danger of fire to the bed patients and
the grave effects of the loss of even one structure in so crowded a community,
smoking in wards and barracks was forbidden until the number of bed patients
and the population of the center were considerably diminished and fire appara-
tus fully installed. The gravity and imminence of the fire menace is attested
by the fact that within two hours after the premises were turned over to the
French, four buildings were burned and the conflagration arrested only with
considerable difficulty.
SIGNAL SERVICE
During the early history of Allerey, the French telegraph line was the only
one available. An interpreter in the engineer's office was the connecting link,
receiving and delivering by telephone, through the French office at the railroad
station, messages pertaining to the center; but this service was very unsatis-
factory as messages were often garbled in transmission. Exterior telephone
service was soon extended to Dijon, but connections were difficult to get, and
these usually were cut before a conversation was completed. It was not until
after the center was linked up with the American lines that exterior service was
reliable. At first no telephones were provided for interior communication, a
circumstance which both slowed up service and necessitated the use of runners
who could illy be spared from other duties, but these instruments were gradu-
ally installed, until by October, 1918, 46 were in operation. At that time a
detachment of the Signal Corps joined and began operating a central office,
which soon handled the following average business daily: Telephone calls,
internal, to the center, 425; outgoing, long distance, 25; incoming long dis-
tance, 36. Telegrams received (2,950 words), 60; telegrams sent (3,400 words),
75. In addition to the foregoing were the internal calls (of whose number no
record was kept) to the several units which had separate systems of local calls.
ENGINEER OFFICER
Throughout the occupancy of the center, the constructing engineers con-
tinued to be engaged in the completion of the project, but were also concerned
to a degree with the solution of engineering problems which arose in sections
already occupied; e. g., settling of water mains, upkeep of roads, etc. As this
constructing force was to be withdrawn, however, as soon as the center was com-
pleted, and as no provision was definitely made for the assignment to the center
of an engineer to solve problems that might later arise in this field of work, an
officer of engineers in the convalescent camp was assigned to duty at head-
quarters to acquaint himself in detail with the problems which the constructing
force had encountered and how they had been overcome. It was proposed to
have him detailed as the engineer officer of the center when the constructing
force was withdrawn, but this never proved necessary as the constructing force
remained until the center closed.
HOSPITALS
517
ASSISTANT JUDGE ADVOCATE
The duties of an assistant judge advocate were discharged by the adjutant
in addition to his other services. These comprised examination and, if need be,
the correction of charges and findings, details of special courts, etc. General
courts-martial for the center were detailed by the commanding general. Services
of Supply.
ASSISTANT PROVOST MARSHAL AND COMMANDANT OF GUARD
When the first unit arrived at Allerey, the only guard provided was a
detachment of 10 men of Company F, 162d Infantry, engaged in protecting
property of the engineers. This nucleus was gradually augmented, partly
from outside sources, partly by details from the convalescent camp. But
few firearms were available for several months, a circumstance which made
it necessary to arm with clubs the interior guards and some of the personnel
at posts outside the center. French gendarmes were too few to effectively
restrict the American soldiers or to enforce the laws controlling sale of alcoholic
stimulants. The police and guard services grew with the center's development,
and by September there were 10 military police posts which covered 6 adjoining
towns and adjacent territory. These were under the command of the assistant
provost marshal detailed by headquarters of the Services of Supply. This
officer was responsible for the discipline, records, etc., of the military police
quartered in the center, reports of their activities, establishment of an adequate
number of police posts throughout adjoining territory, protection of inhab-
itants against disorders and depredations by American troops, supervision
of travel by military personnel, arrest and detention of all stragglers, absentees
without leave, and other violators of the laws and orders whether of French
or American origin, to which Americans were subject. At first the assistant
provost marshal also commanded the interior guard, but this organization
later was separated entirely and placed under the command of a line officer
detailed from patients in the convalescent camp. At this time the guard
consisted of 3 platoons, each having 3 sergeants, 12 corporals, and 79 privates,
each platoon being commanded by a commissioned officer. Almost all this
personnel was drawn from the convalescent camp and, under existing orders,
had to be returned to duty as soon as fit, a circumstance which required the
return of its members about as soon as they were trained, and enhanced greatly
the difficulty of this service. In August, Provisional Company No. 6 and
Provisional Company No. 20, each comprising 100 class B men, were assigned
to the center for guard duty. An efficient military police who, as distinguished
from the guard, functioned outside the camp was necessitated by infractions
of law on the part of some of the local French population. The most serious
of these offenses were illegal sale of alcholic stimulants and the purchase of
Government property, such as military clothing and blankets. These offenses
were controlled only by numerous arrests, search warrants, and prosecutions in
the French courts. Clandestine sales of liquors in camp by employees and
by laborers were suppressed by similar means. Absences without leave were
controlled by demanding passes of all men encountered by the police outside
518 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
of camp, and by sentencing men found guilty to unpleasant duty, as with
the labor battalions. One motor cycle was employed by the military police
for the apprehension of such delinquents. By means of this vehicle the police
reached points where it w^as impractical to post guards, and the radius and
intensity of their control were notably increased.
INTELLIGENCE OFFICER
The intelligence officer for the center was assisted by others occupying
comparable positions in all units, by officers censoring mail, the post-office
force, the telephone and telegraph operatives, etc., so that very complete
information reached headquarters of the conduct and loyalty of individuals
and of morale throughout the center. This service w^as important, for it was
an additional means of determining the needs of personnel and how^ they might
best be met. Derelictions discovered through it were met in other ways
than by court-martial, for none were grave enough to w^arrant this, and could
be handled better by administrative than by juridical methods.
CHAPLAIN
As the center expanded, the number of chaplains present, 4 Catholic and
4 non-Catholic, proved inadequate without some organization, to the many
needs arising for their service. The senior chaplain present therefore w^as
placed in general supervision of the chaplains' activities and in charge of the
center chapel. His functions in these capacities were to make suitable pro-
vision for all those seeking the services of ministers of their faith and to prepare
a roster for the use of the chapel by all ministers in turn. Thus such needs
throughout the center were coordinated. As chaplains made their visits
through wards and elsewhere, they learned the names of those of other faiths
who desired the services for chaplain and promptly took appropriate measures
to secure these services. Each chaplain normally served those of his faith,
not only in his own unit but in others as well.
In addition to the services in the chapel, others were held in the several
units in the recreation halls and, when these were filled at one time by beds,
in dining rooms. Dining rooms were by no means suitable for the purpose,
but the fact that any other arrangement was temporarily impossible was
recognized by ministers and congregations alike, and services were conducted
with normal decorum and success. As noted above, suitable provision for
interments was made by the interment officer, who was the first chaplain to
come to the center.
From time to time the chaplains met informally to discuss questions per-
taining to divine services and social needs, for they charged themselves with
the performance of whatever duty they could discharge which came to hand.
These duties included the promotion of entertainment wdthin the several units,
in conjunction with the American Red Cross, the organization of orchestras,
glee clubs, etc., preparation for Thanksgiving and Christmas celebrations,
waiting letters for disabled or uneducated men, and, by sympathetic helpful
interest, promotion of the happiness of such as sought their aid, or when they
HOSPITALS
519
proved in need of help or encouragement. Their counsel was constantly being
sought by patients and duty personnel alike in matters affecting their secular
welfare.
RAILWAY TRANSPORTATION
The railway transportation officer was responsible for the transportation
by rail of personnel and supplies to and from the center, except movement of
hospital trains and supervision of the railway spur, the former being under
the orders of the regulating station at Is-sur-Tille and the latter under the
center quartermaster. Upon notification of the number of patients fit for
transfer, and their destination, he made appropriate request on the troop move-
ment bureau at Tours and notified the evacuation officer when transportation
was made available. He traced lost freight, notified the center headquarters
of the time of arrival of hospital trains, arranged for the movement of the
shuttle railway car back and forth to Dijon, and maintained liaison with
the fourth bureau of the French War Department. His office in the railway
station was connected by telephone with the hospital center and maintained
day and night service, with the result that local business was handled promptly,
and, by means of long-distance telephone calls, hour of arrival of trains for
outgoing drafts was notified to the center in due time for them to be moved
without tedious waiting, yet without delay.
AMERICAN RED CROSS
Shortly after the hospital center at Allerey was organized, an officer of
the American Red Cross joined the headquarters staff and remained in charge
of Red Cross activities until the center neared its close. His department
grew until it consisted of 3 officers, 23 workers, 2 searchers, and a variable
number of civilian employees. He exercised general supervision over his
department, obtained and distributed needed Red Cross supplies, and coor-
dinated efforts of his department personnel; one of his assistants arranged for
entertainments to be given in the center from extraneous sources, procured
moving-picture apparatus, films, etc., and another, as a field inspector, deter-
mined needs of patients, efficiency of workers, etc. The workers, distributed
among the units, met incoming hospital trains to serve hot chocolate and coffee
and to distribute cigarettes. They assisted patients in many ways throughout
their stay in hospitals, as by the donation of tobacco, confectionery, stationery,
etc., resale at cost of supplies purchased from the commissary, writing of letters,
etc. Among the gifts distributed by the Red Cross prior to January 1, 1919,
were 35,000 comfort kits, 375 cases of bar chocolate, 50,000 pairs of socks,
35,000 sweaters, 5,000 cases of cigarettes and tobacco, 100 cases of chewing
gum; at Christmas, 1918, 15,000 pairs of socks were filled and distributed.
Part of the contents of these were 200 sacks of nuts and confectionery made
from 15 tons of sugar. The Red Cross also met the graver needs of patients,
its depot supplying many articles required for their care and comfort, especially
in emergencies when there was not time to get them from Army depots. Thus,
to meet the needs occasioned by the Meuse-Argonne operation and when ship-
ments from the medical supply depot at Cosne were held up by embargo,
520
ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
the local chief of the American Red Cross procured from the depot of that
society in Paris 10,000 blankets, 10,000 sheets, 1,000 operating gowns, 1,000
helmets, 1,000 pairs of bed socks, 600 suits of pajamas, 2,000 yards Carrel
tubing, and 2 cars of surgical dressings. The promptitude with which these
essential articles were received at this time undoubtedly saved a considerable
number of lives. These articles were shipped by freight cars attached to
the Paris-Marseille express to a point near the hospital center, whence they
were transported to the center by truck.
On the one hand, the searchers located relatives and friends at home, of
patients in hospital, and, on the other, for interested ones at home, men who
had been lost in the American Expeditionary Forces. One of their duties was
the detailed report of the American prisoners of war who reached the camp from
Switzerland and to assist these men in straightening out their affairs.
The several hospital units of the center provided to a degree their own
entertainment, such as dances, theatrical performances, and concerts, but to
the local American Red Cross fell the duty of promoting entertainment generally,
obtaining troups, films, etc., from outside sources, and coordinating resources
among the organizations. Each hospital unit had a recreation hut accommodat-
ing 600 persons; the convalescent camp had a hut accommodating 1,500. All
of these buildings were donated by the American Red Cross. That society
installed 10 pianos in these buildings and furnished instruments for a band,
three orchestras, and a fife, drum, and bugle corps. From the middle of October,
1918, until November 25, the recreation huts in most units were filled with
beds, but as rapidly as these were cleared performances were staged, and when,
in December, sufficient electric current became available moving pictures were
exhibited. These were shown five nights a week in each unit, and from one to
three of the American Expeditionary Forces traveling shows played nightly in
the center.
About January 15, 1919, a nurses' recreation hut was opened by the Amer-
ican Red Cross, providing reading, writing, and lounge rooms. Tea was served
here each afternoon and a dance given every evening except Sundays, the chief
nurses of the hospitals acting as hostesses by roster. In the same month the
Red Cross opened in Chalons-sur-Saone, the nearest large town, a centrally
located building which provided a recreation and writing room for enlisted men,
separate sitting rooms for officers and nurses, and a common drawing room where
tea was served by the Red Cross worker in charge.
A library of 500 books was maintained in each unit and large numbers of
current American, English, and French periodicals, especially those carrying
illustrations pertaining to current events, were distributed.
In the headquarters building, the Red Cross operated a bank and an infor-
mation bureau. The bank made loans and cashed checks, the amount of its
business amounting to over 785,000 francs. The information bureau assisted
some 300 men daily.
CONSULTANTS IN THE PROFESSIONAL SERVICES
The consultants of the several professional branches supervised the activi-
ties of their respective specialties throughout the center, in addition to perform-
ing the duties of chief of service in the hospitals to which they were assigned.
HOSPITALS
521
They were charged with the study of pertinent professional needs and available
resources, in personnel and material, recommending transfers as required to the
best advantage. They acquainted themselves with the qualifications of their
own resources as far as possible, but reported to the commanding officer those
matters needing his cooperation, acquainted themselves with new methods of
treatment, and disseminated professional information. This last important
duty was effected in several ways, such as by conferences attended by all offi-
cers in the center belonging to a given service, by personal discussion with
individuals concerning treatment of a particular case or group of cases, and by
presentation of cases or papers read at meetings of the medical society. In
order to afford a clearing house for professional knowledge, the "clinico-patho-
logical society" was organized, to meet twice weekly. At one of these weekly
meetings unusual cases were presented and discussed; at the other, reports of
autopsy findings and demonstrations were made. It had been noted early that
certain clinical diagnoses had proved difficult, such as certain cases of laryngeal
diphtheria, complicating injury caused by inhalation of "mustard" gas, peri-
carditis, and empyema, and cases selected for presentation were those that
had presented difficulties in diagnosis and treatment. Similarly, difficult sur-
gical cases were presented and discussed. By such means there was promptly
disseminated much information of a highly technical character, which was of
immediate value, especially to medical officers who had newly arrived overseas
and had not yet had practical experience in treatment of certain newly encoun-
tered conditions. By the report of autopsy findings, an error in diagnosis or
treatment by any medical officer was immediately made known to the chief of
service so that appropriate action could be taken. Frequently, the respective
staffs of the several hospitals met to discuss professional matters internal to
the units. A number of papers were written, and later published, on profes-
sional activities in the center. It had been planned that each service eventually
would organize its professional society, but because of shortage of personnel
and pressure of duties, this project could not be effected
Through the visits of the consultants from ward to ward, and the dis-
cussions in the medical society and out of it, a standardization and coordination
of service was effected. Though certain professional measures were manda-
tory, for example, those for the control of diphtheria, medical officers were
encouraged to feel that they had an active part in the development of pro-
fessional methods, and they formulated the few orders published concerning
professional activities.
To meet the fluctuating needs in the nursing service in different parts of
the center, the senior chief nurse, in addition to her other duties, made frequent
surveys to determine what transfers of nurses should be effected between
hospitals and to make recommendations concerning their activities and welfare.
Similarly, the senior dietitian made surveys concerning dietaries, the prepara-
tion and service of foods, recommended transfers of dietitians with the different
hospitals, and gave assistance in her specialty wherever this appeared advisable.
522
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
COLLECTIVE ACTIVITIES OF HOSPITAL UNITS
It is the purpose of this chapter to consider collective, rather than indi-
vidual, activities of the hospitals of which the center at AUerey was composed,
the individual activities were comparable to those of detached base hospitals.
Certain notations regarding each unit composing the center are made, however,
to show how each fitted into the general plan.
The following hospitals joined the center in sequence: Base Hospital
No. 26, comprising personnel from the University of Minnesota, the Mayo
clinic, and the medical profession of Minnesota at large, had been joined in the
United States by 12 officers and 50 enlisted men from Baylor University,
Texas. This hospital joined June 20, 1918, with 36 officers, 65 nurses, 1
dietitian, 2 technicians, 3 stenographers, and 207 enlisted men. Base Hos-
pital No. 25, comprising personnel from the Cincinnati Medical College, and
the medical profession of Ohio at large, joined July 15, with 41 officers, 100
nurses, 1 dietitian, 2 technicians, 3 stenographers, and 208 enlisted men. Base
Hospital No. 49, with 38 officers, 100 nurses, 1 dietitian, 2 technicians, 2 stenog-
raphers, and 208 enlisted men, from the University of Nebraska and the medi-
cal profession of that State at large, joined August 5, 1918. Evacuation
Hospital No. 19, with 33 officers, 100 nurses, and 237 enlisted men, organized
at Fort Riley, Kans., joined September 19. Base Hospital No. 70, with 40
officers, 100 nurses, and 200 enlisted men, organized at Fort Riley, Kans.,
joined September 28. Base Hospital No. 56, with 30 officers, 99 nurses, and
188 enlisted men, organized at Fort Oglethorpe, Ga., joined September 30.
Base Hospital No. 97, with 31 officers, 2 dietitians, 192 enlisted men, organized
at El Paso, Tex., joined November 30. It was joined on December 14 by
97 nurses. Base Hospital No. 82 joined September 19, but on September 21
it was transferred to Toul.
In conformity with the urgent demand for increased hospitalization in the
American Expeditionary Forces, the first five hospitals which reached the center
each organized a provisional hospital consisting of from 7 to 12 officers and
about 40 enlisted men. Each of these provisional units took over an unoc-
cupied, uncompleted section of the center and undertook to care for 1,000
patients whose condition was not severe but who were not ready for transfer
to the convalescent camp. The senior unit relieved its respective provisional
hospital of as much as possible of administrative work — e. g., reports of sick
and wounded, returns for property (except clothing and ordnance) — but,
generally speaking, these junior units were autonomous.
The convalescent camp was organized June 26, 1918, from personnel on
duty at Allerey and by limited casual personnel assigned to the center for that
purpose.
The personnel of the three American Red Cross hospital units which
had been the first hospitals to join had been selected from large resources so
that their commissioned staffs were composed of men well trained in their
several specialties, whether surgery, medicine, laboratory, or dental, and who
were mutually acquainted with the professional methods of others in their
units. Nurses, dietitians, technicians, and enlisted men comprising college
men, professional cooks, technical draftsmen, also had been selected from
HOSPITALS
523
among many who were eligible. Thus each of these units was well balanced.
This balance, however, was considerably disturbed by the need of supplying
personnel to form the headquarters organization, organize provisional hos-
pitals, provide surgical teams which were sent to the front, and to meet other
needs. The other hospitals which composed the center contained many very
capable officers, nurses, and men, but in comparison with the Red Cross units
they were handicapped by the lack of prior mutual acquaintance; also, they
were handicapped in their earlier professional efforts by the necessity for
concentrating, as described below, a considerable part of the limited equipment
available in the hospitals which first arrived in order that the most serious
cases could receive suitable care.
Fui. y5.— An operating room, Allerey hospital center
Each of the Red Cross hospital units had accumulated medical property
to the value of from $30,000 to $100,000 in the United States. But since the
property was not received until about two months after they reported at Allerey,
it was necessary to completely equip them, even at the expense of other units,
so that they could care for all types of cases, and for this reason they were at
first given preferential consideration in the distribution of equipment. This
procedure made it possible to treat satisfactorily all classes of cases who could
not have been so well cared for had equipment been scattered. Later, as
resources developed, other hospitals were equipped to greater or less degree,
especially in their laboratories, operating, and X-ray departments.
524
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
This distribution of equipment had a corresponding influence on distri-
bution of patients. Thus, grave surgical cases were concentrated at first in
Base Hospitals Nos. 25, 26, and 49; psychiatric in Base Hospital No. 25;
neuropsychiatric in Base Hospital No. 49; infectious diseases (other than influ-
enza and pneumonia), complicated venereal and dermatological diseases in Base
Hospital No. 56; ophthalmic in Base Hospital No. 26; otolaryngologic^ in
Base Hospital No. 49; influenza and pneumonia in Base Hospitals Nos. 25,
26, 49, and 70; complicated dental cases in Base Hospital No. 26, etc. Since
many cases admitted were suffering from two or more conditions a sorting of
them was effected in such a manner as to give the graver condition perferential
Fig. 96. — Sterilization room, Allerey hospital center
consideration. The most serious cases of this class were the severely wounded
who had contracted pneumonia. The provisional hospitals cared for patients
not ready for transfer to the convalescent camp.
All hospital imits of the center had their medical and surgical cases in
wards devoted as far as might be to the treatment of one class of patients only.
Thus wards were established for patients with infected wounds, fractures, and
dislocations, clean surgical cases, surgery of the head, face, nose, throat, dental
cases, gassed cases, cases of pneumonia, influenza, etc. Each hospital estab-
lished a cubicled observation ward, to which was transferred each suspected case
of contagious disease, until diagnosis was established, when it was properly as-
signed. A nurses' ward for the service of the entire center was established in Base
HOSPITALS
525
Hospital No. 49. The infectious cases grouped in Base Hospital No. 56 were
segregated, as far as possible, though because of the great overcrowding of the
center and limited personnel and equipment, it was not possible to provide a
separate ward for each type of disease. At the period of greatest overcrowd-
ing in the center, wards built for 50 patients were sheltering 70; however, the
wards for infectious cases were made to house but 48 inmates each.
Consequent upon this segregation of cases was the local development of
several departments in certain hospitals; e. g., an occupational work shop for
psychoneurotic cases in Base Hospital No. 25, orthopedic shops in Base Hospi-
tals Nos. 25, 26, and 49, and the especial equipment of hospitals which were
carrying on special activities. A central orthopedic workshop was never estab-
Hshed. The plan had manifest advantages, but at Allerey shops were operated
Fig. 97.— a surgical waid, Allerey hospital center
in several hospitals in order that orthopedic appliances might be made under
the immediate supervision of the respective surgeons, who could illy afford the
time necessary to go to a central workshop for this purpose.
Except that certain departments were more developed in some hospitals
than in others and that personnel was depleted for various reasons, the organi-
zation of each hospital conformed to the general plan formulated by the War
Department for these institutions. The detail of from 1 to 6 surgical teams
from each unit, except Base Hospital No. 97, took from the center, from time
to time, much of its best operating personnel for from a few days to several
months. These teams usually consisted of 2 medical officers, 3 nurses, and 2
enlisted men.
The total number of cases admitted was 33,658, distributed as follows:
Base Hospital No. 26, 5,512; Base Hospital No. 25, 5,860; Base Hospital No.
526
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
49, 4,626; Base Hospital No. 56, 7,338; Base Hospital No. 70, 5,371; Evacu-
ation Hospital No. 19, 4,951. Base Hospital No. 97 received convalescents
from other units.
The following summary of medical cases treated in Base Hospital No. 25
prior to January 1, 1919, indicates the general scope of the medical activities
of the center:
Disease
Pneumonia and empyema.
Influenza and bronchitis. _
Diphtheria
Diphtheria carriers
Measles -
German measles
Mumps
Scarlet fever.
Erysipelas
Epidemic meningitis
Meningitis carriers
Gas cases
Cases Deaths
248
859
42
97
4
1
3
2
6
2
3
741
Disease
Typhoid fever
Paratyphoid fever
Pulmonary tubeiculosis ---
Malaria
Dysentery and other diarrheas.
Nephritis
Psychoneurosis - - -
Cardiovascular
Tonsillitis
Arthritis..
Miscellaneous
Cases Deaths
5
1
9
3
261
10
575
17
52
70
29
Fig. 98.— .V psychiatric ward, Allerey hospital center
Similarly, the range of surgical activities is indicated by the following list
of operations in Base Hospital No. 49:
Amputations 12
Aneurysms-- 3
Appendectomies 17
Aspirations 1
Circumcisions 4
Closures 305
Colostomies 2
Debridements 13
Decompressions 3
Drainages 75
Foreign bodies 27
Hemorrhoidectomies 22
Herniotomies 12
Laminectomies
Skin draft
Thoracotomies
Tracheotomies
Tubercular glands.
Venectomies
Total 506
HOSPITALS
527
The greatest number of surgical operations was performed in Base Hos-
pital No. 26, where, 1,021 operations were performed in the operating room.
In the treatment of surgical cases, certain hospitals of the center required,
in order, the debridement of wounds if this had not already been done, the
culturing of all deep wounds, preparation of smears from all wounds, treatment
of all wounds by Dakinization, and secondary closure after three clean smears
had been obtained, the last of which had preceded operation 24 hours.
In the center otolaryngological clinic, the following cases were treated
and operations were performed from the date of organization (August 20, 1918)
to January 8, 1919:
Eye and ear clinic in one of the hospitals, Allerey hospital center
New cases seen in clinic 1, 026
Old cases seen in clinic 1, 023
2, 049
Consultations by ear, nose, and throat
department in other hospitals in
center
Operations:
Tonsillectomy
Mastoidectomy
645
85
49
Operations — Continued.
Submucous resection nasal sep-
tum
Antrum of Highmore
Frontal sinus
Ethmoid
Sphenoid
Closure
Miscellaneous
Total.
47
13
14
12
2
3
25
250
Deaths in the center totaled 429, including several deaths by accident, such
as drowning or railway accident, giving a mortality of 1.27 per cent. Seventy-
13901—27 34
528
An]\riXISTRATION, AMERICAN EXPEDITIONARY FORCES
four and two-tenths per cent of the deaths were from disease, 24.8 per cent from
surgical causes, but an exact differentiation is difficult for the reason that though
40 per cent of the deaths among wounded were returned as due to intercurrent
disease, chiefly pneumonia, in certain of these cases the impaired vitality caused
by the wound w^as a contributing factor. The highest death rate was during
October, when 245 deaths occurred, the majority being due to respiratory
diseases. It w^as during this month that influenza and pneumonia were at their
height. Pneumonia was present in 61.2 per cent of the 356 cases which came to
autopsy, bronchopneumonia constituting three-fourths of such cases.
LABORATORY SERVICE
In addition to the unit laboratories, provided for the several hospitals, a
more fully equipped laboratory was operated for the entire command under the
center laboratory officer. The distribution of duties between the unit and center
laboratories was prescribed by the director of laboratories and infectious diseases,
A. E. F. In general terms, the duties of the unit laboratories included routine
urine analyses, blood counts, examinations of sputa and stools, media making,
wound bacteriology, preparation of Dakin's solution, and grouping of blood for
transfusions. For November, 1918, when the center w^as at its maximum, the
following figures were reported from five of the hospitals in the center:
Hospital laboratory
No. 25
No. 26
No. 56
No. 70
No. 19
23
20
15
7
16
White cell count --
47
97
54
40
52
Differential count
40
35
48
30
5
Lime (quantitative) -
253
396
181
141
114
Feces examination - - -
25
95
9
8
2
Sputum examination - -
68
135
34
52
14
Bacteriological examination __ __
1, 257
1,228
346
270
399
Wound smears .-. -
73
324
333
320
121
Miscellaneous... ---
1,115
445
109
514
257
Total
2,901
2, 773
1, 129
1,382
874
Total examinations, 9,059.
For the period prior to January 1, 1919, the following are the figures for the
more important laboratory examinations made at Base Hospital No. 49:
Aerobic wound cultures (1,529 wounds) 3, 198
Wound smears 3, 198
Anaerobic wound cultures 210
Sputum examination for tuberculosis 213
Number positive to tuberculosis .5
Urinalysis (chemical and microscopical) 1, 468
Bloods grouped for transfusion 30
Throat cultures for diphtheria made in unit laboratory and examined in central
laboratory 4, 116
Schick tests 747
Smears for Vicent's organisms 121
White blood counts 214
Red blood counts 29
Differential blood counts 63
HOSPITALS
529
The following statistical list shows some of the more important work
performed by the center laboratory up to January 1, 1919:
Autopsies
Spinal fluids:
Smears for meningococci
Colloidal gold
Dark field examinations for treponema pallida
Positives 3
Stools for typhoid and dysenterj-
Positive typhoid 5
Positive dysentery 0
Pneumococcus typing, Avery
356
37
27
15
157
90
Fig. 100.— Center medical laboratory, Allerey hospital center
Throat cultures for diphtheria 23, 726
Pharyngeal cultures for meningitis 1'
Positives 34
Throat cultures for hemolytic streptococci
coo
Wassermann tests —
Positives
OK
Autogenous vaccines
Wound anaerobic cultures examined
B. Welchii 13
Vibrion septique
Histologic slides
Total examinations ^7, 627
530
AD^riNISTRATION, AMERICAN EXPEDITIONARY FORCES
In addition to the foregoing, much miscellaneous work was performed in
the center laboratory, such as daily examinations of raw water and treated
water from each unit, examination of clothing harboring nits to determine
efficiency of disinfesting apparatus, supply of cultures of hay bacillus to test
sterilizing apparatus, isolation of milk-curdling organisms, bacteriological
examination of doubtful canned foods, examination of chemicals from the
local supply depot and of gonorrheal smears from the convalescent camp, and
disinfection of mail and personal effects of inmates of the contagious wards.
CONVALESCENT CAMP
The convalescent camp at Allerey was organized June 26, 1918, the first
group of convalescents, 11 officers and 116 enlisted men, arriving on July 31.
The camp at first occupied one of the hospital sections, for it was not until
September 19 that its tents were ready for occupancy. Meanwhile, its patients
and duty personnel had been employed in completing construction of that unit,
grading and draining the recreation field (1,060 feet by 700 feet), building
roads and walks, pitching tents, etc. Electric wiring was completed by the end
of October, and a Red Cross recreation hut, measuring 50 by 252 feet, was ready
for use December 11. This hut, which had an important influence on the wel-
fare of the camp and of the center at large, included an auditorium seating
1,500 persons, a stage, quarters for Red Cross personnel on duty in it, canteen
space, writing and billiard tables, piano, etc. About half the hut was given over
to basket ball, croquet, and a boxing ring.
Convalescents were organized into a regiment, subdivided into battalions
of 1,000 men each, and these, in turn, into companies of 250 and platoons of
50. The staff consisted of the commanding officer (who also acted as inspector),
a receiving and evacuating officer, an adjutant, a field adjutant, a supply offi-
cer, mess officer, physical director, six medical officers who sat on disabihty
boards and cared for medical and surgical cases, respectively, and a sanitary
inspector.
The adjutant's duties were of a dual character, one pertaining to military
supervision, the other to medical records. In the former he was assisted by a
regimental sergeant major, 1 duty sergeant, and 1 clerk; in the latter by 1
sergeant, first class. Medical Department, and 10 clerks, including 4 stenog-
raphers. This number was increased to 21 clerks when the camp reached its
maximum strength, of approximately 6,000.
The regimental sergeant major prepared the camp morning report, sent a
list of absentees to the assistant provost marshal, organized details for special
duties, furnished lists of men on detached service, and took charge of many
minor administrative details that arose, including supervision of the post office
established in the camp and the card index of convalescents. The office of the
sergeant, Medical Department, checked the field medical cards against the
nominal roll received with each convoy, placed these in the dead file when men
w^re to be evacuated, and forwarded them monthly to the chief surgeon, A. E. F.,
prepared diagnosis cards for all men admitted, listed B and C class cases for
the camp disability board, prepared the roll of casualties and changes, and
HOSPITALS
531
listed outgoing men. At the time each platoon was examined, the platoon
sergeant made one list of .men placed in class A for his own use and one for the
office so that the sergeant, Medical Department, knew, when an evacuation
was ordered, which men were to be transferred. As travel orders were prepared
in advance, this measure made it possible for an evacuation of 1,500 men to be
effected within two hours after notice was received that transportation was
available.
The field adjutant met and inspected incoming drafts, gave them a short
talk on discipline, and, in the absence of the camp commander, inspected out-
going men and their equipment, marched them to the railroad station, superin-
tended entraining and rationing for the journey. He was, furthermore, fire
marshal and summary court officer of the camp and acted on passes for patients
and duty personnel.
The supply officer was charged with reception and disposition of both
medical and quartermaster property. He was assisted by 12 enlisted men who
performed the following duties: General supervision, 1 sergeant; subsistence,
including office and field work pertaining thereto, 1 sergeant; transportation of
all supplies to kitchens subsisting men under the camp's jurisdiction but quar-
tered outside of its main element, 1 sergeant; paper work pertaining to subsist-
ence, 1 sergeant and 1 private; subsistence storeroom, 1 private; clothing,
blankets, and other durable property, 1 sergeant and 2 privates; transporta-
tion of fuel, 1 sergeant; medical supplies, requisitions, and returns, 1 private.
The mess officer was assisted by 1 mess sergeant, 14 cooks and assistant
cooks, 5 butchers, and necessary details of 20 men for kitchen police, 6 stokers,
etc.
The physical director had charge of all calesthenic drills and exercises.
These will be discussed below.
The sanitary inspector performed the duties indicated by his title, includ-
ing supervision of water-heating appliances, bathrooms, bathing schedules, oper-
ation of delousing plants, and preparation and service of food, disposal of waste.
The convalescent officers rendered very valuable assistance in camp
administration, and in the service of the center generally. Though patients,
they took charge of details, conducted drills and inspections, organized the
guard, and took command of troops en route to regulating stations.
Other departments in the organization of the camp were as follows: Pay
office, 1 sergeant and 2 clerks; provost, 1 sergeant, 3 enlisted men; sanitation,
1 sergeant, 1 corporal and 3 privates for each incinerator, 1 corporal and 3
privates for each set of latrines; medical dispensary 1 noncomissioned officer;
druggist, 1 private; surgical dispensary, 1 noncommissioned officer, 1 private;
phyiscal training, 1 sergeant for each company; fire department, 1 sergeant,
10 privates; prophylaxis, 2 corporals; baths, 1 corporal and 2 privates for
each bath and ablution barrack, 1 corporal and 2 private for each laundry
barrack; battalion organization, 1 battalion sergeant major, 1 duty sergeant,
1 clerk, 1 corporal of the sick; company organization, 1 first sergeant, 1 com-
pany duty sergeant, 1 orderly corporal, 1 clerk; platoon organization, 1 ser-
geant, 1 clerk.
532
ADMINISTRATION, AMERICAN EXPEDtTIONARY FORCES
Incoming drafts were received by the regimental duty sergeant, who
arranged the men in two lines, one on each side of the infnmary, for inspection
by medical officers. They were examined for vermin, scabies, venereal disease,
and were classified as A, B, or C patients. After examination, those not
rejected were formed in columns of squads and were marched to headquarters.
There their field records, clothing, sUps, etc., were checked, the roll called
by the sergeant major and checked with the field medical cards. They were
inspected by the camp commanding officer, who noted if their clothing and
equipment were complete. Men rejected for any reason, such as physical
ailment, vermin, and lack of equipment were returned with their field medical
cards and appropriate notation to the hospital whence they came. Men passing
medical and military inspection were then given a short talk on discipline,
standing orders, and daily schedide, divided into detachments and assigned
to platoons according to vacant bed reports. The platoon sergeants then
listed names of men assigned to them, and gave the lists to the sergeant major,
who checked them against the nominal rolls from base hospitals. The admission
classification was given the platoon clerk.
The duties of the personnel were such as normally fall to men in comparable
positions with line troops, except that the noncommissioned officers performed
also some duties usually discharged by commissioned officers. The object
of this measure was to reduce the commissioned staff of the camp to a min-
imum.
The battalion sergeant major received incoming men and distributed
them among the companies. He saw that the men were properly quartered
and fed, supervised sanitation and police, formed promptly all details called
for, consolidated company morning reports, verified same, enforced orders from
higher authority, and convoyed evacuation groups from his battalion to the
railroad station. The battalion duty sergeant verified service details called
for, checked battalion and company formations and all reports of company
first sergeants, turned over delinquents to the labor squad, reported to the
adjutant men returning from absence without leave, reported the battalion
at drill formations and took command of it during the absence of the battalion
sergeant major. The company first sergeants carried out orders from battalion
headquarters, checked convalescents into and out of their companies, super-
vised all efforts to promote health and comfort of their men, furnished details
promptly, verified company and platoon reports. The platoon sergeants in-
formed the incoming men of the regulations of the camp, which were few as
possible, checked absentees at formations, taps, and reveille, organized details
promptly, made out nominal rolls, and marched platoons to the medical hut
for classification.
The repeated classification of patients was one of the most important
and probably the largest portion of the routine medical work in the camp.
It was essential that the machinery for doing this be simple, adequate, and
accurate. Therefore, men were examined, by platoons, at semiweekly inter-
vals, and as their condition improved were advanced to a higher category.
Those in class A constituted the standing evacuation list. A man remaining
for from two to four weeks in class C was usually examined by the disability
HOSPITALS
533
board and assigned to suitable service for a limited period in the Services
of Supply, after which he was reexamined.
The average stay in camp was from two to six weeks. If the convalescent
period was longer than six weeks, the patient was examined by the disability
board with a view to reclassification and appropriate transfer.
Accurate physical classification was essential to the success of the camp;
therefore, the physical and recreation trainers kept new arrivals under close
surveillance to notice lagging during exercises, with a view to reclassification
if indicated. Men properly classified were soon infused with a spirit of enthu-
siasm and competition so that malingering was rarely found. Within one
week all patients were carefully reexamined and reclassified. Men suffering
from cardiac insufficiency, effort syndrome, joint diseases, war neuroses, effects
of gassing, or were convalescent from infectious disease were assigned to special
schedules. The medical staff included specialists for cardiac, pulmonary, and
orthopedic conditions.
Second only to proper classification and prescription of appropriate
exercises, the establishment of a cheerful and competitive spirit was looked
upon as the most important factor in furthering convalescence. The treat-
ment in general consisted of graded exercises, work that interested, and play
that diverted and cheered. To keep the convalescents as fully occupied as
possible, any measure that might promote among them good fellowship and
light-heartedness was eagerly sought and practiced. Games productive of
enthusiasm and merriment in which all participated were especially successful.
As a measure of the success obtained, 95 per cent of the patients advanced
regularly, upon the weekly physical examinations.
Because of the fact that many men in hospital tended to lose interest
in military precision, personal responsibility and enthusiasm in their activities,
the physical exercises for convalescents were diversified to meet these several
needs. Commands were given from a drill stand, and as the troops were under
the surveillance of their sergeant instructors, there was no difficulty in iden-
tifying delinquents. Parades and military formations before and after exercises
helped appreciably. Garrison schedule was conducted with evening parade,
which was attended by the band.
The routine of the camp was as follows: Reveille, 6.45; breakfast, 7.10;
sick call, 7.30. At 8 a. m., the morning reports were received by the regimental
sergeant major from battalion sergeant majors. From these reports the
regimental report was made, the list of absentees being sent to assistant pro-
vost marshal. Service detachments were organized and distributed as requested.
From 8 to 8.45 a. m., calisthenics; 9 to 9.15, running and walking; 9.25 to
9.40, athletic games. At 10 a. m., the guard was mounted; from 10 to 10.30,
jumping exercises were held for other troops; 10.30, recall; 12, dinner; 1 p. m..
first sergeant's call; 1.30 p. m. reception, inspection, and disposition of incom-
ing convalescents; 2 p. m. athletics, 2.30 p. m., parade, inspection, and entrain-
ing of outgoing convalescents; 3.30 p. m., recall from calisthenics; 4.10 p. m.,
parade; 5, supper; 10.30 p. m., taps.
In order that the military purport of the training might not be slighted,
the men were brought into platoon formation before and after each period.
Sunday was a holiday.
534
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
It will be noted that calisthenics, games, etc., were conducted simulta-
neously with military formations which affected only certain details. Class C
patients had a routine somewhat different from the foregoing schedule, which
was for class A and class B men. Their schedule of exercises was as follows:
From 8 to 8.45 a. m., exercises with A and B men; 9 to 9.15 a. m., short relay
races, passing ball to rear of column, etc.; 9.30 to 9.40 a. m., falling exercises
for the arms; 10 to 10.30, jumping contest with A and B men; 10.30 recall;
2 to 2.20, indoor base ball, or relay race; 2.45 to 3, passing the ball; 3.30,
recall. Gassed cases received a special set of exercises.
Complementary to the schedule of exercise and drills was the system of
employments. There was grave and urgent need that construction of the
center be pushed as rapidly as possible, and for this purpose convalescents
were detailed to the constructing engineer for service wherever needed. They
proved indispensable, for the camp was a reservoir of highly skilled workmen,
mechanics, clerks, chauffeurs, etc., as well as of unskilled labor. A labor
bureau was maintained in the sergeant major's office. As occasion required,
he called on company sergeants for lists of men for designated duties, listed
them and assigned them for temporary duty, rations, and quarters to the unit
making the request. After a variable period, determined by circumstances,
these men were recalled and others detailed. In the same manner, carpentering,
plumbing, and ditching details were kept up in the camp at all times.
The only patients receiving continued medical attention who were treated
in the camp were the uncomplicated cases of venereal disease. Originally all
such cases had been cared for in Base Hospital No. 56, but when this became
overcrowded, the uncomplicated cases were transferred to the camp. The
clinic there was found to function so satisfactory and disciplinary control was
so effective that this clinic was continued until the camp closed.
As the reports were received daily from the medical examiners, lists of
patients fit for evacuation were prepared and the men named therein were
paraded for the inspection of the commanding officer. He inspected all equip-
ment, assured himself that each man was fit for transfer, and ordered all who
did not feel fit for duty to fall out. Such men were immediately reexamined
by the disability board. The remainder, under the officer in charge of the
movement, were marched to the railroad station with the band and field music.
At the station, the command was divided into platoons of 40 men, with a
noncommissioned officer in charge of each, and entrained. One noncommis-
sioned and six men from each car loaded its rations. The travel order was
checked by the sergeant major with the officer detailed to accompany the
detachment to its destination.
Until October 14, 1918, the organization of two battalions of 1,000 men
each was adequate, but thereafter the camp grew constantly until by Decem-
ber 9 it contained 6,004 men. This eventuated from the fact that evacuations
from the center were stopped by higher authority and orders were received
from the same source that men fit for duty be not carried as patients. To
simplify administration and to reduce congestion, certain hospitals transferred
men fit for duty to others and these operated under the jurisdiction of the
convalescent camp. The largest incoming groups to the camp were on Novem-
HOSPITALS
535
ber 19, when 1,763 men were received. The largest outgoing group was 1,918
men on November 17.
Theatrical troups, glee clubs, and orchestras were organized in the camp.
Motion pictures of the center were taken and exhibited. A band of 35 pieces
and a fife and drum corps of 15 pieces organized in the camp participated in
military formations, assisted at theatrical performances, gave band concerts,
etc. For a few weeks the band of the 155th Infantry was attached to the
camp.
Provision was made from the outset for diversion of the men when the
day's schedule was completed. In addition to the many entertainments pro-
cured from outside sources for the camp, a number were provided from local
resources. The convalescent camp was closed January 31, 1919.
CLOSURE
As patients in the center diminished after January 1, when the ban on
their transfer was lifted, hospitals were cleared and closed. Evacuation
Hospital No. 19 was transferred to the army of occupation on the Rhine, and
most of the personnel of Base Hospital No. 97 was retained to form Camp
Hospital No. 108. With these exceptions all units were returned to the United
States upon closure. On March 1 the center became the agricultural depart-
ment of the American Expeditionary Forces University, whose headquarters
were established at Beaune. On May 28, when the university ceased its
activities at Allerey, this place was closed and turned over to the French.
COMMANDING OFFICER
Col. Joseph H. Ford, M. C.
CHAPTER XXIII
OTHER HOSPITAL CENTERS
HOSPITAL CENTER, BAZOILLES «
The hospital center at Bazoilles-sur-Meuse was located about 4 miles
southwest of Neufchateau (Vosges) and was built around the small village of
Bazoilles-sur-Meuse. The center was located on both sides of the River Meuse.
The site was well suited for a hospital. The moderate slope of the ground
afforded excellent natural drainage and the Est Railroad ran through the
village.
A group of six hospital sections, each accommodating 1,000 patients, was
authorized, each section to have sufficient ground space for a tent expansion
accommodating 1,000 beds. The capacity of the entire group was to be about
13,000 beds. This included one hospital unit (Base Hospital No. 18), which
occupied buildings that had been erected around a chateau in Bazoilles and
operated individually before the center was organized. Another unit, Base
Hospital No. 66, at Neufchateau, about 4 miles from Bazoilles, was added
later to the center. The Engineer Corps began construction toward the last
of October, 1917, but progress was very slow. Macadamized roads were built,
and the French railway authorities put in siding to accommodate hospital and
freight trains. An unloading quay was provided for patients.
The commanding officer of the center arrived June 30, at which time the
construction was far from complete. Sections 1,5, and 6 were most advanced,
but in them windows and plumbing fixtures were wanting. A warehouse was
Hearing completion and work on a steam laundry was just beginning, but this
plant did not begin operating until October 10, 1918.
The project was reported completed, with the exception of minor changes,
on November 1, 1918. Its cost was approximately $2,027,266.
ADMINISTRATION
On July 2, 1918, when the center was officially organized, three base hos-
pitals were present. The chief surgeon, A. E. F., furnished the following out-
line of the organization of the center, for which personnel would be furnished.
• The statements of fact appearing herein are based on the "History of the Bazoilles hospital center," prepared under
the direction of the commanding officer by members of his staff. The material used by these oflBcers in the compilation of
the history comprised official reports from the various divisions of the hospital center. The history is on file in the Histori-
cal Division, S. G. O.—Ed.
537
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
HOSPITALS
539
American Expeditionary Forces,
Ofuce of the Chief Surgeon.
Memoraiulum to commanding officer, Bazoilles:
Table of organizations — central administration
Number of base hospital units, 7.
Commanding officer and assistants (colonel or lieutenant colonel)
Adjutant and assistants (major or captain)
MtNlical supply officer (captain)
Laboratory officer (major or captain)
Evacuation officer (major or captain)
Sanitary s()uads (captain or lieutenant)
Kvacuatioii ambulance company (captain or lieutenant)
Subsistence, procurement, and issue; cold storage; clothing, equipment, procurement and issue; fuel,
procurement and issue; salvage (captain or lieutenant, Quartermaster Corps)
Detachment and records; finance, paying, accounting, railwayt ransportation (captain or lieutenant,
Quartermaster Corps)
Technical lai)or troops to care for buildings, electric light plants, water system, drains (captain or
lieutenant, Quartermaster Corps)...
Labor troops performing purely common labor (30 to each base hospital unit)
Motor truck company .
Assistant iirovost marshal (lieutenant)
l{ailway transportation officer (lieutenant)
Fire marshal (lieutenant)
Officers
Total.
Enlisted
men
" 23
210
84
10
6
2
<■ Quartermaster.
QUARTERS ALLOWANCE
Administration, barracks IJ^
Officers' mess, barracks 1
Officers' quarters, barracks 13^
Men's mess 2
Men's quarters IJ^
Total 7}4
Some of this staff personnel was sent from other stations, and some was
taken from base hospital units of the center. The ambulance and truck com-
panies did not arrive until after the armistice. No attempt was made at first
to interrupt the customary administration routine of the hospitals, but as the
center headquarters organization improved it was required that practically all
reports, with the exception of the monthly sick and wounded report, be sent
through the center commander.
The function of the headquarters was in general the same as in any other
large military command. The center commander was able to keep in close
touch with the activities within his command through various reports and
returns, and by inspections, either personal or by members of his staff. Con-
ferences with the unit commanders and among personnel employed on special
work were of much value.
Various orders, bulletins, and circulars received from higher headquarters
were distributed and the most important of these abstracted, or had attention
called to them in special memoranda. The usual difficulties in getting officers
among the personnel to read and study instructions were met with in a degree
corresponding to the experience of the personnel, and an effort was made to
overcome this by means of informatory memoranda and by requiring attendance
upon formal instruction, devoting to it a certain number of hours each week
for both officers and enlisted men.
540
ADMINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
The following data summarize the activities of the organizations forming
the center:
Designation
Arrived
Base Hospital No. 18 July
Base Hospital No. 42 July
Base Hospital No. 46 _ j July
Base Hospital No. 60 ! Sept.
Jan.
Oct.
Base Hospital No. 66"
Base Hospital No. 79
Base Hospital No. 81
Base Hospital No. 116
Evacuation Hospital No. 21
Provisional Base Hospital No. 1 .
Convalescent Camp No. 2..
Sanitary squad No. 29
Sanitary squad No. 30
School of Roentgenology..
Evacuation Ambulance Company No. 10.
Hospital unit A
26, 1917
15,1918
2, 1918
15,1918
13, 1918
16,1918
Sept. 25, 1918
Apr. 9, 1918
Jan. 4, 1919
....do
(org.)
June 10,1918
July 13,1918
....do
Sept. 1,1918
Dee. 29,1918
Feb. 1, 1918
Began
operation
July
Aug.
July
Oct.
Jan.
Nov.
Oct.
June
Jan.
Jan.
31,1917
6, 1918
23, 1918
4,1918
15,1919
5,1918
4,1918
2, 1918
7,1919
9,1919
July 13,1918
(")
Ceased
operation
Jan. 9, 1919
Jan. 7,1919
Jan. 1,1919
Mar. 31, 1919
(")
(')
Mar. 31,1919
Jan. 31,1919
22, 1919
27, 1919
Departed
Apr.
Apr.
Jan. 25,1919
Jan. 18,1919
Jan. 29,1919
Mar. 19,1919
Mar. 19,1919
Mar. 7, 1919
Mar. 12,1919
Do.
Dec. 4, 1918
Jan. 18, 191»
« This unit, located at Neufchateau.was assigned to this center and first included in its bed report on .\ug.l5, 1918.
>' Ceased to be part of center Nov. 10, 1918.
' Still operating .\pr. 30, 1919.
Attached to Base Hospital No. 18 (enlisted personnel only) on Feb. 4, 1918.
ENGINEER OPERATIONS
Date of arrival
Companies B and C, 101st Engineers Oct. 23, 1917
Companies C and F, 6th Engineers Feb. 5, 1918
Company C, 502d Engineers Service Battalion Feb. 8, 1918
Companies A and D, 508th Engineers Service Battalion Feb. 11, 1918
At various intervals during construction, detachments of 23d, 26th, 28th, 33d, and 37th
Engineers, 162d Labor Company (Portuguese), and Chinese Labor Company No. 26 were
attached to 508th Engineers Service BattaUon.
All engineer organizations withdrew from the center November 1, 1918.
MILITARY POLICE
Company L, 2d Pioneer Infantry, arrived July 27, 1918. On December 13, 1918,
the detachment of 210th Company Military Police Corps was organized by transfers from
Company L, 2d Pioneer Infantry.
LAUNDRY COMPANIES
Designation
313th Mobile Laundry Company
505th Laundry Company '
517th Laundry Company ' " '
519th Laundry Company "
Provisional Laundry Company 1, Company B .
162d Administrative Labor Battalion... I'Mar IQTS
185th Administrative Labor Battalion (organized Sept. 13, ins) x a^i..
Arrived
Oct. 8, 1918
May 12, 1918
Sept. 13, 1918
Mar. 1, 1919
do
Departed
Feb. 27, 1919
Oct. 7, 1918
CASUAL ORGANIZATIONS
Designation
Evacuation Hospital No. 2
Evacuation Hospital No. 6
Evacuation Hospital No. 16
Evacuation Hospital No. 20
Convalescent Camp No. 1
Mobile Operating Unit No. 1 .....
Evacuation Ambulance Company No. 64
115th Sanitary Train
Motor Supply Train No. 46 "..."'"^
156th Infantry Band.
(•)
(»)
Sept. 23, 1918
do
(«)
July 18,1918
Dec. 5, 1918
Dec. 14, 1918
Oct. 23, 1918
Nov. 19, 1918
» Before organization of center.
HOSPITALS
541
In July and August, 1918, the quantity of water was insufficient. At
one time it seemed as though the operation of the center would be seriously
liampered on this account. Several wells were drilled and dug near the river
and pumped to a collecting reservoir at the main pumping plant, where the
water was chlorinated and pumped into the system through 3-inch turbine
pumps. Water was drawn also from an old French system in Bazoilles, a
booster pump being located at the spring about 3 3^ miles south of the center.
The sewer system carried only the drainage from sinks and bathhouses,
as the pail and soakage pit system was used for all latrines. Two Horsfall
destructors were installed in each hospital unit. One sink was installed in
Fig. 102.— Covered walk connecting the wards at Base Hospital No. 18, Bazoilles hospital center
each ward and in other buildings as required. A part of the kitchen waste
was burned; some was disposed of to civilians. When sold, usually little or
nothing could be received for it, and sometimes it was necessary to pay for its
removal.
Electrical power for lighting and X-ray machines was supplied by 19
generating units; eighteen 17-kilowatt and one 14-kilowatt machines being
used. Each of the seven hospital units had a separate power plant and could
be supplied independently with electric power from its own machines. Some
trouble was experienced by the hospitals in adapting the large 7 ^-kilowatt
X-ray machines to the 110-volt direct current furnished, as their rotary con-
verter had been built for 220-volt direct current.
Disinfection of clothing and bedding was accompHshed by means of
large Thresh or American steam sterilizers. The Thresh apparatus was
542
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
stationary and required a good deal of labor and material. Six of these were
received, one for each hospital section. Four were installed and work on
others was stopped when hostilities ceased. The American sterilizers were
portable and four hospitals used this type during the period of their activity.
This model was considered the better of the two.
The supply service of this department was uniformly satisfactory, for
rarely was there any shortage or inability to furnish articles. No bakery was
operated, and bread w^as obtained from the Quartermaster Corps at Neuf-
chateau. A small cold-storage plant was built, but was not operated, as
weather was never sufficiently warm to require the use of a cold room. A
small amount of ice w^as made, but the hospitals showed no inclination to
make use of it.
From six to nine men were constantly employed as clerks, checkers, and
packers. In addition, 10 men on an average w^ere used in handling property;
unloading it from cars and delivering it to hospital units. The amount of
property received during the 10 months beginning July 1, 1918, aggregated
310 carloads. Sup|^lies were received from supply depots at Is-sur-Tille,
Gievres, Cosne, and the base ports. The American Red Cross also supplied
10 carloads of prepared dressings and mess and kitchen equipment. All
supplies w^ere formally transferred to supply officers of separate units on
invoices. It was believed, however, that the issue of supplies on memorandum
receipt w^ould have been better, thus leaving the center supply officer account-
able for all property in the center. This arrangement would have put one
experienced man in charge rather than several who usually were very inex-
perienced.
On July 1., 1918, the available transportation was such as had been fur-
nished to hospital units then operating, namely, 9 ambulances and 9 trucks,
and other motor cars. The greater part was old and in poor condition, but
no material additions w^ere made until after signing of the armistice. Trucks
were used for transportation of patients throughout the whole period prior to
November 11, 1918.
In the latter months additional transportation was received, and on April
1, 1919, there were on hand: 11 motor cycles, 8 touring cars, 5 Ford ambulances,
15 G. M. C. ambulances, 6 Ford light trucks, 12 one and one-half and two
ton trucks, and 30 three-ton trucks.
The pooling of all transportation was highly successful, for by so doing,
the work of seven or eight hospital units was done with the normal allowance
of two or three.
As all of the buildings of the center were of light w^ood construction and
the intervals between hospitals were taken up wdth tentage, the fire hazard
was very great. A center fire marshal was appointed, and w^orking under his
supervision each hospital unit had its local fire marshal in charge of a fire
platoon. The loss from fire was insignificant. During the winter some hun-
dreds of stoves were installed, usually in a very crude way. Many times fires
started, but were extinguished almost at once.
A school was established and began operating January 4, 1919. Qualified
enlisted men were detailed as instructors. Organization commanders were
HOSPITALS
543
required to have attend such men as were most in need of instruction, including
tliose deficient in primary branches. By April the number of students reached
a total of 167, and classes were held in reading, spelHng, and writing, French,
French history. United States history, civics, economics, mechanical drawing,
and agriculture.
LABORATORY
At first the center laboratory was located in Base Hospital No. 18. Later
a building was provided, and on September 2, 1918, the equipment was trans-
ferred to the new location. As the several units arrived in the hospital center
the laboratory personnel of each unit came under the control of the laboratory
officer of the center, who was empowered to detail them to the central labo-
ratory as needed. The work of the laboratory was organized as noted below,
but elasticity in the scheme was allowed in order that the personnel could
assist in any department whose work might suddenly increase. There were
eight general divisions, with one of the laboratory staff in charge of each, as
follows :
1. General bacteriology — blood cultures, throat cultures, spinal fluid examination,
and general bacteriologist work.
2. Typhoid-dysentery examination and water analysis.
3. Wound bacteriology.
4. Pneumococcus typing.
5. Serology.
6. Pathology. This department handled the surgical specimens submitted for diag-
nosis and performed all the post-mortem examinations into the hospital center.
7. Preparation room. This department made all stains and solutions used by the
sterilization of discarded cultures and glass ware.
8. Office and supplies.
No chemical work was done in the central laboratory. All clinical pathol-
ogy was done in the subsidiary laboratories and the center laboratories assisted
in an advisory capacity. No operative procedures were done by the staff of
the center laboratory.
OPTICAL AND OPHTHALMOLOGICAL DEPARTMENT
This service for the center was maintained at Base Hospital No. 18 until
November, 1918, when it was transferred to Base Hospital No. 46. In May,
1918, an optical unit was added to this department. The personnel usually
consisted of 5 officers and 6 enlisted men. This department served not only the
center, but also a large part of the entire advance area, including other base
hospitals in the vicinity and the army of occupation in Germany.
SCHOOL OF ROENTGENOLOGY
A school of Roentgenology was established in August, 1918, its purpose
being the provision, at a convenient point near the American front-line sector, of
a school for the instruction of officers and enlisted men in various matters per-
taining to X-ray work under war conditions and to maintain a depot from which
skilled operators could be taken for service when needed. From September 1 to
November 11, 1918, the school was in constant operation. Both officers and
enlisted men were received and after a period of training sent to the front.
13901—27 35
544
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
RECEIVING AND EVACUATION
The receiving and evacuating system was organized in July, 1918. The
evacuating officer maintained control over all admissions, distribution, transfer,
classification, and evacuation of all patients. During the earlier months of our
military operations, unremitting efforts were made to evacuate to hospitals
farther toward the rear; later, when the fighting progressed more nearly in the
immediate front of this hospital center, all the hospitals were in reality function-
ing as evacuation hospitals. Frequently patients were received, operated upon,
and transferred to the rear within 48 hours. During the Meuse-Argonne
operation approximately 7,000 sick and wounded were received and about
12,000 evacuated. At this time, many of the wounded were received in bad
shape. Conditions in the advanced area were such that many battle casualties
did not reach the center for four or five days after receiving their wounds. A fair
proportion had not been operated upon, and severe infections were present.
The following charts show the admissions and dispositions in the center.
Admissions and dispositions, by hospitals, August 1, 1917, to April 30, 1919; hospital centei ,
Bazoilles-sur-Meuse, France, including hospitals operating independently prior to July 1,
1918
Hospitals
Base
Hospi-
tal
No. 18
Base
Hospi-
tal
No. 116
Base
Hospi-
tal
No. 46
Base
Hospi-
tal
No. 42
Base
Hospi-
tal
No. 66
Base i Base
Hospi- j Hospi-
tal tal
No. 60 1 No. 81
Provi-
visional
Base
Hospi-
tal
No. 1
Evacu-
ation
Hospi-
tal
No. 21
Base
Hospi-
tal
No. 79
Total
Period, Aug. 1, 1917, to June
30, 1918:
Admissions _
7,066
6,411
855
I
7,921
6,673
Disposed of
262
L__
Remaining June 30,
1918
655
593
1.248
Period, July 1, 1918 to
Apr. 30, 1919:
Remaining July 1, 1918-
Remaining at Base
Hospital No. 66, Aug.
11, 1918
. 665
593
(-)
562
1,248
■ 1
562
Admitted
7, 106
11,526
8, 323
7, 111
6, 913
5,988 5,991
2, 413
3, 391
4,993
63, 755
Total
7, 761
12, 119
8, 323
7, 111
7, 475
5,988 5,991
2,413
3, 391
4,993
65,565
Disposed of. -
7, 424
'337
11,328
<< 791
7,915
« 408
6, 443
/668
6, 624
» 851
5,723 1 5,781
* 265 I > 210
2,261
• 152
3,240
* 151
4, 781
61,520
3.833
Transferred _.
Remaining Apr. 30,
1919
0
0
0
0
0 j 0
0
0
'212
212
« Base Hospital No. 66 was operating independently of the center until Aug. 11, 1918.
Number of patients in Base Hospital No. 66 when the organization came under the command of the center.
' Transferred to Provisional Base Hospital No. 1 when Base Hospital No. 18 discontinued operations on Jan. 5, 1919.
<> Transferred to Base Hospital No. 79 when Base Hospital No. U6 discontinued operations on Jan. 31, 1919.
' Transferred to various hospitals of center when Base Hospital No. 46 discontinued operations on Jan. 19, 1919.
/ Transferred to Evacuation Hospital No. 21 when Base Hospital No. 42 discontinued operations on Jan. 7, 1919.
» Number of patients in Base Hospital No. 66 when the organization was taken from the command of the center.
* Transferred to Evacuation Hospital No. 21 (165), Provisional Base Hospital No. 1 (100), when Base Hospital No. 60
discontinued operations on Mar. 31, 1919.
■ Transferred to Base Hospital No. 79 (145), Provisional Base Hospital No. 1 (65), when Base Hospital No. 81 discon-
tinued operations on Mar. 31, 1919.
' Transferred to Base Hospital No. 79 when Provisional Base Hospital No. 1 discontinued operations on Apr. 27, 1919.
* Transferred to Base Hospital No. 79 when Evacuation Hospital No. 21 discontinued operations on Apr. 22, 1919.
' Remaining in Base Hospital No. 79, the only unit operating Apr. 30, 1919.
HOSPITALS
545
Summary of sick and injured admitted to hospital center, Bazoilles-sur-Meuse, France, July 1
1918, to April 30, 1919
Total
"a
■V
Cases of sickness
'H
o
>>
as
"a
phoi
KB.
m bt
O C
feve
o
a
Quarte
"3
o
e
Disease
Injury
Pneum
Dyscnt
Malarii
Venere
Paraty
Typhoi
Cerebi
men
o
c3
u
m
<
Remaining »
'■1,248
0
1,248
447
801
5
0
0
24
20
0
0
0
2
416
Admitted
62, 521
0
62, 521
36, 718
25, 803
1,450
85
18
1,481
45
280
111
80
72
33,
096
Total treated
63, 769
0
63, 769
37, 165
26, 604
1,455
85
18
1, 505
45
280
111
80
74
33,
512
Died...
850
0
850
564
286
414
2
0
1
2
28
1
28
2
86
Transferred to organization.
15, 908
0
15, 908
11, 254
4, 654
324
42
5
576
10
43
33
6
24
10,
191
Otherwise disposed of ''
46, 799
0
46, 799
25, 135
21,664
705
41
12
828
33
209
67
43
48
23,
149
Remaining sick <=
212
0
212
212
0
12
0
1
100
0
0
10
3
0
86
" The remaining 1,248 eases comprises total number of patients in Base Hospitals Nos. 18 and 116 on July 1, 1918,
the date the hospital center was established.
>> Sent to other hospitals, replacement depots, regulating stations, etc.
' In Base Hospital No. 79, the only hospital operating April 30, 1919.
Cases completed by hospitals operating independently prior to July 1, 1918: Base Hospital No. 18, 6,411; Base
Hospital No. 116, 262; total, 6,673.
Cases evacuated by hospitals ceasing to operate to other hospitals in the center are included in admissions and
discharges. Base Hospital Nos. 46, 60, 79, and 81 were so evacuated.
Cases taken over from outgoing units by arriving units are not included in admissions and discharges. Base Hos-
pitals Nos. 18, 42, and 116 were relieved by incoming organizations.
Thirty-two deaths occurring in prisoners of war and allied patients at Base Hospital No. 66, shown in total of 850
above, not included in table for admission and disposition.
AMERICAN RED CROSS
This was the only welfare organization authorized to operate in hospitals
after August 31, 1918. Prior to January 1, 1919, the Y. M. C. A. conducted
a canteen, religious services, and entertainments.
The buildings erected by the American Red Cross consisted of two very
large and two smaller huts, operated by them for officers and nurses.
The representatives of the American Red Cross worked constantly in
cooperation with the center and unit commanders, their chief functions con-
sisting in searching for missing men and distributing supplies (Red Cross),
writing letters for the patients, sending or procuring information from their
homes, or any similar service which would relieve mental or physical trouble.
Also they furnished athletic equipment, musical instruments, etc. In the huts
were presented opportunity for refreshments, recreation, education, and
entertainment. They contained billiard rooms, auditoriums, writing rooms,
and rest rooms. There were on the average 8 entertainments and 32 moving-
picture shows each week.
CONVALESCENT CAMP
The chief surgeon in a letter of June 21, 1918, ordered that a convalescent
camp be operated in connection with the center. The proportion of beds was
fixed at one convalescent bed to five of the base hospital capacity of the center,
all crisis expansion accommodations being excluded. For this purpose, the
number of active beds in buildings was assumed to be 7,000, thus fixing the bed
capacity of the camp at 1,400. The site for the camp was selected at Liffol-le-
(irand, a village 4 miles west of Bazoilles. This site had been used at one
time as a camp hospital and contained a number of small structures and a
14-room chateau. The personnel of Convalescent Camp No. 2, consisting
of 10 officers and 90 enlisted men, arrived on June 10, 1918.
The preparation of buildings and grounds with provision of new barrack
buildings, water supply, and roads was begun at once. A satisfactory water
supply was not obtained until November, 1918.
546
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The medical organization of the camp was quite simple. On admission
after the bath, the patient was weighed, stripped. He was outfitted with
essential clothing and assigned to a bed in the barracks. At once a physical
examination was made, and he joined in the class work the following day.
This class work consisted of physical exercise in the morning, followed by a
short period of squad drill. After dinner and after an hour's complete relax-
ation in bed, he was sent on a mile march. On returning, he took part in
various games according to his ability. After supper, varying amusements,
held in the Y. M. C. A. hut, were available. At the discretion of the medical
officer, he was promoted to Company 2, with its increased physical demands,
and then to Company 3, where the work consisted of 40-minute setting-up
exercises, an hour's squad drill, and a 5-mile march in the afternoon. By
the time the patient had successfully passed the physical examination in this
company and could successfully perform the strenuous exercises, he was dis-
charged to duty. Men unable to meet these qualifications were reclassified.
In the first 5, 000 cases, there were less than 10 classified D. But there were
probably about 7 per cent who proved unable to meet the tests. It is worthy
of comment that these tests were of much greater value as a basis for classification
than those heretofore employed; that is, the stethoscope, physician's opinion
of patient's statement. Great emphasis was laid on the necessity for military
discipline; and although on a patient's status, all convalescents were treated
as soldiers training for the front line. Great difficulty was experienced in
the lack of standardization of the type of patients received. Thus, one convoy
would comprise a case of pneumonia out of bed one day, a mumps patient
convalescent three weeks, a patient with flat-foot, gas cases of varying degrees
of severity, and superficial gunshot wounds. An ocasional valve lesion was
discovered, a few cases of pulmonary tuberculosis were found, and not infre-
quently patients were sent directly from the admitting office to the camp
hospital suffering from acute infections, such as bronchopneumonia, influenza,
and tonsillitis. Another interesting feature is the fact that promotions were
made daily instead of at weekly intervals. This increased markedly the
capacity of the camp, and cut down the stay in camp of those physically fit
on admission to the remarkably short period of 72 hours. It was this factor
that allowed 2,431 admissions and 998 discharges in October, when the camp
was in full working order.
A follow-up system was instituted, and the final proof of the success
of the camp as measured by the ability of members of the outgoing drafts
to perform front-line duty was supplied by the medical oflftcers of units to
which the patients were returned.
The constant support and assistance afforded by the American Red
Cross carried the camp far beyond the standards obtainable under purely
military control. Games and other equipment for the amusement of the
patients were all supplied through this organization. A regular representative
of that society did not arrive for some weeks after the camp was opened because
of the lack of such officers, but thereafter it engaged in numerous activities
for the promotion of morale.
The convalescent camp ceased to function on January 25, 1919.
HOSPITALS
547
DISCONTINUANCE
The Bazoilles center ceased operation May 1, 1919, evacuating on that
date all patients remaining in Base Hospital No. 79 to Angers and Nantes.
The shipment of all medical property remaining in the center began at once.
A large quantity of beds and bedding already had been shipped to Treves.
Other property was now shipped to the hospital center at Mars-sur-AlHer
for storage.
This center was the first to start as an organized center, and after 10 '
months of very active service was one of the last to close.
COMMANDING OFFICER
Col. Elmer A. Dean, M. C.
HOSPITAL CENTER, BEAU DESERT >>
In the late fall of 1917, Beau Desert, in the vicinity of Bordeaux, was se-
lected as the site for a hospital center, and construction was begun in December
of that year. The site, about 5 miles west from Bordeaux and near the small
village of Pichey, was a nearly level tract of land of approximately 550 acres.
Originally it was planned that there would be 10 base hospital units
at this center, each of 1,000 beds, with an emergency expansion to 1,500,
but during the summer of 1918 the construction of 7 additional units was
authorized.
A railroad track built by the American engineers, which connected with
the P. & O. Railway, ran through the center. The hospitals were located
on either side of the track, thus affording rapid detraining and entraining
of patients. The storehouses and laundry were also situated on this line,
so that freight could easily be removed from cars to the loading platform.
Construction was effected by the United States Army Engineers. A
large force of men was employed for this work, and during the summer of
1918 more than 4,000 American soldiers, prisoners of war, Chinese, and other
laborers were at work. On June 22, 1918, when the first base hospital group
arrived, only one unit had been completed. Nine hospital units were
eventually completed, in addition to the convalescent camp, steam laundry,
and warehouses, making a total of nearly 600 buildings. Twelve miles of
gravel walk and 8 miles of board walk were constructed and 4 miles of roads
and over 11 miles of railroad track were built.
When the Medical Department took over the center there were available
a few old wells, mostly in a dirty condition. Only one of these was in use,
furnishing about 50,000 gallons of water daily. This output was barely enough
for drinking and a reasonable amount of washing, so that on many occasions the
entire center was practically without water for 24 hours at a time and with none
whatever for fire purposes. An artesian well, 1,500 feet deep, was sunk, but
could not be used for some time through lack of a powerful enough pump.
Later this well, connected with a 100,000-gallon cement storage tank, afforded
ample supply.
' The statements of fact appearing herein are based on the "History of The Beau Desert hospital center," prepared
under the direction of the commanding officer by members of his staff. The material used by these officers in the com-
pilation of the history comprised official reports from the various divisions of the hospital center. The history is on file
in the Historical Division, S. O. O.— Ed.
548 A]):\IIXISTKATI()N, AMERICAN EXPEDITIONARY FORCES
HOSPITALS
549
Due to the very slight fall in the ground, laying sewers which would
promptly carry off the waste water and take care of the drainage proved diffi-
cult; however, all the hospital units had a sewer system which emptied into a
clarification tank, which in turn emptied into a small stream running through
Pichey. The sewer system received only wash and waste water.
Human excreta were disposed of by the pail system. These vessels were
emptied by contract with French laborers and buried 18 inches below the sur-
face of the ground. At first an attempt was made to burn feces in Horsfall
incinerators, but there were so few of these and the method was so unsatis-
factory and expensive that the burial system was resorted to.
Fig. 104. — Beau Desert hospital center, showing railway facilities
Electric power was furnished by the French from Bordeaux. At first the
system was very unsatisfactory, as the lights were frequently off and short
circuits due to imperfect wiring were the rule rather than the exception. Even-
tually the powerhouse at Bordeaux was taken over by the Government, and
after January 1, 1919, no trouble was experienced.
Early in August, 1918, a motor-transport officer was assigned to the center
to organize the service. A motor-transport pool was established and the 312th
Motor Truck Company was assigned to Beau Desert for duty. This service
had grown from 1 ambulance and 4 trucks to 131 motor vehicles. All motor
vehicles were pooled, subject to call from any organization at any time under
certain restrictions imposed by orders from center headquarters.
ORGANIZATION AND ADMINISTRATION
The center was officially organized on July 6, 1918, the staff then consisted
of the commanding officer and adjutant, assisted by two clerks. Later, when a
large force was available, the center administration was organized as follows:
550 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
< > ^
S b t:"
03 — ^ a
« " o
S-« o
o
-'- 5 *
o-
E 2
-D g
b«0
c ho
■> E
Si
o J2
CO
<q:
HOSPITALS
551
Though only two base hospital units arrived prior to the armistice, the
following hospital units eventually were located at this center: Base Hospitals
Nos. 22, 114, 104, 106, 111, 121, Evacuation Hospital No. 20, and the con-
valescent camp.
The sanitary inspector had general supervision of the sanitation of the
entire center and -was authorized to order the correction of such deficiences as
were in his judgment necessary.
A center chaplain was assigned in July, 1918. It was his duty to super-
vise the work of all chaplains in the center; also, he was directly responsible
for the record of all deaths in the center, for the care of the cemetery, and all
funerals.
The office of center chief nurse was not created until March, 1919, when
changes in the nursing personnel became very numerous. The incumbent
met all the chief nurses of base hospitals periodically, observed the work of
nurses in all the hospitals, and recommended transfers in the interests of the
service.
Shortly after the establishment of the center an officer of the Quarter-
master Corps was appointed center fire marshal. Fire companies were ,
organized in the dift'erent units and frequent drills were held. Great difficulty
was experienced in obtaining fire-fighting apparatus and the extreme shortage
of water in the summer of 1918 made fire hazard very serious. In its whole
history the center had but one serious fire. This occurred on the night of
February 6, 1919, a ward in one of the units being destroyed.
The center laboratory officer was in charge of all the laboratory activi-
ties. The staff consisted of 5 officers and 8 enlisted men. The laboratory
made all important examinations, including Wassermann tests and routine
examinations of water.
The medical supply depot occupied a building, 150 by 60 feet, with an
adequate unloading platform, situated on a spur track. Supplies were received
from the supply depots at Cosne, Brest, and Bordeaux. Large quantities of
supplies were also purchased in open market.
The center quartermaster office was organized July 22, 1918, when it was
divided into the following departments, each under charge of an officer or
noncommissioned officer. Subsistence, finance, clothing and miscellaneous sup-
plies, fuel procurement and issue, laundry, salvage and disposal of wastes,
corral and stable, Quartermaster Corps detachment and labor troops. The
bakery operated in the center for a short time but was then transferred to
Camp de Souge, about 7 miles distant. Hospital laundry was at first done
by the quartermaster at Bordeaux and by a French laundry, but in September,
1918, a large laundry was completed in the center. This center plant laundered
all hospital garments of base section No. 2, and in addition did the bulk of the
salvage work for the section. It operated 19 hours a day, with a personnel
of 20 oflScers, 26 enlisted men, and 165 female civilian employees. During
March, 1919, the plant laundered approximately 1,300,000 pieces.
The duties of the receiving and evacuating officer were specifically laid
down in orders issued by the center. He was charged w^ith meeting all hos-
pital trains, the distribution of patients to the various hospitals of the center,
according to their classification or instructions from the commanding officer,
as well as the evacuation of all class A patients to the convalescent camps or
to their organizations. The evacuation officer kept in touch with the railway
552
ADMINISTRATION, A:MERICAN EXPEDITIONAKV FORCES
transport officer in Bordeaux as to the time of arrival of hospital trains, and
boarded all the trains at Bordeaux. During the trip from Bordeaux to Beau
Desert, which occupied from two to three hours, the receiving officer classified
all patients. When each patient was classified, he was tagged with a large
slip, showing the number of the hospital to which he was assigned. The
majority of patients received in the center came on hospital trains; at times
two or three trains arrived almost simutaneously. Ambulatory patients were
always detrained first. Detraining for a full train occupied, on the average,
one hour. These hospital trains were always furnished, when required, all the
supplies they needed.
The evacuating officer was also responsible for the efficiency of receiving
officers in the various hospitals and of the litter squads effecting reception and
evacuation. He was the only officer authorized to give any orders to the
train crew relative to switching points, stop, splitting of train, etc. He also
kept a chart showing the rapidity of evacuation of each hospital. If it was
found that a hospital was slowing up on its evacuation the reason was sought
for by him and usually found to be due to failure of the ward surgeons promptly
, to report cases suitable for evacuation. Experience proved that the evacua-
tion of class A patients from the hospitals averaged about 2 per cent of
strength daily. Before the establishment of a convalescent camp, class A
patients were evacuated direct from the hospitals to replacement depots.
Each hospital was furnished each month with a chart showing the standing
of the hospitals with regard to evacuation, thus creating a spirit of competition
among them.
Shortly after the armistice began, the Beau Desert center was changed into
an evacuation center. Base Hospitals Nos. 114 and 22, because of their experi-
ence, were designated as evacuating hospitals and the remaining four as receiv-
ing hospitals. Later only Base Hospital No. 22 performed this evacuation duty.
In this way all the responsibility of evacuation was placed on one unit, thereby
eliminating all differences in method and standards which would have existed
if all the hospitals had been charged with evacuation. All patients for evacu-
ation were divided, according to the classification required, into companies of
150 or less, all papers w^ere completed, and five copies of passenger lists made
for each company. All patients were examined physically, issued new uniforms,
and paid in full. They were inspected when leaving the center and again while
boarding the transport at Bordeaux. The following tables show the number of
patients received and their disposition.
Total number of admissions and disposition of patients to April 1, 1919
Admitted by convoy 45, 398
Admitted from command 1, 840
Total 47, 238
Transferred to United States ' 22, 880
Returned to duty 12, 699
Died 304
Total ; 35, 883
Total number of hospital trains received, 84.
From April 1, to the date of closing of the hospital center, on June 25, 1919,
3,681 patients w ere received, making the total of cases handled over 51,000.
HOSPITALS
553
CONVALESCENT CAMP
This camp was organized late in July, 1918, and consisted of 25 wooden
buildings and about 200 double hospital-ward tents, giving a capacity of about
4,500 beds, with a possible expansion to 8,000. The largest number ever accom-
modated was 3,800. No personnel was at first provided, and the hospital fur-
nished the personnel required. Later, personnel was secured from officers and
men that were unfitted for combatant service. The patients were divided into
companies and battalions and given regular graded drills, exercise, and sports.
WELFARE WORK, SCHOOLS, ENTERTAINMENT, AND ATHLETICS
The welfare societies comprised the American Red Cross, Young Men's
Christian Association, Knights of Columbus, and the Jewish Welfare Society.
The American Red Cross, in addition to providing entertainment, furnished
large quantities of hospital supplies. The Young Men's Christian Association
confined its activities to the convalescent camp, providing there athletic enter-
tainments and educational and musical programs. The aid extended by the
Knights of Columbus was occasional and was rendered from Bordeaux. The
Jewish Welfare Society conducted a clubhouse.
Post School was established on February 1, 1919, where at first only ele-
mentary courses for illiterates were given. Later, courses were given in higher
mathematics, mechanical engineering, fine and applied arts, government, law,
French, Spanish, shorthand, and typewriting.
COMMANDING OFFICER
Col. Harold W. Jones, M. C.
HOSPITAL CENTER, BEAUNE ^
This center was located close to the city of Beaune, Department Cote
d'Or. Its construction was authorized on December 12, 1917, but did not
commence until March, 1918.
A double-track spur from the Paris, Lyon & Mediterranean Railway ran
east and west the full length of the center, and the hospital units were placed
on both sides of this track. Ten units were planned, but only seven were
constructed when hostilities ceased. Hospital construction, varying with the
material available, was of brick, tile, concrete blocks, and poured concrete,
with fabric cord roofs. One complete unit was of wooden Adrian barracks, but
it was occupied throughout by construction personnel and never used as a
hospital. Warehouses, laundry, and bakery were of galvanized iron. All units
were built on the type A plan, each successive one being somewhat modified
in detail, chiefly in the direction of economy of labor and material, with a view
of speeding up the work. Special construction included the center laboratory
building, located in unit 2, and a special neuropsychiatric building, which was
used as an isolation ward for diphtheria and meningitis was located in unit 7.
« The statements of fact appearing herein are based on the "History of the Beaune hospital center," prepared
under the direction of the commanding officer by members of his staff. The material used by these officers in the com-
pilation of the history comprised official reports from the various divisions of the hospital center. The history is on file
in the Historical Division, S. O. O.— Ed.
554
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Water at first was hauled from Beaiine in large wine barrels; and later,
about the time when first patients arrived, water from Beaune was piped into
the center. Meanwhile the engineers were making efforts to develop an inde-
pendent supply through driven wells, and were finally successful in locating
an abundant artesian flow, from which about 500,000 gallons a day could be
secured. Receiving tanks and pumps were installed and about the time the
armistice began the water supply was fully provided for. The Beaune and
artesian supplies were rather hard, but repeated laboratory tests showed them
to be entirely potable at their source. However, the delivery pipes were
badly contaminated, as tests showed the water to be dangerous for use as
delivered through them, so that chlorination in Lyster bags was always
practiced.
The bucket latrine system was used; solid matter was disposed of in
Horsfall incinerators, and liquids were emptied through sewers into a septic
tank.
One large steam sterilizer was used to disinfect all bedding and clothing.
Electric power was brought into the center from Beaune. A permanent
transformer was never installed, but only a temporary one of insufficient
capacity was available, necessitating the use of a number of oil lamps and
candles. An improvised Prest-O-Lite apparatus for emergency use was
installed in each operating room. During November, 1918, an accident
occurred by which the high-power transmission line became fouled with the
lighting wires, resulting in the death by electrocution of 3 patients, 2 Hospital
Corps men, and 1 civilian employee.
Laundry was handled at first by Mobile Laundry Unit No. 303, which
arrived September 11, 1918; on September 19, the permanent laundry was
put into operation by Mobile Laundry Unit No. 321.
The transportation consisted of 3 General Motors Co. ambulances, 3
trucks, 1 touring car, and 1 motor cycle. These were far insufficient, and
trucks had to be used late into the night in order to handle the large amount
of incoming supplies. Motor Transport Co. No. 477 arrived for duty on
November 10, 1918, and took charge of all transportation.
The first base hospital unit arrived on July 31, 1918, and shortly after-
wards the center was organized. The following units operated in this group:
Base Hospitals Nos. 47, 61, 77, 80, 96; Evacuation Hospital No. 22, Sanitary
Squad No. 22, and Hospital Train Unit No. 40; Evacuation Hospital No. 23
(September 19 to October 9, 1918), and Hospital Train Unit No. 45 (August
27 to October 31, 1918). None of the units brought their hospital equipment.
The equipment was received from supply depots in various shipments and
immediately installed, and as soon as a hospital was prepared to feed and
house patients its beds were reported. Each hospital first received medical
and minor surgical cases, the more severe ones going to the more completely
equipped units. The matter of equipment and nurses chiefly governed the
distribution of patients throughout. Special wards for officers, women, conta-
gious and mental diseases were established, but the more detailed classification
which was contemplated in the fully developed center was not put into effect.
HOSPITALS
555
Valuable assistance in the matter of medical supplies was given by the
American Red Cross, especially in the way of blankets and prepared surgical
dressings. A hut was furnished by this organization in each unit where
concerts, dances, moving-picture shows, etc., were given.
CONVALESCENT CAMP
Convalescent camp was opened on October 7, 1918, and operated as such
until January 31, 1919, handling approximately 5,000 patients. A disability
board was appointed and evacuation began within a few days. The average
length of stay of each patient in the camp was 11 days.
Fig. 105. — An operating room, Beaune hospital center
DISCONTINUANCE
The Beaune center was discontinued on March 29, 1919, and the site
utilized for the American Expeditionary Forces University.
COMMANDING OFFICER
Col. Clarence J. Manley, M. C.
HOSPITAL CENTER, CLERMONT-FERRAND
The hospital center, with headquarters at Clermont-Ferrand, was estab-
lished on September 23, 1918, for the purpose of not only extending hospitaliza-
tion of that district but also of unifying the hospitalization already established
''The statements of fact appearing herein are based on the "History of the Clermont-Ferrand hospital center,"
prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the
compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file
in the Historical Division, S. O. O. — Ed.
556
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
there. This group included hospitals in the towns of Chatel-Guyon, Royat,
Mont-Dore, la Bourboule, and Riom. These towns were composed almost
entirely of summer hotels, the capacity of which varied from small villas of
15 to 20 rooms to large hotels of 250 to 300 rooms. Certain public and private
buildings in the above places were taken over by the American Army, and
plans were formulated for the establishment of six base hospitals with a capacity
of 13,600 beds. Two base hospitals (Nos. 20 and 30) were functioning in Chatel-
Guyon and Royat, respectively, when the center was organized.
Headquarters were established first at Royat, and on October 1 at Cler-
mont-Ferrand. On October 17, a provisional base hospital was extemporized
at Mont-Dore by drawing some personnel, and 100 convalescent patients from
the two hospitals already operating. On November 6, 1918, Base Hospital
No. 93 arrived and two days later Base Hospital No. 103. Base Hospital No.
103 never functioned as a hospital.
After the signing of the armistice further extension of the hospitalization
in section was abandoned and buildings were gradually returned to the French.
Discontinuance of the hospitalization in this region was completed about Febru-
ary 20, 1919.
The total number of patients cared for in this center was 17,042. This
includes patients admitted prior to the organization of the group.
COMMANDING OFFICER
Col. John S. Lambie, M. C, September 23, 1918, to February 8, 1919.
Lieut. Col. John A. Murphy, M. C, February 9, 1919, to March 10, 1919.
HOSPITAL CENTER, COMMERCY '
This center was organized on November 4, 1918, at Commercy, where it
occupied the Caserne Oudinot. Barracks were taken over also at Lerouville,
a few kilometers northwest of Commercy. The buildings were of stone and in
fairly good condition, but a great deal of renovating was necessary to make
them suitable for hospital purposes. The windows were torn out, electric wir-
ing was missing, sewers were blocked, and the water was unsafe for drinking.
Evacuation Hospital No. 13 had been operating in the Caserne Oudinot since
October 30, and was the only hospital in the center during the active period.
Base Hospitals Nos. 91 and 90 arrived on November 30 and December 1, respec-
tively. The former relieved Evacuation Hospital No. 13 and the latter took
over the caserne at Lerouville, but never functioned as a hospital. During
January, 1919, all patients were evacuated to Vichy and Bazoilles-sur-Meuse,
and the center was discontinued on January 30, 1919.
COMMANDING OFFICER
Col. Wilham A. Powell, M. C.
HOSPITAL CENTER, JOUE-LES-TOURS f
This center was established in the grounds of a chateau about 5 kilometers
(3 miles) west of the city of Tours. The property was leased by the United
' The statements of fact appearing herein are based on the "History of the Commercy base hospital center, "pre-
pared under the direction of the commanding officer by members of his staff. The material used by these officers in the
compilation of the history comprised official reports from the various divisions of the hospital center. The history is on
file in the Historical Division, S. G. O. — Ed.
/The statements of fact appearing herein are based on the "History of the Joue-les-Tours hospital center," prepared
under the direction of the commanding officer by members of his staff. The material used by these ofllicers in the com-
pilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in
the Historical Division, S. G. O. — Ed.
HOSPITALS
557
States Government from the owners in April, 1918, and two type A units and a
convalescent camp were constructed by the United States Engineers. The
entire center, including its water supply and sewerage system, was completed
in October, 1918. The bed capacity of this group was 4,600 beds, but this
capacity was never reached.
The method of handling the sick and wounded followed the usual procedure
in base hospitals.
The center was operated by Base Hospital No. 7 from July 30, 1918, to
the latter part of October, 1918, when Provisional Base Hospital No. 2 was
organized. On January 18, 1919, Base Hospital No. 120 took over the activi-
ties of Base Hospital No. 7, thereafter, with Provisional Base Hospital No.2,
operating the center until its closure early in June following.
Fig. 106. — A view of part of Kerhuon hospital center
COMMANDING OFFICER
Col. Allen M. Smith, M. C, July 30, 1918, to January 17,1919.
Col. Edward W. Pinkham, M. C, January 18, 1919, to closure of center.
HOSPITAL CENTER, KERHUON "
The hospital center at Kerhuon was situated 4 miles southeast of Brest
and about 13^ miles from the railroad station of Kerhuon. The center was
planned to consist of 8 base hospitals, with a total capacity of 8,000 beds,
for embarkation purposes; however, only 4,000 beds had been provided when
the armistice was signed and further construction was abandoned.
» The statements of fact appearing herein are based on the "History of the Kerhuon hospital center," prepared under
the direction of the commandinj; officer by members of his staff. The material used by these officers in the compilation
of the history comprised official reports from the various divisions of the hospital center. The history is on file in the
Historical Division, S. G. O.—Ed.
558
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The construction of the center, according to the estimate of the Enginoor
Department, was to be completed by September 15, 1918. However, at that
time only about 50 per cent of the buildings were under roof, few of thorn
were entirely finished, the water and sewerage systems still were under con-
struction, and there were no roads or walks of any kind.
The first unit (Base Hospital No. 65) reported on September 16, 1918,
and on the 20th the center was organized. Subsequently, the following addi-
tional arrived: Base Hospitals Nos. 105, 92, 120. Unlike the other hospital
centers of a like capacity, this center always operated as one hospital, this
in view of the fact that at least 90 per cent of the activities were devoted to
receiving, preparing, and evacuating patients to the United States, and one
administration instead of four was desirable.
Approximately 75 per cent of the patients who passed through the center
required little or no professional care. Bedridden medical and surgical cases
and those requiring professional care were placed in two blocks of wards.
The ambulatory cases requiring no professional care were placed in other
wards regardless of their physical disability. Medical officers assigned to
these wards acted more in the capacity of detachment commanders than
ward surgeons; their principal duties were to see that all patients were properly
clothed, equipped, and paid preparatory to their embarkation.
The evacuating activities were entirely dependent on space alloted patients
on naval transports, on the one hand, and the availability of patients at other
hospitals in France, on the other. It might be said that the center coordinated
the patients with the vessels so that there was always on hand a sufficient
number of patients under the classification demanded by the Navy to fill
all space on vessels allotted to them. The Navy was represented by a naval
medical officer who furnished the information relative to the dates of sailing
and the space allotted for patients. The port of embarkation was represented
by a medical officer of the army who, after consultation with the commanding
officer of the center, made requisitions on the chief surgeon 's office for patients
to fill the Navy requirements. The chief surgeon, in turn, ordered patients
from hospital centers at Savenay, Nantes, and Beau-Desert to the center
at Kerhuon.
When information was received from the naval authorities that a vessel
would sail on a certain date and the number and classification of patients
required was forwarded, passenger lists of patients were prepared from those
available for evacuation and patients tagged with colored tags, each color repre-
senting a certain physical classification. These tags were very much cherished
by the patients and regarded by them as a ticket home. One-half hour before
the evacuations were to begin a bugler sounded "assembly," followed by
^'overcoats." At this signal all patients who had been tagged repaired to
their wards and thence marched to the receiving ward. Here a final inspection
of their personnel appearance was made, their records were verified as to com-
pleteness, and they were then loaded on ambulances and taken to Pier No. 5,
Port du Commerce, Brest. From here they were taken by steam lighters
to the transports. This activity was so organized that frequently 1,100 patients
were evacuated in less than three hours.
The following is a detailed outline of the evacuation system as operated
in the center.
HOSPITALS
559
Evacuation Office, Hospital Center, Kerhuon, France
Administration of Receiving, Recording, Equipping, and Evacuating of Patients
Evacuation:
Receiving ward.
Ward surgeon.
Equipment.
Statistical department.
Registrar department.
Tagging department.
Liaison.
Function of receiving ward. — To receive patients sent to this hospital center and inves-
tigate source of admission as to authority and correctness; to receive papers and data; to
assign patients to ward on information from evacuation office; to receive and check baggage
and furnish runners to conduct patients to wards, and litter bearers for bedridden patients.
Reception of patients. — When notice is received of train arrivals a noncommissioned
officer from this office is dispatched to the station. He represents this center and obtains
information relative to convoys, etc., and accordingly makes out report, which is placed on
file at this office.
report of hospital trains, patients, baggage and equipment (arrival)
Hospital train No. Date of arrival
Number of patients in convoy: Officers, ; enlisted men, ; total,
Embarked at ; time, ; date,
Arrived at ; time, ; date,
Detrained at ; time,
Name of train commander
Seriously ill on train
Remarks:
Condition of men on detraining Time of loading ambulances
First ambulance arriving HCK Last ambulance arriving HCK
Last patient sent to ward
Number of patients not paid for preceding month
Record shortage
Baggage Number of pieces Sent via
Condition Shortage
Officers in charge train. Number of attendants
Detraining Sergeant.
Evacuation Officer.
Patients arriving at this center are brought to the receiving ward, lined up and are given
a slip of paper with the number of the ward to which assigned written thereon. Passing
down the line they are questioned by medical officers who write on the ward assignment
sHp, data relative to pay. Navy classification and diagnosis taken from field medical and
transfer cards; the latter in conformity with the Manual, Sick and Wounded, A. E. F.
Patients then have an opportunity, if they desire, of handing over money or valuables to
a representative of the registrar's office, for safe-keeping, to be given back when ready to be
evacuated to the United States. They then pass on to the clerical room, where a force of
about 12 typists fill out the Form 55a complete in quadruple, getting the data from the
patient and from the records in his possession. The patients are then sent to the ward to
which assigned. This work can be accomplished at a rate of about 175 men per hour.
Ward surgeon. — We depend upon the ward surgeon for the accurate and easy running
of the mechanism — first, when patients arrive in the ward, verification of data on the Form
55a, any change in Navy classification, diagnosis or delayed evacuation to be made on form
provided.
13901—27 36
560
ADMINISTEATION, AMERICAN EXPEDITIONARY FORCES
CONTAGIOUS DISEASE CHANGE OF DIAGNOSIS— CHANGE OF CLASSIFICATION DELAYED
EVACUATION RELEASES FOR EVACUATION
Note:
Chiefs of service.
Ward Date
Name
Serial No. Rank Organization
Navy class Navy class new
Admission diagnosis
Present diagnosis
Noted by registrar
Reason for delayed evacuation
Ward surgeon
Approved by chief of service
Received by evacuation officer
This form is sent to evacuation and registrar's office within 24 hours, if possible.
Second, transfer of patients from one ward to another. This should be carefully
recorded by use of the following transfer form.
HOSPITAL CENTER, KERHUON TRANSFER OF PATIENTS
Request transfer of this patient from ward to ward
Name No.
Rank Organization
Diagnosis
Navy class Navy class, new
Reason for transfer
Approved :
[Medical.
Chief of j Service transportation.
[Surgical.
Approved:
r Medical.
Chief of < Service records.
[Surgical.
W ard No. Ward Surgeon.
Base Hospital No.
Base Hospital No.
Registrar.
The above patient will be transferred to ward
Notice to detachment commander to transfer above patient.
Detachment Commander.
Received the above patient.
Ward Surgeon, ward
Evacuating Office.
Notice received of transfer. Date Time
Change in file made by Evacuating Officer.
To receiving officer, to note and return to evacuating officer.
rpu , . . Receiving Officer.
Ihe question of diagnosis is carefully considered and any change is immediatelv reported
through proper channels, to the registrar and evacuation office. ' '
HOSPITALS
561
EQUIPMENT
Equipment officer. — The function of this oflflcer is to see that the enhsted patients
coming into this hospital are made ready to be evacuated as soon as possible, and that all
existing orders relating thereto are comphed with. When patients are sent to the ward, a
careful inspection of the personal equipment is made by the ward surgeon, and any shortage
noted.
The articles to complete the personal equipment are immediately drawn from the
quartermaster and supplied to the patients.
After careful inspection of their physical condition, the ward surgeon submits a hst
of those ready for inspection to the local inspector who notifies the inspector general at
base headquarters, and the section inspector comes out and certifies to the equipment, physi-
cal condition, and pay of each man.
This certificate is made in duplicate on blanks provided for that purpose, one of which
is retained by the patient until he reaches the receiving ward on evacuation, where a final
inspection is made. This certificate is retained with the hospital records. The original
copy accompanies the patient.
This form is shown below:
General Orders, No. 3, Hospital Center Kerhuon, January 10, 1919.
1. The physical examination of patients and the completion of their equipment must
be certified by the ward surgeon within the period of 24 hours after a patient is admitted
to the hospital. The certificate will be made in duplicate on the evacuation-inspection
slips which have been provided for the purpose.
2. In each case one of the certificates will be retained by the patient until he reaches
the evacuation office, where it will be required by the evacuation officer before the patient
is allowed to leave the hospital.
3. The other certificate will be transmitted by the ward surgeon through military
channels to the section director.
4. The section director each day, at 2 p. m., will supply the representative of the
inspector general's office with the certificates of patients who are prepared for inspection.
5. The certificates furnished by the section chiefs will be used by inspection department
to compile a list of the patients who are prepared for inspection.
6. These certificates, after having been initialed by the inspector general, will be deliv-
ered to the evacuation officer and will be filed in the patient's envelopes with their other
records.
7. Upon notification that the inspector general is prepared to inspect the patients in
any ward, the ward surgeon will direct that the equipment of the patients concerned be
displayed on their beds in an orderly manner so that every article may be easily seen. When
physicalljr able to do so, the patient will stand b}^ his bed dressed as when he will embark
upon the ship. His identification tags must be worn about the neck and displayed outside
his clothing.
HOSPITAL CENTER, KERHUON, BREST EVACU.\TION INSPECTION SLIPS
Ward
Name
Rank
Classification
Date -
-_ No.
Organization
Complete equipment:
Cap
Coat, olive drab
Breeches, olive drab. .
Belt, waist
Leggins
Shoes
Overcoat
Shirts, olive drab
Undershirts
Drawers
Socks, pairs
Slicker
2
2
2
4
1
Blankets, olive drab__
Barrack bag
Canteen and cover
Gloves, pairs
Laces, shoe, pairs
Tags, identification —
Ornaments, collar, cap
Toilet kit, complete.. -
Cup
Knife
Fork (1 spoon)
Meat can
3
1
1
1
1
1
3
1
1
1
1
1
562
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
I have received the articles checked on this list, required to complete equipment as
shown on list.
I was paid in full to include month of 1919, $
I certify that I did not enter the service in Europe.
Patient.
I certify this patient's equipment to be complete as shown by above list, except for
initialed erasure of articles not available for issue.
Date 1919.
(Name) ,
(Rank) Ward Surgeov.
I certify that I have examined this patient and found him free from communicable
venereal diseases, from skin and contagious diseases, and vermin infestation.
(Name) ,
(Rank) Ward Surgeon.
Inspection, general:
I inspected this patient immediately before evacuation from the ward and found no
evidence of acute infection in eyes, nose, throat, skin, or general condition to contradict
evacuation, and has no explosives or combustibles.
(Name) ,
(Rank) Ward Surgeon.
Evacuated Date
S. S.
The detail of this process is outlined as follows:
Before the sick and wounded are ready to return to the United States a number of
conditions must be satisfied, including:
1. The physical condition of the patient must be such as to insure his safe transportation.
2. He must not be suffering from a communicable disease or vermin infestation, thereby
endangering the health of his traveling companions.
3. He must be provided with clothing which will afford him protection and, in the case
of ambulatory patients, they must present a neat and military appearance.
4. He must have been paid in full to include the month preceding his embarkation for
the United States.
5. His service record must accompany him, if available; and, if not, a supplementary
service record must be provided.
6. All foreign money must be exchanged for American money.
EQUIPPING THE PATIENT
Immediately after the reception of the patient in the ward the ward surgeon proceeds
with the preparation of the patient for evacuation, and takes the following steps:
(a) The equipment which the patient possesses is orderly displayed upon his bed and
checked against the specified list given on page 8 of Embarkation Instructions No. 13, Jan-
uary 4, 1919, headquarters, Services of Supply, A. E. F.
(6) The articles mentioned in the aforesaid list which are not in the possession of the
patient are immediately requisitioned from the quartermaster. If the quartermaster is
unable to supply any of the articles requisitioned he certifies to that fact.
(c) Inquiry is made of the patient regarding the pay he has received and he is required
to state over his own signature the amount and the period of time covered.
(d) Inquiry is made as to whether or not he enUsted in Europe, if so, whether he desires
demobilization in the United States, under provision of General Orders No. 40, G. H. Q-,
paragraphs 1-6. If he so desire, the attached declaration is used and information sent
to base commander through military channels.
HOSPITALS
563
Hospital Center, Kerhuon,
Base Section No. 5, A. P. O. 716,
(Date) , 1919.
Under the provision of General Orders No. 40, paragraphs 1-6, G. H. Q., March 3, 1919,
I, , hereby declare that I entered the service of the United
States in Europe, at , on (date) ;
I desire to be retained in the service for the purpose of returning to the United States for
discharge. I understand that I am privileged to be discharged in Europe if I so desire. I
do not request to be retained in the service for the purpose of returning to the United States
for discharge. In consideration of this privilege of being returned to the United States, I
waive all claim for travel allowance from the place of discharge to the place of entry into the
service, and fully understand that I will be discharged at the demobilization center nearest
my home and that I must defray my expenses from the demobilization center at which dis-
charged to my home.
Witness :
(e) The physical inspection of the patient determines whether or not he is suffering
from communicable venereal disease, skin diseases, contagious diseases, or vermin infestation.
(/) The requisition upon the quartermaster having been filled and the articles thus
acquired having been added to those already in the possession of the patient, the ward
surgeon now makes a final check to determine that the patient's equipment is in full accord
with the instructions contained in Embarkation Instructions No. 13.
notification by the ward surgeon
The ward surgeon now requests the chief of the service to verify the findings which he
has recorded with regard to the patient's physical condition, equipment, and pay.
The cliief of the medical service confirms the findings whenever a patient is reported
suffering from vermin infestation, communicable diseases, etc.
A representative of the inspector general's office visits the ward and confirms the fact
that the patient is properly equipped for evacuation to the United States, initialing the
record in evidence of the fact that this inspection has been made.
The statistical oflScer verifies the pay status of the patient and prepares his service
record for return to the United States.
certification
The correctness of the findings which have been enumerated is attested by proper
signature. The patient acknowledges over his signature the correctness of the statement
regarding his pay and also that the required equipment for evacuation is in his possession.
The ward surgeon certifies that the patient has been equipped in a proper manner and
also signs a certificate indicating that the patient may be transported to America with safety
to himself and without endangering his fellow passengers from vermin or communicable
diseases.
As a period of a few days may elapse between the time when a patient arrives in the
hospital and the time when he is placed upon the passenger list, the ward surgeon makes a
final inspection in each case in order that he may give the proper assurance regarding the
suitability of every case for evacuation. This final certificate covers the question of acute
infection, vermin infestation, and venereal disease.
WOUND CHEVRONS
General Orders, No. 110, general headquarters, A. E. F., July 7, 1918, prescribes the
conditions under which wound chevrons may be worn. Many wounded men have been
unable to secure authority to wear these chevrons, due to the loss of necessary papers. To
obviate this difficulty, telegraphic authority was given to the commanding officer of this center
to take the affidavit of any man whose papers were lost or confused. As a matter of practice
it is found that greater speed is obtained and better records made available for our own
protection if the affidavits are prepared in each case. As soon as the patients are assigned
564
ADMINISTRATION', AMERICAN EXPEDITIONARY FORCES
to the ward, the ward surgeon ask? for all men to notify him who have never had ati order
authorizing the wearing of his wound chevron. The ward surgeon prepares an affidavit
showing, name, rank, company, organization, number, place of action where wound was
obtained, nature of missile or gas, part of body injured, and date of injury. This blank is
sent to the adjutant's office. The adjutant sends a commissioned officer, having power to
administer an oath, to see the soldier and attest his signature on the affidavit. This affidavit
is returned to the adjutant's office, and a special order issued authorizing the individual to
wear a wound chevron for the wound specified. Two chevrons are then issued to the men
with the order authorizing their use, one for the coat and one for the overcoat. If the patient
already has an order but no chevron, a chevron is issued and a notation made on the order.
If one chevron only is needed for the overcoat, one is issued for that purpose. In the month
of March, about 800 wound chevrons were issued.
Hospital Center, Kerhtjon, France
A. P. 0. 716
(Date) , 1919.
Personally appeared before me, the undersigned authority, one ,
, who, after being duly sworn, deposes and sayeth, I was (1) wounded
(Number)
while in action with the enemy; (2) wounded as a result of an act of the enemy; (3) was
gassed, which necessitated treatment by a medical officer at ,
(Place)
That the wound was due to
(Date) (Nature of weapon)
and I was wounded in ; that I am not now wearing a
(Part of body injured)
wound chevron for this wound.
Further deponent sayeth not.
Ward
(Name, rank, and organization)
Sworn to and subscribed before me this day of , 1919.
Headquarters, Hospital Center, Kerhuon, France
A. P. O. 716
(Date) , 1919.
Special Order No.
extract
*******
Par-_ Pursuant to telegraphic authority, headquarters, Services of Supply, 8th Febru-
ary, 1919, the following-named men, having been w^ounded in action with the enemy, or as
the result of an act of the enemy, on the date and at the place specified opposite their names,
are hereby authorized to wear the wound chevron prescribed in G. O. 110, G. H. Q., July 7,
1918:
Name Number Rank Organization Date and place of injury
By order of Colonel Koerper:
Frederick Thomas,
Major, Sanitary Corps, Adjutant.
Original copy.
HOSPITALS
565
SERVICE STRIPES
This matter is taken up with every man coming into this center, and handled in a similar
manner to wound chevrons. Many men are found who are not wearing service stripes,
although entitled to them. In the month of March about 3,000 service chevrons were issued
and authorized as per order attached.
Headqu.\rters, Hospital Center, Kerhuox, France
A. P. O. 716
(Date) , 1919.
Special Order No
extract
Par__ Pursuant to the provisions of G. O. 110, sec. 1, Hqrs., A. E. F., July 7, 1918, as
amended by G. O. 147, sec. 3, par. 4, Hqrs., A. E. F., Sept. 2, 1918, permission is hereby
granted the following-named members of the American Expeditionary Forces, now at this
hospital center, to wear war service chevrons.
Name Number Rank Company Organization Date of arrival
By order of Colonel Koerper:
Frederick Thomas,
Major, Sanitary Corps, Adjutant.
Ward
Original copy.
evacuation
The evacuability of a patient is indicated when the ward surgeon forwards, through
military channels, the evacuation — inspection slips, which contain the certificates referred
to above. This slip is made in duplicate, one of which is taken up by the inspector; when
all are collected a list is made and handed to evacuation department, which thereupon
releases the equipment check of patient, kept on file at evacuation office. The dupHcate
slip is kept by patient, who brings it to the receiving ward and when he is checked on the
passenger list he hands the slip to the inspector, who examines it once more to insure correct-
ness and then places it in the patient's envelope. This envelope is then given directly to the
detachment commander. At this point the patient is given the final inspection as to neat-
ness and military appearance.
ror.MATiON INTO detachments
Prior to evacuation, patients are grouped into detachments of 75 to 150 and placed in
the charge of a medical officer, who receives the records relating to the patients and conveys
them to the United States.
ST.\TISTICAL
The function of this department is to see that the service records are complete; or if
not and not obtainable, to provide supplemental service records, and to see about pay for
every man. A roster of detachments of men to be evacuated, which is the passenger list of
the evacuation office, is submitted to this department, and 12 copies of passenger Ust made
from the data contained thereon. Two copies of the twelve contain red-ink notations con-
cerning the absence of service records. These copies are disposed of as follows:
5 copies for personnel adjutant, United States port of debarkation.
2 copies to central records office.
1 copy to headquarters, Services of Supply.
1 copy to be retained at port of embarkation, A. E. F.
1 copy for executive officers on board ship.
1 copy to The Adjutant General of the Army.
1 copy to detachment commander.
566
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
REGISTRAR
The registrar accepts one of the Forms 55a, places it in live file; when passenger list
is called for and patient ready to go out the Form 55a is taken out, stamped with proper date,
and placed in dead file.
TAGGING
This department receives a copy of passenger list, and fills out the tag, form shown
below :
p. L. No Detachment Class
Name
Rank Serial No
Company Organization
Diagnosis
Home State Ward No
The patients are tagged in the wards, and made readily distinguishable and ready to go
to the receiving ward for final inspection and loading when called for.
Tags are colored, denoting classifications:
White— Walking, no dressing (WND a, b)
Green— Walking, dressing (WD a, b, c)
YeUow— Tubercular (TB a, b, c)
Red— Mental (Ment a, b)
Blue— Bedridden (BR a, b)
Barrack tags. — Tags are made in duplicate, one part is tied on the barrack bag and the
other the patient keeps in his possession.
Det. 278. No. 50 Det. 278. No. 50.
John Doe John Doe
Pvt. 1/cl. Pvt. l/cl.
Office Stjrgeon, Base Section No. 5, A. P. O. 716,
(Date) March 24, 1919.
To: C O., Hospital Center, Kerhuon, France.
Requisition for classified patients for evacuation to transport:
Transport: S. S. Mount Vernon.
Date of saiHng: March 28, 1919.
Hour for ambulance loading: 8:00 a. m.
Bed ridden
Walking, dressing
Walking,
no dressing
T. B.
Mental
Total
A
B
A
B
C
A
B
A
B
C
A
B
OflBcers---
Enlisted men
10
SO
750
810
Nurses
Total
10
50
750
1 m
1
1
(Signed) ,
Captain, M. C, Assistant Adjutant.
HOSPITALS
567
The duty of this department is to keep in touch with the base evacuation officer and
otlier points that send patients to this center for evacuation to the United States; to arrange
for their reception and requisition through office when needed; to keep live statistics on the
general information board as to movement of patients and nurses, and expected arrivals of
ships. In other words, to coordinate all outside information that has to do with the re-
ception and evacuation of patients, and to maintain a sufficient number of patients at all
times to fill the requisitions made by the Navy.
****** :|e
The physical function of evacuating patients is as follows:
When the passenger list is completed the following form is made out:
Evacuation Office,
Hospital Center, Kerhuon, A. P. O. 716,
Memorandum: , 1919.
1. Loading from the S. S. will start at M.
, 1919.
The following detachments will load:
Detachment No. In command of
Detachment No. In command of
Detachment No. In command of
Detachment No. In command of
Detachment No. In command of
Detachment No. In command of
Detachment No. In command of
Detachment No. In command of
2. Evacuation will take place from the following wards:
Evacuation Officer.
Copies to —
Commanding officer, Base Hospital No. 65.
Chief of professional services.
Chief of medical service.
Chief of surgical service.
Chief nurse.
Detachment commander.
Receiving officer.
Mess officer.
Baggage sergeant.
File.
These are sent to officers that are in any way connected with the process that they
may be informed and have patients designated to go at appointed hour. To the receiving
officer is sent, first, a "ward check," that he may know the wards from which the patients
are to be called, their number, and classification:
Detachment No. 136:
Enlisted men —
BRb_
WNDb.
Detachment No. 137:
Enlisted men —
WNDb
TBc
J2
J4
J5
J6
3
10
34
1
Y7
Y4
45
5
Y7
Zl
X2
D7
30
22
2
1
A3
E5
X2
A4
31
19
2
17
568
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Detachment No. 138:
Enlisted men —
TBa
TBc
WNDb
Detachment No. 139:
Enlisted men —
WNDb
WDa
Detachment No. 140:
Enlisted men —
WNDb
WDb
Detachment No. 141:
Enhsted men —
WNDb
Detachment No. 142:
Enhsted men —
Mentb
Detachment No. 143:
Enlisted men —
WNDb
Detachment No. 144:
Enlisted men : —
WNDb
Detachment No. 145:
Officers —
WNDb
WNDa
TBc
WDc
WDb
WDa
Detachment No. 146:
Nurses —
WNDb
Detachment No. 147:
Mental officers —
A3
A4
A6
Jl
E5
E6
" 8
A6
3
Jl
16
E6
12
7
4
" 16
Zl
3
Z2
1
Y7
C6
HIO
H9
F3
D5
' 1
CI
1
E4
9
E3
1
E2
3
1
3
2
2
4
1
1
D3
D4
' 34
C5
36
C4
H2
Al
C2
" 2
11
1
26
10
D4
D5
D6
" 4
Zl
38
C6
28
Y3
C2
Z2
Y2
" 4
2
3
3
2
1
J7
CI
A8
Al
X2
A2
Z2
Z3
" 29
13
21
4
8
1
20
53
A9
AlO
P2
P6
" 24
38
4
6
Zl
Z3
H9
D3
D2
•
~ 62
44
19
1
24
H9
HIO
C5
C6
" 21
37
29
38
B2
Al
B3
B4
B5
B6
' 16
1
11
8
4
1
B4 B5
1 1
B2
1
B5
2
B4 B5
1 2
B4 B5
K4
22
Mentb ^
32 or 33
HOSPITALS
569
Second, an office detachment sheet showing how each detachment is to be made up.
An office detachment sheet is given below, showing the make-up of the passenger Hst of the
Steamship Leviathan. This list, as wiU be noted, calls for most of the sick and wounded
classification. It will be noted that the detachments are made up in "splits"; that is, not
all are of the same class, the reasons for which are: First, evacuating facility; second, part
of the detachment in the class are able to help the others, which tends to shorten the trans-
portation time; third, it does not load up a detachment commander with a lot of one class
of patients who might be sick and require a lot of attention and care.
OFFICE DETACHMENT SHEET STEAMSHIP " LEVIATHAN"
In command of convalescent detachment No. 138, Capt. :
(1) TBa (patients), 49 enlisted men, 1 civilian 50
TBc (patients) 20
WNDb (patients) 29
Total "~99
In command of convalescent detachment No. 136, Maj. :
(2) BRb (patients) 49
WNDb (patients) 50
Total ~99
(Supplemental 101 to 110.)
In command of convalescent detachment No. 137, First Lieut. :
(3) TBc (patients) 69
WNDb (patients) 55
Total 124
In command of convalescent detachment No. 142, Maj. :
(4) Mentb (patients) 58
Attendants 6
Total ~64
In command of convalescent detachment No. 139, Capt. :
(5) WNDb (patients) 69
WDa (patients) 49
Total 118
In command of convalescent detachment No. 140, Capt. :
(6) WNDb (patients) 70
WDb (patients) 49
Supplemental list, WNDb (patients) 12
Total 131
In command of convalescent detachment No. 141, Capt. :
WNDb (patients) 148
In command of convalescent detachment No. 143, Maj. :
WNDb (patients) 150
In command of convalescent detachment No. 144, Capt. :
WNDb (patients)
In command of convalescent detachment No. 145, Lieut. Col. :
Officers —
TBc (patients) 1
WDa (patients) 2
WDb (patients) 3
WDc (patients) 2
WNDa (patients) 2
WNDb (patients) 40
Total 47
570 ADMINISTRATION, AMEEICAN EXPEDITIONARY FORCES
In command of convalescent detachment No. 146, Capt. :
Nurses —
WNDb (patients) '■^^
Attendants
Total 25
In command of convalescent detachment No. 147, Lieut. Col. :
Officers — Mentb (patients) 32
When there are many bedridden patients to be evacuated, the ambulances are run right
down to the wards where they are located, where a temporary evacuating shelter is set up
and the patients checked there instead of in the receiving ward. The burden of transporting
is practically nil, the patient being taken out of his ward and almost into the waiting ambu-
lance, and thence directly to the ship. The ambulatory patients go through the receiving
ward. Thus the evacuation can be carried on in two places at the same time. It might be
interesting to note that the passenger list of the Leviathan, calling for 1,162 patients, a some-
what complicated one, calling as it does for bedridden, ambulatory, mentals, and attendants,
was loaded from this center in 3 hours and 15 minutes.
OFFICE ADMINISTRATION
A file, made up of Forms 55a, a copy of which was obtained from clerical room on the
reception of the patients, is arranged according to the classification of sick and wounded as
required by the Navy, and under which the Navy calls for patients to be transported. Form
55a contains all information necessary to make out a passenger list, and since they are filed
in order of arrival, they thus establish a priority list.
This file is also kept in subdivision by wards, so that the number in each class and also
the number in each ward of each class can be readily determined. For a daily report the
following form is used:
Morning situation report of patients, hospital center, Kerhuon — Navy classification
OFFICERS
Bedridden
Walking, dressing
Walking, no
dressing
Tubercular eases
Mental
cases
Total
A
B
A
B
C
A
B
A
B
C
A
B
Remaining
Admitted-- --
Total
Disposed of:
Lost by reclassification-.
Died
Remaining
ENLISTED MEN
Remaining
Admitted
Total
Disposed of:
Lost by reclassification _--
Gained by reclassification
Died
Remaining
HOSPITALS 571
P./L
P/L
P/L
Temporarily held
Available
Total
Local patients
Grand totals
The distribution of the Form 55a is made either immediately following the completion
of its typing in the receiving ward, or as soon as the patients have passed through it, and
sufficient time has been had to make a careful check as to diagnosis, etc., and to make com-
parison with the transfer card from the forwarding hospital and other papers which will
come in on the convoy, but not in the possession of the patient. The original of the Form
55a which is retained in the receiving ward is filed according to wards, and the patient remains
unavailable for evacuation until such time as he has been released from all checks. The
Form 55a is transferred from the "hold-over" file to the "available" file, and there arranged
according to the Navy classification and by wards.
A patient to be made evacuable must be equipped, paid in full to include the month
j)rcceding his evacuation to the United States, have his service record completed, not be
awaiting trial hy court-martial, be free from orthopedic complications and temporary illness-
In other words these are six points which have to be considered and checked.
When this office is called on for a certain number of patients in the various classifications
required by the Navy, the Forms 55a are "pulled" from the "available file" and blocked
out and given the serial numbers to be used in making the passenger list. Typists prepare
the passenger list. Approximately 10 per cent more names, if available, in each classifi-
cation as called for by the Navy are placed on the passenger list and service records for this
number called for. As the system works out we find that in practically every list there
are a number of "hold-ups" at the last moment, so that as a name is scratched one of the
other names is used to fill in. Those that are not needed are scratched. After the passenger
list is complete, the Forms 55a are kept in their respective order, to be accessible, in case
anything arises requiring their use for reference, until the patient is actually evacuated.
For instance, if at the last minute a patient for evacuation is found too ill to travel, change
will be made. When the evacuation is accomplished and the patients have gone to the
ship, final disposition is made of the Form 55a by marking each copy with the number of
the special order and paragraph which authorizes the patient's evacuation, giving date and
ship on which he travels. They are then filed alphabetically as a permanent record of
this office.
Seventeen copies of a passenger list are made by the evacuation office; disposition a
follows :
4 to transport surgeon for use at port of debarkation.
1 to chief surgeon, A. E. F. (through base surgeon).
1 to base surgeon.
1 to statistical and registrar departments.
8 to Army and Navy medical authorities.
1 retained for tagging and permanent file.
RED CROSS HUT ACTIVITIES
Previous to arrival of a convoy the American Red Cross is notified by the receiving
department. When the patients arrive and are awaiting registration, hot chocolate is
served, and cigarettes are passed.
When patients go out, representatives of the Red Cross are present and supply each
patient as he passes by the desk with a cigarette, giving him a Ught and a parting word
before he gets into the ambulance. This detail, while small in itself, is important, as it
serves to leave a good impression in the minds of the patients.
572
ADMINISTEATION, AMERICAN EXPEDITIONAEY FORCES
COMMANDING OFFICER
Col. Clyde S. Ford, M. C, September 20, 1918, to February 11, 1919.
Col. Conrad E. Koerper, M. C, February 12, 1919, to discontinuance of
HOSPITAL CENTER, LANGRES
This hospital center was situated about three-fourths of a mile to the
east of the city of Langres. Construction of the center began during the
early part of the summer, 1918, but delay in receipt of building material and
the shortage of labor prevented its completion until after the armistice began.
The original plans for this center contemplated four base hospitals and a con-
valescent camp; however, buildings for only two base hospitals, a conva-
lescent camp, and for the center administration were constructed.
To the wooden buildings were added later, 36 marquee tents, crisis expan-
sion, to each base hospital, and 72 to the convalescent camp. This addition
gave each hospital a capacity of 1,500 and 1,000 to the convalescent camp, a
total of 4,000 available beds for the entire center.
The center was organized on August 15, 1918. At this time the permanent
buildings were partially completed, most of the roads and a few walks laid,
the electric plants in operation, and water and sewer pipes laid.
The administrative staff of the center was organized into the following
divisions: Adjutant, evacuating officer, sanitary officer, medical supply officer,
laboratory officer, and quartermaster.
The following units comprised the center: Base Hospital No. 53; Evac-
uation Hospital No. 18 (temporarily, September 15 to October 26); Base
Hospital No. 88; Hospital Unit I, which arrived on January 10, 1919, and
was incorporated with Base Hospital No. 53.
One of the greatest handicaps under which the center operated was its
distance from the detraining point, necessitating the transportation of all
patients a distance of more than 2 miles by ambulance and truck over rough
narrow roads. There never was sufficient ambulance transportation available,
and the majority of patients were transported by trucks. At the time the
armistice began, plans were under way providing for a railway track to be
built directly into the hospital area.
Water was obtained from the Marne River. It was treated with alum
for coagulation, and then with free chlorine. Because of the heavy pollution,
it was necessary to chlorinate again in Lyster bags all water used for drinking
purposes.
The sewerage system handled only liquids, which passed through a septic
tank, and after purification were discharged into a branch of the Marne River.
The bucket system latrines were in operation and proved fairly satisfactory.
One Horsefall destructor was installed. This proved effective, but proved
rather expensive in the matter of fuel. One steam sterilizer was adequate
for all the work for the center.
* The statements of fact appearing herein are based on the "History of the Langres hospital center," prepared under
the direction of the commanding officer by members of his staff. The material used by these officers in the compilation
of the history comprised official reports from the various divisions of the hospital center. The history is on file in the
Historical Division, S. G. O.—Ed.
HOSPITALS
573
CONVALESCENT CAMP
The camp consisted of 72 marquee tents and 17 portable wooden barracks.
The patients were classified and divided into several grades, according to
physical strength, and were given graduated exercises, drills, and walks.
The American Red Cross constructed a large hut where amusements
in the form of motion pictures, athletic exhibitions, and games were held.
During its three months' existence the camp received about 3,500 patients.
DISCONTINUANCE
On January 13, 1919, Base Hospital No. 88 was ordered to Savenay,
leaving only one base hospital in the center. As the central administrative
staff was no longer necessary, it was discontinued on January 22, 1919.
COMMANDING OFFICER
Col. WiUiam R. Davis, M. C, August 27, 1918, to November 21, 1918.
Col. Conrad E. Koeper, M. C, November 22, 1918, to January 22, 1918.
HOSPITAL CENTER, LIMOGES «
The hospital center at Limoges was organized July 22, 1918. Several
hotels, schools, and other buildings were leased from the French; in addition,
type A barracks were constructed by the United States Engineers. The
hospitals were widely separated in different parts of the city. The entire
group was planned to accommodate 5,500 patients, but this number was
increased so that on November 13, 1918, 9,093 beds (including the convalescent
camp) were reported as available.
Three base hospital units, Nos. 13, 24, and 28, arrived and were func-
tioning some time before the center was established. Ambulance Company
No. 347 arrived September 25, 1918, and was used in the evacuation of patients.
Sanitary squad No. 79 reported September 29, 1918, and performed the sanitary
work in the center. Dm-ing January, 1919, Evacuation Hospital No. 32
and Base Hospital No, 98 arrived, relieving Base Hospitals No. 13 and No.
28, respectively.
Laundry was handled by local contract, but faciUties were inadequate
and a center laundry was authorized, but due to the signing of the armistice
it was never completed.
Laboratory work of the center was distributed among the three hospitals,
one performing the Wassermann tests, another the survey work, and a third
the paraffin section work. Each laboratory operated independently, making
its owTi routine examinations, with the exception of meningococcus typing,
which was assigned to one hospital.
Beginning December, 1918, the bed capacity of the center was gradually
reduced, until on February 28, 1919, all buildings but one were returned to
the French. During its activity, this group admitted 23,592 patients.
• The statements of fact appearing herein are based on the "History of the Limoges hospital center," prepared under
the direction of the commanding officer by members of his staff. The material used by these officers in the compilation
of the history comprised official reports from the various divisions of the hospital center. The history is on file in the
Historical Division, S. (i. O.— £d.
574
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CONVALESCENT CAMP
The camp was opened September 21, 1918, and occupied a tract of land
of about 10 acres, on which 50 tents and 12 frame buildings were erected. The
initial capacity of the camp was to be 1,000 beds, but during November this
was found insufficient and barracks were rented from the French Government,
increasing the bed capacity to 2,200. The largest number of patients in camp
at any one time was 2,165; total number cared for was 3,077.
Fig. 107.— a view of part of Limoges hospital center
The camp was operated by a section of Convalescent Company No. 5,
consisting of 7 officers and 45 enlisted men. Patients were also used, especially
in the offices and in the kitchen. Incorporated in the daily schedule of the
camp operation were regular hours for physical exercises, drills, and outdoor
games, patients being formed into graded companies which were allotted
schedules based on the physical possibilities of its members. The camp was
evacuated on January 2, 1919, and turned over to the Engineers on January 13.
COMMANDING OFFICER
Col. William B. Bannister, M. C.
HOSPITALS
575
HOSPITAL CENTER, MARS-SUR-ALLIER '
The construction of this center was authorized in the fall of 1917. It
was located about 2 miles from Mars-sur-Allier and was to have a capacity of
43,000 beds, including crisis expansion and convalescent camp. This capacity
was never reached. At the time of the armistice the center had 30,000
available beds.
Actual construction began in February, 1918, but at first it was com-
paratively slow through lack of material. The work was under the direction
of United States Army Engineers. Railroad sidings ran into the center and
the hospital units were grouped on either side, thus making it possible to
stop the train in front of any hospital designated to receive patients. When
the commanding officer of the center arrived, on July 19, 1918, two units were
fairly well toward completion. After August 2, 1918, the development of the
center was very rapid. Material came in by trainloads almost every day.
By November 11, 14 units had been completed and were functioning; 3 were
almost completed, and material was on hand for 3 other units.
The following organizations formed the center and arrived in the order
named: Base Hospitals Nos. 68, 48, 35, 14, 62, 131, 123, 107, 110; Evacuation
Hospitals Nos. 31 and 37. Some of these did not arrive until after the armi-
stice began.
At first, water for the center was derived from a spring, being pumped
into a large concrete tank, located at the highest point in the center. This
supply was ample in the early stages of development, but when the population
increased to about 10,000 it proved to be insufficient, so additional water was
drawn from the Allier River, some 4 miles distant. The water from both of
these sources was fairly good, but too uncertain in ciuality for use without
chlorination.
The sewerage system disposed of only the liquid waste. The pail system
was used in connection with the latrines, the pails being collected once or twice
a day and their contents burned. A few of the earlier units to arrive were
equipped with Horsfall incinerators, but the later units used improvised cre-
matories which seemed to work equally as well. These crematories were
fairly satisfactory, but required a great deal of fuel and were not entirely free
from odor.
All laundry work was done at Nevers, the nearest city of any size. A
laundry was under construction in the center when the armistice was signed.
Bread at first was obtained at Nevers. Later a bakery company estab-
lished a bakery, which proved very efficient and adequately met all demands.
The headquarters of the center were organized into the following depart-
ments: Commanding officer, chief of staff, adjutant, professional staff, sanitary
staft", medical supply department, quartermaster department, receiving depart-
ment, evacuating department, motor transport, railway transport, personnel
adjutant, central purchasing agent, signal corps, central records office, engi-
' The statements of fact appearing herein are based on the "History of The Mars-sur-Allier hospital center," pre-
pared under the direction of the commanding officer by members of his staff. The material used by these officers in the
compilation of the history comprised official reports from the various divisions of the hospital center. The history is on
file in the Historical Division, S. O. O.—Ed.
1:3901—27 37
HOSPITALS
577
neers, headquarters detachment and band, post office, fire department, provost
marshal, welfare organization, judge advocate department, chief nurse. These
departments were developed to fit the needs of various organizations, and with
slight modification proved very efficient in hospital administration. As an
example, the professional staff at headquarters, consisting of the surgical,
medical, genitourinary, neuropsychiatric, orthopedic. X-ray, eye, ear, nose and
throat, laboratory and dental consultants, were responsible for the coordination
of the professional work of the center. Another important department was
the central purchasing agency, a development made necessary by the large
amount of supplies purchased and the tendency of independent organizations
to bid against each other, thus raising the price of supplies. This was over-
FiG. 109.— One of the operating rooms, Mars hospital center
come by having all purchasing for the entire center made through one depart-
ment and distributed to the various organizations as required.
The central records office was established at the beginning of the center.
In this office an effort was made to keep a duplicate record of every person
that came into the center. Thus it was possible within a very few moments
to locate any individual in the hospital. This department was a great time-
saver and proved its value as the center grew.
As frequent calls came in for operating and special teams for duty at the
front, many of the hospitals were reduced to an actual minimum of working
personnel. It became necessary to centralize the various departments of the
hospital. The central laboratory was first to be organized, and here the bulk
of laboratory work was performed, but each hospital maintained sufficient
equipment to do routine urinalysis and simple blood work. Similarly the
578
ADMIXISTRATION, AMERICAN EXPEDITIONARY FORCES
X-ray and eye, ear, nose, and throat departments were centralized. As the
center grew, it proved advisable to classify all cases and assign them to special
hospitals. Some of the special hospitals were concerned largely with bone
work, some with chest, and others with general medicine and surgery. A
complete contagious hospital was in the process of organization when the
development stopped. A central dental clinic was in active operation nt
the time the armistice was signed.
Prior to the influenza epidemic, in the fall of 1918, the medical service
was not very active. With this epidemic, however, came a great number of
pneumonia cases, with resultant complications of empyema. This made spe-
ciahzation of chest work necessary, and most of this surgery was handled by
one unit. Each hospital maintained a contagious department of its own for
each particular class of disease. One hospital cared for mumps, another
for measles, another for scarlet fever, and so on. Medical cases were almost
entirely confined to two hospitals. In addition to those mentioned, there
was the orthopedic hospital and one for neuropsychiatric cases.
Owing to the unfamiliarity of the new personnel of the hospitals with
Medical Department records, it was necessary to install some system of instruct-
ing the new organizations on these particular subjects as soon as they arrived.
Two of the units were utilized as school of instruction. When a new hospital
unit arrived its adjutant, registrar, mess officer, sanitary officer, senior non-
commissioned officers, and clerks were distributed for instruction to one of
these hospitals and remained there until they were fairly familiar with the
records and their own hospitals were ready to receive patients.
All notices regarding the arrival of hospital trains were sent by telegram
from regulating stations. Upon arrival of the trains the ambulant cases were
removed first, all patients as a rule being taken directly to the receiving sheds
of the hospital to which they had been assigned. At first, class A patients
were evacuated direct to duty; later all evacuations were made from the con-
valescent camp.
A Red Cross hut was established at each hospital, where refreshments
were served every afternoon, and practically every night some form of enter-
tainment was given. In addition to these huts, a central theater was operated
by the Red Cross.
The center organized a complete symphony orchestra of about 60 musicians,
and a band of 36. It had an excellent vaudeville troupe, glee club, and several
male quartets.
The convalescent camp occupied an area of about one-half mile square
and comprised 100 tent units, with 301 tents (299 marquee and 2 Denry),
38 wooden buildings, 4 wooden latrine groups, 3 sheds, and 4 feces destructors.
All tent units, buildings, and roads had double ditches.
Patients were admitted to this camp not only from the Mars center, but
also from the Vichy center, Chatel Guyon, and Chaumont. On August 18,
1918, there were 130 patients in the camp, and on October 1 there were 1,796.
This number steadily increased until the maximum of 4,565 was reached on
December 5, 1918. The greatest number ever received in one day was 435.
The largest evacuation was 1,336, made on December 18, 1918. Up to Jan-
uary 1, 1919, 11,497 men had been received and 9,638 evacuated.
HOSPITALS
579
The policing of camp was a large problem, necessitating a guard of approxi-
mately 210 men. The guard was partially armed during the day and com-
pletely so at night. An officer of the permanent personnel always acted as
police officer, while the officers of the day were drawn from the convalescent
line officers. The institution of formal guard mount very much improved the
discipline and behavior of the guard. The center sanitary officer did not exer-
cise jurisdiction over the sanitation of the camp, therefore a sanitary squad of
from 50 to 100, headed by one of the permanent officers and assisted by a num-
ber of noncommissioned officers, was organized.
The military discipline was splendid, largely due to a greater percentage
of military ceremonies and drills than usually occurs in establishments of that
I h. I Id \ II \\ ,j| convalescent camp (east end), looking north from water tower, Mars hospital center
nature. The camp maintained from 4 to 10 companies of convalescents, num-
bering from 150 to 520 each. The medical officer in charge of each company
was not only responsible for the records and the health of the men, but also for
tlicir military instruction. All phases of military work were taken up, includ-
ing the school of the soldier, company, battalion, and regiment, and special
ceremonial formations as well.
Next to military discipline and drill there was nothing that contributed so
much to the physical and mental welfare of convalescents as agreeable work.
Ten shops were established, 2 tailor shops, 2 barber shops, 1 electrical-repair
shop, 1 cobbler shop, 1 cot-repair shop, 1 carpenter shop, 1 disenfecting shop,
and 1 sign-painting shop. When a patient was discovered who had any par-
ticular training or inclination, industrially or artistically, he was given every
opportunity to work.
580
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Athletics were encouraged in all forms, and intercompany competition in
baseball and football was very keen. The convalescent camp closed on Feb-
ruary 1, 1919. The hospital center at Mars-sur-Allier was discontinued on
May 20, 1919.
COMMANDING OFFICER
Col. George A. Skinner, M. C.
HOSPITAL CENTER, MESVES *
CONSTRUCTION FEATURES
Construction of the Mesves hospital center, located between the villages
of Mesves and Bulcy, in the Department of Nievre, was approved by the general
Fig. 11].— a view of part of Mesves hospital center during the construction period
staff, A. E. F., in December, 1917. This site was selected because of its location
on the Paris, Lyon & Mediterranean Railroad, its rolling and slightly elevated
contour and its accessibility to the Loire River for water supply.
The original plan for the center embodied 10 base hospital units, each of
1,000 beds, with space for crisis tent expansion of an additional 1,000. Each
unit was to consist of 55 buildings apportioned to administration, receiving and
evacuating, bathhouses, quarters for personnel, recreation hall, morgue, X-ray
and operating, supply storehouses, garage, and disinfection.
In July, 1918, additional plans were approved to increase the construction
of this center to 20 base hospital units. These additional units were somewhat
modified; the number of ward buildings was reduced by half, and each ward
building made twice the size of the earlier ones.
* The statements of fact appearing herein are based on the " History of the Mesves hospital center," prepared under
the direction of the commanding officer by members of his staff. The material used by these officers in the compilation
of the history comprised official reports from the various divisions of the hospital center. The history is on file in the
Historical Division. S. G. O— Ed.
HOSPITALS
581
The construction of the center was left to a firm of contractors in Paris, on
January 31, 1918, and under the terms of the contract they were to furnish all
material which could be obtained in France and all labor possible. The actual
construction was to be done under the direction of an engineer officer, American
Expeditionary Forces. The construction work was begun on February 7, 1918,
but progressed very slowly during the first three months. In fact, so slowly,
that on June 15, 1918, when the commanding officer of the center arrived, the
only buildings completed were 6 wooden barracks in unit No. 10, and 5 barracks
in unit No. 1, partially completed. At this time about 20 hotels and other
buildings in Pouges-les-Eaus, about 11 miles from the Alesves center, were taken
over by the center and converted into a base hospital.
Fig. 112.— a row of wards, Mesves hospital center, during construction period
This delay in construction was largely due to difficulties in receiving
building material and transportation. A standard-gauge railroad siding was
built and numerous roads were constructed throughout the center before any
construction of barracks was begun. The first units to be partially completed
were Nos. 1 and 5, closely followed by 6, 10, 2, 3, 4, 7, and 8. Patients began
to arrive before the hospital buildings were completed, and many of these
were occupied with only a floor, walls, and a roof; there were no windows,
doors, plumbing, lighting, and heating facilities. However, they served the
purpose of shelter, which was a point of paramount importance. During the
last six months of 1*918 the construction work progressed fairly satisfactorily,
and by December 1 the first half of the center was practically 100 per cent
completed, and in the second half, units 15, 16, 12, 13, and 11 were partially
completed, were occupied, and cared for a full quota of patients. The con-
struction of the five remaining units was stopped with the signing of the
armistice.
582
ADMINISTEATION, A:MERICAX EXPEDITIONARY FORCES
The water supply at first was obtained from a well, which soon dried,
necessitating the use of water from the highly contaminated Mazon Creek,
which required the utmost care and supervision as to proper chlorination
before using. This continued until the latter part of October, 1918, when the
supply was augmented from the Loire River. In the latter part of November
all water was supplied by the pumping station on the Loire, with chlorination
at the source.
The sewerage system emptied into a clarification tank, constructed of
reinforced concrete, on the banks of the Loire about 2 miles from the center.
The construction of the sewerage system was very slow, and it was late in
Fig. 113.— Rock quarry, used in construction of Mesves hospital center
November before any of the units in the first half of the center had sewerage
connections.
The latrines of the center were operated on the pail system. Five Hors-
fall destructors and a central destructor were in operation until January, 1919,
when each hospital unit was supplied with a brick feces destructor. Some
garbage and wastes were disposed of by contract to civilians; the remainder
being destroyed in the central destructor. Later a type A hospital incinerator
was constructed in each unit.
At first only one disinfector, American Sterilizer Co. type, was available;
however, in August, 1918, two Thresh disinfectors were received, and these by
constant use took care of all disinfections. In December there were 4 portable
and 4 Thresh disinfectors in use.
The lighting system consisted of two 25-kilowatt General Electric sets
and one 50-kilo volt-ampere steam-driven plant. A permanent lighting system
OSPITALSH
583
was installed December 10, 1918, furnishing current of 110 volts to all build-
ings throughout the center and 220 volts to X-ray and operating buildings.
UNITS
On June 15, 1918, the commanding officer of the center arrived. On
June 23 the crew of Hospital Train Unit No. 26, consisting of 2 officers and 31
enlisted men, arrived, and were immediately assigned to work on unit 1, making
it ready for the reception of patients. On June 26, 6 officers and 60 enlisted
men, comprising Convalescent Hospital Unit No. 2, arrived at Pougues-les-
Eaux and were assigned to the newly leased hotels at that place. On this
date Convalescent Depot Unit No. 1 (the only one ever organized), consisting
of 2 officers and 5 enlisted men, also arrived. This constituted the Medical
Department personnel until July 18, when the Sanitary Squad No. 2, consist-
ing of 1 officer and 26 men, reported for duty. On the 23d the crew of Hospital
Train Unit No. 35 arrived.
The following organizations constituted the Mesves Hospital Center:
Sanitary Squad No. 44.
Sanitary Squad No. 50.
Sanitary Squad No. 78.
Sanitary Squad No. 80.
Hospital Train Unit No. 35.
Provisional Base Hospital Unit No. 3.
Provisional Base Hospital Unit No. 8.
Base Hospital Unit No. 44.
Base Hospital Unit No. 50.
Base Hospital Unit No. 54.
Base Hospital Unit No. 67.
Base Hospital Unit No. 72.
Base Hospital Unit No. 86.
Base Hospital Unit No. 89.
Base Hospital Unit No. 108.
Evacuation Hospital Unit No. 24.
Evacuation Hospital Unit No. 27.
Evacuation Hospital Unit No. 29.
ENGINEERS
Detachment 109th Engineers.
Engineer Train Unit No. 109.
Detachment 521st Engineers.
Detachment 529th Engineers.
Casual Engineers Detachment.
QUARTERMASTER CORPS
Quartermaster Detachment.
Detachment Bakery Company No. 2.
Detachment Bakery Company No. 314.
Detachment Butchery Company No. 328.
Detachment Laundry Company No. 323.
Detachment Laundry Company No. 324.
Pack Train Company No. 329.
ARMY SERVICE CORPS
Administrative Labor Company No. 2.
Administrative Labor Company No. 26
Administrative Labor Company No. 28.
Administrative Labor Company No. 90.
Administrative Labor Company No. 91.
Administrative Labor Company No. 134.
Administrative Labor Company No. 182.
MOTOR TRUCK COMPANY
Motor Truck Company No. 543.
MILITARY POLICE
Military Police Company No. 223.
ADMINISTRATION
HEADQUARTERS
The commanding officer established his headquarters in a set of buildings
known as the central administration group, and from here the entire adminis-
tration of the center was accomplished. The work was, as rapidly as possible,
divided into departments, and an officer assigned in charge of each.
584
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The officers composing the staff of the commanding officer and many of
their assistants, were taken from the various organizations within the center.
This personnel Hved in buildings provided for this purpose in the adminis-
tration group. The enlisted men composing the headquarters detachments
were secured from various sanitary squads, hospital train units, and casuals,
ordered to the center. These organizations, upon arrival, immediately lost
their identity as such and were amalgamated into the headquarters detachment.
Each organization in the center was allowed absolute freedom in adminis-
tering its own internal affairs, subject to existing regulations. Policies affect-
ing the entire command were controlled by the commanding officer of the
center.
SANITARY OFFICER
In addition to the center sanitary officer, each unit had a sanitary officer,
who was directly accountable to his unit commander but cooperated with the
center sanitary inspector. The center sanitary officer maintained a shop
where sanitary appliances were made and repaired.
QUARTERMASTER
The office of the center c^uartermaster was established July 13, 1918,
with 1 officer and 5 enlisted men. The personnel was augmented gradually
until early in January, 1919, when it reached maximum strength of 500 officers
and enlisted men and 600 laborers. The office eventually comprised the
following divisions: Personnel, finance, property, subsistence, bakery, laundry,
and salvage sections, and center purchasing agency.
MEDICAL SUPPLY DEPOT
This depot was organized in August, 1918. The major portion of the
medical supplies was received in carload lots from base storage stations and
the larger central depots, ranging from 10 to 15 cars per day. A spur track
permitted placing cars of supplies alongside the warehouse.
RAILROAD TRANSPORTATION SERVICE
This office was inaugurated on August 1, 1918. In addition to numerous
clerks and messengers, an engineer, fireman, conductor, and two brakemen
were added to operate the center switch engine. During its existence this
office handled 3,500 cars. In addition, 86 hospital trains were handled between
August 1, 1918, and January 1, 1919, and 1,600 transportation orders were
issued.
MOTOR TRANSPORTATION DEPARTMENT
This department was organized in the latter part of September, 1918,
when all transportation of the center was placed in a pool under direct control
of the motor transport officer. The transportation consisted of 127 trucks,
ambulances, and other vehicles.
RECEIVING AND EVACUATION SERVICE
On arrival of a train at the Mesves station, the center receiving and
evacuating office was so notified by the railroad transportation office. Mes-
sages, stating the number and kind of cases, were sent immediately to hospitals
HOSPITALS
585
of the center that were to receive patients. The motor transport officer was
also notified as to the number of the train and the prospective disposition of
the patients in hospitals. The assignment of patients to hospitals was gauged
by the kind of cases being received.
Up to January 1, 1919, 86 hospital trains arrived at the center, with a
total of 31,912 patients. Seventy-two of these trains came directly from the
evacuation hospitals at the front, arriving in an average time of 28 hours. In
addition to these patients brought by the hospital trains, a great many con-
valescents and slightly sick and wounded were received from near-by hospitals.
Upon arrival, patients were classified into class A, B, C, or D.
Prior to October 1, 1918, all evacuations, except class D, were made from
the convalescent camp, transfers to the camp taking place informally by returning
men to duty status from the hospital in which they had been treated. After
October 1, all class A and permanent class C men were evacuated directly
from hospitals, and class B and doubtful class C cases were sent to the con-
valescent camp. Class D patients were transferred to the base ports. Up to
January 1, 1919, the center evacuated a total of 28,456.
MEDICAL INSPECTOR
This department was opened December 20, 1918. Its object was con-
structive criticism and the rendering of assistance in the various departments
of hospitals. Particular attention was directed toward the administration
work of the organizations.
MILITARY POLICE
As regular military police were not available, a company was formed from
class A patients, and an officer for them was detailed from the Engineer regiment.
In addition to this company a traffic police detachment was organized, consist-
ing of 70 men under the direction of the fire marshal. The latter were employed
in policing, fire prevention, and as watchmen over quartermaster and medical
supply depots.
PROFESSIONAL SERVICES
MEDICAL SERVICE
The original conception of the center called for 20 hospitals, with a crisis
expansion capacity for a total of 40,000 beds. Such an immense plant necessa-
rily presented broad opportunites for classification of cases, and although but
little over half the number of patients originally intended were sent there, the
scheme of differentiation of the medical cases was maintained throughout. The
patients with pneumonia and severe infectious diseases were sent to specified
units; patients with influenza, gastrointestinal diseases, and gas poisoning to
another group, while in a third group the slightly ill were collected.
The distinctively influenza hospitals were cubicled. When shortage of
sheets was imminent, newspapers were employed most usefully to replace them.
Isolation was carried out, and incipient cases of pneumonia were transferred
promptly to the near-by pneumonia units.
The usual group of contagious diseases was divided between two hospitals.
Diphtheria, scarlet fever, measles, and mumps were treated in one, and epidemic
586
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
meningitis and typhoid fever in another. The grouping of other diseases
gradually took place.
An organization for control of diseases at the hospital center at Mesves was
a board consisting of the chiefs of medical and laboratory services and the
sanitary inspector, who met informally from time to time and devised preven-
tive measures, as required.
OPHTHALMOLOGY AND OTOLARYNGOLOGY
A consultant in otolaryngology was appointed in October, 1918. Each
hospital in the center had on its staff a qualified specialist in these branches, who
cared for the cases w^ithin his own unit.
MAXILLOFACIAL SURGERY
In October, 1918, a consultant for the center was appointed. He had direct
supervision over all maxillofacial cases and determined whether or not the per-
sonnel of the hospital where these cases were under treatment w^as capable in
every way to care for them, and ordered the transfer of any cases that needed
special care to the unit particularly designed for that purpose. A central dental
laboratory was established and operated under the direction of the consultant.
All available material and apparatus for the construction of splints and appli-
ances was grouped in this laboratory.
ORTHOPEDIC SERVICE
A consultant in orthopedic surgery for the center was appointed the latter
part of August, 1918. At this time two hospitals were selected for the reception
of orthopedic cases, but later it proved necessary to take over certain wards in all
other hospitals. The admission of fracture and joint cases was so great in
October that it became necessary to establish 16 fracture wards in various hospi-
tals. Owing to the fact that it was necessary to change dressings on all these cases
on admission, it was impossible for the ward surgeon to adjust splints, erect Balkan
frames, and apply extensions, so a splint team was organized, consisting of 1
medical officer, 1 sergeant, and 1 private. As soon as a ward began receiving
orthopedic patients this team was set to work erecting frames and suspending
the cases. Usually this work would be done for all the urgent cases in a day.
In a latter part of October a curative workshop combined with a splint shop
was opened. During its existence 658 special splints were manufactured. At
this time six reconstruction aids in physiotherapy arrived and were assigned to
duty in the fracture wards.
LABORATORY SERVICE
The center laboratory w^as opened August 3, 1918, its work being outlined
as follows: (1) Special pathology (gross and microscopic); (2) special bacteri-
ology (pneumococcus typing, typhoid and dysentery); (3) serology (agglutina-
tion and complement fixation reactions); (4) general board of health for center
(water analysis, carrier work); (5) preparation of media, purchase and requi-
sition of supplies.
All laboratory supplies arriving in the center (except those of Base Hospital
No. 44, at Pougues-les-Eaux) w^ere invoiced to the central laboratory officer
and isssued by him on memorandum receipts to the several unit laboratories.
HOSPITALS
587
CONVALESCENT CAMP
On July 17, 1918, a temporary convalescent camp was established in the
crisis expansion tents of one of the base hospital units. The first convalescent
patients were received on July 19. The construction of the permanent con-
valescent camp began on July 28, near Bulcy, northeast of the center. The
camp was occupied on August 7, before any of the permanent buildings were
completed.
The personnel at this time consisted of commanding officer, adjutant,
mess and supply officers, 2 medical officers, commanding companies, 1 con-
valescent line officer, and 35 men from Hospital Train Unit No. 35. By August
30, there were 1,030 convalescents in camp, and 131 tents had been erected,
each accommodating 16 men on cots. The administration building, officers'
quarters, and mess and kitchens were partially completed and occupied. On
September 19, Convalescent Camp Unit No. 4, consisting of 9 officers and 90
men, arrived, and the patients, now numbering 1,800, were organized into 6
companies. One medical officer was assigned to each company.
Admission and evacuation to the camp occurred almost daily, the admis-
sions always being larger, leaving an increasing balance in camp, until Novem-
ber 10, 1918, when the greatest number (2,859) was reached.
THE AMERICAN RED CROSS
In the early days the work of this organization consisted of distribution of
extra comforts in the wards, letter writing for patients, and searching work.
Later, 10 recreation halls were opened, equipped with stages, furniture, and
canteens. In addition to these, an especially large hall was equipped at the
convalescent camp. Also, halls were opened for the Red Cross personnel,
nurses, and others. Daily entertainments were furnished by six moving-
picture machines and various theatrical productions.
YOUNG men's christian ASSOCIATION
The Young Men's Christian Association provided a number of lectures,
musicians, and vaudeville artists. Baseball outfits, footballs, and basket balls
were also furnished.
CLOSURE
The center ceased operating in April, 1919, and was closed in May, 1919.
COMMANDING OFFICER
Col. Henry C. Maddox, M. C, June 15, 1918, to August 16, 1918.
Col. WilHam H. Moncrief, M. C, August 17, 1918, to January 30, 1919.
Col. Guy V. Rukke, M. C, January 31, 1919, to closure of center.
HOSPITAL CENTER, NANTES '
The hospital center at Nantes was organized July 29, 1918, at Doulon, a
suburb of Nantes. One base hospital unit (No. 34) was located at Nantes,
about 3 miles from the center proper. The group originally consisted of three
' The statements of fact appearing herein are based on the "History of the Nantes hospital center," prepared under
the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of
the history comprised official reports from the various divisions of the hospital center. The history is on file in the His-
torical Division, S. O. O.—Ed.
588
AD^rIXISTHATrOX, AMERICAN EXPEDITIONARY FORCES
base hospitals, Nos. 34, 38, and 11, and to these, on November 2, 1918, was
added Base Hospital No. 216, which had been organized from personnel in the
center. During January, 1919, Evacuation Hospitals Nos. 36, 31, and 28
relieved the three original base hospitals. In addition to the above units, the
following organizations served in the center: Sanitary Squads Nos. 39 and 59
and Ambulance Company No. 346.
Water was obtained through the city of Nantes from the River Loire, and
proved to be of good quality. Sewage was emptied into the River Loire,
after having first passed through a septic tank. Waste material was disposed
of in two type A incinerators constructed by the engineers.
The laundry at first was handled by contract, but as this proved unsatis-
factory, small hand laundries were installed in each unit and operated by
civilian laundresses.
ADMINISTRATION
The headquarters staff comprised the following divisions: Adjutant, quar-
termaster, sanitary inspector, evacuating officer, laboratory officer, fire marshal,
medical supply officer, and guard officer. The commanding officer in no way
interf erred with the internal administration of the units; his relations with
the hospitals concerned chiefly matters which were outside the jurisdiction of
the hospital commanders. The office of the group quartermaster was estab-
lished on August 15, 1918, and a subsistence and sales commissary on October
15. Supplies were easily procured as the quartermaster depot of base section
No. 1 was within 4 miles of the center, and all requisitions were promptly filled.
The medical supply depot was not fully established until October 15, 1918.
Supplies were usually received from intermediate medical depot No. 2, Gievres,
and base medical storage depot, St. Nazaire. The center laboratory occupied
a type A barracks and a subsidiary laboratory building, 20 by 40 feet. The
addition, connected with the main laboratory building, contained an ice chest
and autopsy and tissue rooms.
The duties of the evacuating officer comprised: (1) Receiving all patients
arriving at the hospital center, and by the use of bed reports from the various
hospitals directing them to the proper hospitals for admission; (2) file and
rendition of reports showing the number and nature of cases of patients in the
various classes in the center; (3) receiving and executing through the unit evac-
uating officers, the regulations and orders relative to the evacuation or final
disposition of all cases.
Prior to the arrival of a hospital train the evacuating ofl&cer was invariably
notified by telegram or telephone. Sixteen ambulances were kept available at
the center for the evacuation of patients from hospital trains. These trains
were sidetracked at the Doulon station, less than five minutes' drive from the
center. The patients on arrival at receiving wards were served hot chocolate
and other nourishments by the American Red Cross.
Evacuations to the United States were made through one hospital unit
(Base Hospital No. 216) which was designated as the embarkation or evac-
uation hospital for the center. Certain wards of that unit were set aside
as embarkation wards, and an embarkation office was opened, in charge of an
oflficer, assisted by an experienced clerical force. Each day this office notified
HOSPITALS
589
the various hospitals of the center the exact number of patients expected from
them on the following day. Before transfer to the embarkation department
these cases were paid, their records completed, they were equipped as for trans-
fer to any other hospital, furnished with wound and service chevrons and certi-
fied as free from venereal or contagious diseases and vermin. Upon admission to
the embarkation department, they w^ere organized immediately into convalescent
detachments of 50 or more, all their records checked and corrected, their money
exchanged for United States currency, and the passenger lists prepared.
Upon receipt of requisition for convoy of certain numbers of patients the
center evacuating officer made arrangements with the local railway transport
officer as to the hour of loading, necessary baggage cars, etc., and also notified
the local representative of the inspector general's office of the number of patients
to be evacuated and the time that patients' records and equipment would be
ready for final inspection, which was held not more than 24 hours prior to
entraining. After the final inspection, detachment commanders receipted to
the evacuation officer for the patient's records and equipment, and patients were
again checked on board the hospital train by passenger lists.
CONVALESCENT CAMP
The camp was opened on November 7, 1918, and was operated by Conva-
lescent Company No. 5. Seventy-two marquee tents, with a bed capacity of
1,000, were provided for the housing of patients. The camp functioned from
November 7, 1918, to January 9, 1919, during which time it admitted approxi-
mately 1,500 patients. About 30 per cent of these were restored to class A and
returned to their organization.
CLOSURE
The hospital center was abandoned and ceased to function on June 8, 1919.
COMMANDING OFFICER
Col. Thomas J. Kirkpatrick, M. C, July 29, 1918, to Alarch 16, 1919.
Col. Ralph C. DeVoe, M. C, March 17, 1918, to June 8, 1919.
HOSPITAL CENTER, PAU
A hospital center at Pau was authorized on September 3, 1918. It was
planned that this would be located in hotel buildings in several widely separated
towns in the Department of Basses-Pyrenees, near the Spanish border. Nearly
a month was required for inspection of the properties oft'ered by the French, and
not until October 16, 1918, were headquarters of the center opened at Pau.
Personnel and supplies had begun to arrive at the time the armistice w^as signed.
Four hospitals reported to the center during December, 1918. These w^ere
located as follows: Base Hospital No. 71, Pau; Base Hospital No. 98, Lourdes;
Evacuation Hospital No. 20, Dax; Evacuation Hospital No. 29, Bagneres-de-
-• The statements of fact appearing herein are based on the "History of the Pau hospital center," prepared under the
direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the
history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical
Division, S. G. O.— Ed.
590
ADMINISTKATIOX, AMERICAN EXPEDITIONARY FORCES
Bigorre. These hospitals never functioned, as orders were received on Decem-
ber 30, 1918, to abandon the center and the various organizations were ordenMl
to other stations.
COMMANDING OFFICER
Col. Adam E. Schlanser, M. C.
HOSPITAL CENTER, PERIGUEUX "
The hospital center at Perigueux was located in the valley of the Isle River
on both its banks, about 1 Yi miles above the city of Perigueux and about 90 miles
east of Bordeaux. The center was organized on September 16, 1918, and the
following organizations were attached: Base Hospital No. 84, Base Hospital
No. 95, Administrative Labor Companies Nos. 147 and 148, Motor Truck
Company No. 523, Sanitary Squad No. 75, Regimental Band, 136th Infantry,
Bakery Company No. 316, and half of Convalescent Company No. 12.
The roads in the neighborhood of this center were excellent. Buildings
occupied consisted of new construction distributed according to the type A plan
for base hospitals. Construction was of concrete throughout except nurses'
and enlisted men's barracks, which were built of wood. Five units were planned
for this group, two on the south side and three on the north side of the river, but
only the two units on the south side of the river were completed and occupied
when hostilities ceased.
Water was obtained from the Perigueux city supply, and was chlorinated at
the pumping station, two enlisted men being stationed at the pumping station to
supervise chlorinating the apparatus. In general the supply of water was
abundant, though occasionally difficulty was experienced for a few days at a
time. Separate lavatories and baths were provided for patients, personnel,
officers, and nurses connected with the sewerage system through a septic tank.
Garbage was readily disposed of to farmers, but it was found more profitable to
buy pigs and feed them the garbage. Two Horsfall destructors were erected.
They proved ample and satisfactory and were economical of fuel.
The operating pavilion was heated by steam; all other buildings were heated
by stoves. Coal was shipped from Bordeaux and there never was a shortage.
Wood was also provided in sufficient amount. Until November 20, 1918, all
electricity was furnished by a local generator and after that date, from the city
supply.
The various messes of the center were coordinated under the management
of a center mess officer. This permitted various economies and a more intel-
ligent use and division of the supplies which were obtained by the quartermaster
from Bordeaux. A central butcher shop was installed from which all organiza-
tions drew their meat, properly cut. A bakery company was established in
tents and made excefient bread. After this organization left, the source of
bread supply was Bordeaux, but this was not dependable. A laundry was
constructed early, but machinery was not obtained until after the armistice
» The statements of fact appearing herein are based on the "History of the Perigueux hospital center," prepared
under the direction of the commanding officer by members of his staff. The material used by these officers in the compila-
tion of the history comprised official reports from the various divisions of the hospital center. The history is on file in the
Historical Division, S. G. 0.~Ed.
HOSPITALS
591
began. Until then it was necessary to send laundry to the Beau Desert hospi-
tal center in trucks and ambulances, a circumstance which did not allow frequent
changes of linen.
The first hospital train arrived October 18, 1918, and up to March 1, 1919,
4,558 patients were received from 9 trains. Early in January the center was
designated as an orthopedic center, and 10 orthopedic surgeons reported for
duty. Evacuations were made by Hospital Train No. 68 to the Beau Desert
hospital center. This group was discontinued in May, 1919.
COMMANDING OFFICER
Col. Edward G. Huber, M. C.
HOSPITAL CENTER, RIMAUCOURT «
The hospital center located at Rimaucourt, Haute-Marne, occupied new
structures consisting of five type A base hospital plants, supplemented by
buildings to house the center staff. A railroad spur of three tracks was built
into the center, and hospital units were aligned along both sides of this spur.
The normal bed capacity of the wards was 5,000, but by erection of Marquee
tents this was more than doubled. On November 11, 1918, the center reported
10,338 available beds for patients and 1,675 personnel. A convalescent camp
and five additional sections were under construction when hostilities ceased.
The water supply was excellent and ample. A 50,000-gallon reservoir was
l)uilt on a clifl" about 1,000 yards from the camp, and two electric engines pumped
all the water that could be used. A system of plumbing conducted this supply
into nearly every building of the group.
A sewer system emptied all kitchen and bath wastes into a canal about
2,000 yards distant. Bucket type latrines were used in connection with Hors-
fall incinerators.
Electricity for illumination was obtained from a local French plant, supple-
mented by a small gas-operated electric machine that was provided for each unit.
One bakery capable of baking for 20,000 men and one laundry able to
care for a like number were also provided.
The following organizations composed the center: Base Hospitals Nos.
52, 58, 59, 64, 238; detachments. Quartermaster Corps, bakery company,
butchery company, laundry company, Motor Transport Corps, and labor
battalion.
The headquarters were organized into administrative and professional
staffs. The administrative staff consisted of the adjutant, quartermaster,
medical supply officer, sanitary officer, assistant provost marshal, post-office
officer, food conservation and kitchen technique officer, and railway transport
officer.
The professional staff consisted of a staff consultant, consultants in gen-
eral surgery, neurosurgery, orthopedics, oroplasty, urology, ophthalmology,
" The statements of fact appearing herein are based on the "History of the Rimaucourt hospital center," prepared
under the direction of the commanding officer by members of his staff. The material used by these officers in the compila-
tion of the history comprised official reports from the various divisions of the hospital center. The history is on file in the
Historical Division, S. O. O.—Ed.
13901—27 38
592
ADMINISTRATION, A:MERICAN EXPEDTTIONAKV FORCES
Otolaryngology, X ray, dentistry, neuropsychiatry, dermatology, laboratory,
and pathology. The staff consultant had no administrative power. His duties
were (1) to coordinate with the visiting consultants and to present his rec-
ommendations to the center commander; (2) to advise and keep the center
commander informed about every professional question and to act as his
medical inspector; (3) to advise changes in personnel so as to group special-
ists where their services were needed, and to report any excess of personnel;
(4) to arrange through base hospital commanders, by mutual consent, such
transfer of patients and personnel as might be desirable without the necessity
of issuing orders to accomplish this result. Upon receipt of notification of
the arrival of a hospital train, the staff consultant requested all hospital com-
manders to require such officers as were desired to report to him for orders.
The staff consultant and evacuation officer then decided where to "spot"
the train and gave necessary instructions to the rail transportation officer.
As soon as the train arrived the staff consultant assigned to each of three
or more cars, suitable teams of medical officers. These officers decided to
which hospital each patient was to be sent and gave him a slip of paper bear-
ing that number. The litter-bearer section followed the officers and evacuated
the train. Walking cases were not permitted to walk from the train to the
hospitals, but were transported in trucks.
Each commander of a base hospital kept two wards open for receiving
purposes. All beds in these wards were cubicled and all persons on duty
therein wore masks. As soon as admissions began, the surgeons in these
wards began the secondary triage, sending to the registrar and the disinfecting
station all cases ready for final disposition. At this triage, if it was found,
for example, that a man had been admitted to the respiratory infection hospital
when he should have been admitted to the gas hospital, the staff' consultant
was notified and transfer was effected.
The number of patients admitted to the center from date of opening on
September 14, 1918, to January 28, 1919, was 18,308. The center was discon-
tinued in May, 1919.
COMMANDING OFFICER
Col. Henry Page, M. C.
HOSPITAL CENTER, RIVIERA"
The origin of the Riviera hospital center was an urgent need for a location
for hospitals that would give the maximum hours of sunshine and clear skies,
even temperature, and the most stimulating atmospheric conditions within
practicable distance of the advanced areas. This was found in that strip of
coast line extending from Marseille to Men ton, called the Cote d 'Azure, or
Riviera, about 180 miles in extent, 5 to 10 miles in depth, facing the Mediter-
ranean Sea and sheltered by the Maritime Alps. Rainfall was limited and the
climate mild rather than hot. Aerial bacteriology was low and the general
atmospheric condition partook of the mingling of marine and mountain air. It
"The statements of fact appearing herein are based on the "History of the Riviera hospital center," prepared under
the direction of the commanding officer by members of his staff. The material used by these officers in the compilation
of the history comprised official reports from the various divisions of the hospital center. The history is on file in the
Historical Division, S. G. O.—Ed.
HOSPITALS
593
was too far from the scene of active operations to receive cases of recent injuries
or acute illness, and therefore all cases received were patients who had so
far recovered as to be able to stand a long journey. The center comprised
all the hospitals along the north coast of the Mediterranean from Toulon
to the Italian border, and functioned as a group of convalescent hospitals.
The number of these hospitals was 29.
The hospitals established by the American Expeditionary Forces were
located at Tamaris, Hyeres, St. Raphael, Cannes, Nice, Cap d'Ail, and Menton.
In each of these places commodious hotels were leased and changed to hospitals
fully equipped as regards both personnel and furnishings for the accomplishment
of the most modern work in medicine and surgery. A certain number of
acute medical and surgical cases developed among those who were on leave
or stationed in the area, and hospital equipment took cognizance of that
fact. All hospitals were established in hotels and no new construction was
attempted. Garage and warehouses were rented for purposes of supply.
Acquisition of hotel properties began in July, 1918. By September 1,
accommodations for 9,000 beds had been secured and by November 1, 1918,
12,000. On November 11, requests for locations for 6,000 other beds which
previously had been made were canceled.
The geographical location of hospitals made it advisable to establish five
groups, with one hospital in each group for acute medical and surgical cases,
and the remainder in each group for ambulant cases requiring but little treat-
ment or professional observation. Each group was organized as one hospital
for purposes of admission, transfer and discharge, and general administration.
Each building had its own personnel with a responsible administrative officer
under the group commanding officer.
Growp 1. — Hyeres, Department of Var (including Tamaris), consisted of
9 hotels, with a total capacity of 3,600. This group was first designated
Convalescent Hospital No. 1, but on arrival of Base Hospital No. 99, on No-
vember 26, 1918, the designation was changed to that of the base hospital.
Group 2. — St. Raphael (including Agay Var) consisted of 3 hotels, with a
total of 800 bed capacity. It was known as Convalescent Hospital No. 2
and was staffed by casual personnel. It opened January 4, 1919, and closed
January 31, 1919.
Group 3. — Cannes (including An tiles) consisted of 5 hotels, with 1,450
beds, and was known as Convalescent Hospital No. 3. On December 22, 1918,
this group was taken over by Base Hospital 93.
Group 4- — Nice (including Cap d'Ail) consisted of 3 hotels, with 2,300
beds, and was known as Convalescent Hospital No. 4.
Group 5. — Menton consisted of 9 hotels, with 2,700 beds. This group
was first started with casual personnel and was knowm as Evacuation Hos-
pital No. 5. From December 23, 1918, to February 13, 1919, Evacuation
Hospital No. 49 operated this group. The headquarters of the entire center were
located at Cannes, A. M., the organization being as follow^s: Commanding
officer, adjutant, personnel adjutant, urologist, historian, medical supply
officer, group supply officer, and motor transport officer.
594
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The records of the Riviera center embodied the daily, weekly, monthly,
and quarterly reports received from each unit commander throughout the
center. Reports were transmitted daily by the various units by a system of
couriers on motor cycles. This system, in conjunction with the telephone
and telegraph, was the main factor in the administrative control of the area
and made it into a compact unit, reducing the 220 km. which separated the
farthest situated groups from each other into a center linking all the groups
together. Under its efficient service the great distances were minimized, and
daily contact was maintained by headquarters with each group and by all
groups with one another.
Fic. 114.— Base Hospital No. 99, Ilyeres, Riviera hospital center
Patients were received from November 7, 1918, to April 1, 1919, a total
of 13,975 cases being admitted during this period. Patients were classified by
a disability board appointed for each unit by the commanding officer of the
center. Hospital trains were provided for transporting discharged patients.
Those for home ports were shipped direct to embarkation ports, others to
duty or special hospitals, as the case called for.
The exercise and training of men partially disabled through wounds
received in battle were under the supervision of the commanding officers of
the various units. Voluntary movements were insisted upon, which, with the
aid of massage and use of electrical instruments, greatly aided in restoring
parts, the use of which would have otherwise been lost.
HOSPITALS
595
Railroad transportation officers were assigned to Hyeres, Cannes, and
Nice on December 15, 1918, and handled all transportation for the personnel,
patients, and supplies for the hospitals. Men from the different rail trans-
portation offices met the incoming and outgoing trains and did all that was
possible to assist members of the American Expeditionary Forces while trav-
eling on the Riviera. Practically all patients were handled on regular United
States Army hospital trains. Thirty-four of these trains arrived during the
period the center was open. These trains parked at La Bocca, just west of
Cannes, where they were resupplied. When receiving patients, they were
"spotted" at Cannes, and patients from Menton and Nice were transferred
FKi. 115.— Base Hospital No. 93, Cannes, Kivicra hospital wnter
to that place for evacuation. The trains for Base Hospital No. 99 were
switched at Toulon and "spotted" directly to Hyeres.
Medical supplies for the center were received on requisition from the
supply depot at Cosne, Maramis, and the depot of base section No. 3. At
first, because of congestion of railroad transportation, supplies were often
delayed (the opening of this center had been delayed by inability to procure
supplies), but in February, 1919, a medical supply depot was established at
Cannes, and thereafter local requisitions of hospitals were filled promptly.
The Quartermaster Department began to function on October 29, 1918,
with headquarters at Cannes. A suitable warehouse was leased at the latter
phu'c and a depot established. Later, four subdepots were established for the
needs of the entire hospital center. At the beginning of the center the quarter-
596
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
master operated the post office and railway transportation until these activities
increased to such a great extent that a regular post office and a rail ti-ansportation
office were established. Repairs and improvements to hotels were made under
the engineer officer.
The American Red Cross attached workers to all the groups, where they
promoted the w^elfare of all persons in the center.
After November 11, 1918, properties were gradually returned to their
owners or made into accommodations for leave areas. No patients were
received after April 1, 1919, and evacuation began May 1, 1919, the personnel
leaving the whole area June 1, 1919.
Fir,. 116.— Evacuation Hospital No. 49, Menton, Riviera hospital center
COMMANDING OFFICER
Col. Haywood S. Hansell, M. C, September 12, 1918, to April 28, 1919.
Lieut. Col. Leopold Mitchell, M. C, April 29, 1919, to June 2, 1919.
HOSPITAL CENTER, SAVENAY "
The hospital center of Savenay was located in the city of that name, about
18 miles northeast of St. Nazaire. Its construction was authorized by the
commander in chief in February, 1918, and was to consist of 15 type A base
hospital units and 1 base hospital in the normal school of Savenay, w^hich had
« The statements of fact appearing herein are based on the "History of the Savenay hospital center," prepared
under the direction of the commanding officer by members of his staff. The material used by these officers in the com-
pilation of the history comprised official reports from the various divisions of the hospital center. The history is on file
in the Historical Division, S. G. O. — Ed.
HOSPITALS
597
been in operation since August 21, 1917. A convalescent camp, the so-called
type C hospital, was also authorized, with a capacity of 5,200 beds. The
center was organized on August 5, 1918, when the commanding officer of Base
Hospital No. 8 was also appointed commanding officer of the Savenay center.
On that date his staff consisted of an adjutant, quartermaster, evacuating
officer, and a sanitary officer. Later the organization of the center head-
<|uarters was as follows: Commanding officer, executive officer, adjutant's
department (2 assistant adjutants), evacuation officer (1 assistant), receiving
officer (2 assistants), personnel adjutant (1 assistant), service record division,
inspector (3 assistants), maintenance officer, sanitary inspector (4 assistants),
center laboratory officer (3 assistants), medical supply officer (1 assistant),
motor transport officer, hospital train replenishment depot, orthopedic con-
sultant (2 assistants), dental supervisor, historical officer, athletic director.
Fig. 117.— Airplane view, Savenay hospital center
entertainment director, disability board, quartermaster (8 assistants). Ade-
quate elements of the center staff were kept on duty during the night so that
there was no interruption of its central service.
The following Medical Department units formed the center: Base Hospi-
tals Nos. 8, 29, 88, 100, 113, 118, 119, 214, Hospital Unit F, field hospital
company. Ambulance Company No. 345, 87th Division. The eventual capac-
ity of the center was to be 25,000 beds. This program was never fully
realized because of the termination of hostilities.
All the unit buildings which were built by the United States Engineers
consisted of demountable sectional barracks and plaster-block structures. To
build and maintain the unit shops were established, a garage, stable, and
two large freight yards were built. Several miles of standard-gauge track were
598
ADMINISTRATION, AIMERICAN EXPEDITIONARY FORCES
constructed and spur tracks laid to connect the various units of the center.
About a mile and a half of roads were built in the units. Each unit was con-
nected by telephone with a central exchange, installed by the Signal Corps.
Electric power was obtained from a French producer at St. Nazaire.
Each unit of 1,000 beds had a 50-kilowatt capacity, the convalescent camp
25-kilowatt, and the tuberculosis camp 5.
During the early days of the center most of its important work was carried
on by Base Hospital No. 8, which was the first unit assigned to this center. As
each new hospital unit was constructed and made ready for patients, it was
given a number as a unit of Base Hospital No. 8, and its activities were carried
on that hospital's records until personnel of a base hospital arrived from the
United States to continue its functions. Thus, when a new unit reported for
duty it was assigned to take over some provisional hospital already operated
by Base Hospital No. 8.
The shortage of water was very serious until a dam was constructed.
This dam, of reinforced concrete, was built across a small valley between two
hills, forming a reservoir, which had a total capacity of about 140,000,000
gallons. It was completed April 10, 1918. An additional reservoir was
planned and built, but due to the signing of the armistice was never used.
Sewerage for the service of three units was taken care of by an Imhofl"
type tank. In the units not having sewerage connections the contents of
latrine pails were collected each day in cans by prisoners of war, and carried
by truck to a gravel pit.
Clothing and equipage were difficult to obtain during active operation,
but after the armistice this shortage was relieved. An excellent laundry was
in operation, which averaged 450,000 pieces of laundry per month. A modern
bakery was constructed which supplied all bread for the center. From October,
1918, to March, 1919, this bakery produced 5,094,438 pounds of bread.
The medical supply depot was instituted on September 12, 1918. This
organization completely equipped and maintained all the hospital units in the
center, served as a base of supply for all hospital trains entering that area, and
furnished medical supplies for prisoner of war companies and engineers doing
duty near the center.
The location of Savenay, within one hour by rail of the port of St. Nazaire,
and only seven hours from Brest, made it particularly important as an evacua-
tion center.
The problem of receiving and admitting patients to the hospitals of this
center was at first handled by a receiving officer from each hospital in rotation,
each assuming the work for a definite period of one or two days, and then being
succeeded by the receiving officer of the hospital next on the list. Since the
functions of certain of the hospitals of this center were of a special character
(e. g., Base Hospital No. 88 cared for all venereal cases, Base Hospital No. 118
all cases of tuberculosis, and Base Hospital No. 69 the very seriously wounded
litter cases), it was always necessary that a classification of the patients be made
upon arrival of each hospital train. A more satisfactory system was finally
developed when a center receiving officer, with 2 junior officers and 8 enlisted
men, was appointed. The receiving officer met the incoming trains, with such
HOSPITALS
599
a number of men that one could be assigned to each car. The receiving officer
went through the train, inspected the field medical card of each patient, and
decided to which hospital he should be sent. With the officer a sergeant was in
attendance, carrying a box of tags of various colors, each color representing a
different hospital. When the officer decided to which hospital a patient should
be assigned, the sergeant tagged him accordmgly.
While this work w^as going on, the men assigned to the several cars of the
train made a nominal list of every patient, showing rank, serial number, diag-
nosis, hospital of origin, and hospital to which assigned at Savenay. These lists
were then turned in to the records office of the hospital center in order that
admission cards might be made for file and other purposes of record. The
greater percentage of .patients arriving at the Savenay hospital center came on
hospital trains, but there was always a certain number coming by way of trench
trains of the regular passenger service type, and also some who came by motor
transportation. Also some were admitted from the personnel of the center. All
of these patients, no matter from what route admitted, were required to pass
through the center receiving office in order that they might properly be classified
and assigned, and in order that record might be made of their admission in the
center records office.
Each hospital of the centei- also maintained its own receiving office, but the
receiving officer of any of these hospitals was not allowed to accept a patient
until he had been through the regular channel of the center receiving office.
In the early days of the hospital center, all evacuations made from Savenay
were handled through Base Hsopital No. 8 and passed through the records of
that hospital.
Prior to November 11, 1918, all American Expeditionary Forces patients
returned to the United States on surgeon's certificate of disability w^ere evacuated
through Savenay. Until that date efforts of the Medical Department were
directed to sending men back to duty where possible, and large numbers of
evacuations were made to the convalescent camp and from that camp back to
duty.
After Noveml)ei' 11, 1918. instructions w^ere so modified that many patients
who under previous rules would have been sent to duty in class B, were returned
to the United States.
The evacuation service at the hospital center, Savenay, increased after the
armistice began to such an extent that the simple measure theretofore employed
proved insufficient, and the work was centralized under the direction of a center
evacuating officer. Each hospital, however, retained its own evacuating officer
also, and the center, together with the individual units, combined to form one
great evacuation hospital. The operation of the system of evacuation now^
adopted was as follows:
A representative of the base surgeon at St. Nazaire,or at Brest — for evacu-
ations from Savenay were made through both of these ports — on learning that a
vessel was ready for hospital service and able to accommodate a certain number
of patients, would telephone to the center evacuating officer to the effect that
accommodations were in readiness for a specific number of patients of certain
types which he specified. He might designate, for instance, that there were
600
ADMIXISTHATIOX, AMERICAN EXPEDITIOXAHV FORCES
accommodations for 30 litter cases, 60 ambulatory surgical rec^iiring dre6sin{;>.
210 medical and surgical patients in standees, 590 medical aiid surgical cases
not requiring attention, and 20 mental cases requii4n^ restraint. The evacu-
ation officer of the center would call upon the -"evacuating officers of the
various hospital units telling them how many and what class of patients he
would require from their respective hospitals. In order that he might know
just what he reasonably could call for, a morning report was supplied by each
hospital, showing the number and classes of patients ready for evacuation.
From these reports the center evacuation officer would know the number and
character of patients in each unit ready for evacuation.
As soon as they had received the patients, the evacuation officer of units
sent the patients' records to the central evacuation office.of the center, in order
that passenger lists might be prepared. These lists carried the patients in
consecutive numbers for the entire center, giving the quota from each hospital
on a separate sheet, and showing at the head of that sheet the organization from
which' each patient came. It was the duty of the evacuating officer of each
hospital to see that the patients whose names were sent in on the passenger lists
were fully prepared ready for evacuation in every respect. In order to insure
uniformity in evacuation, the following method of procedure was prescribed :
PKOCEDURE OF EVACUATION OF PATIENTS FOR EMBARKATION FROM HOSPITAL CENTER,
SAVENAY
1. When the number of patients for Brest or St. Nazaire is known, the capacity blank
is filled out, apportioning cases to the various hospitals according to the classified morning
report of evacuable cases.
2. Determination of number of detachments of ambulatory sick and wounded.
3. Determination of number of officers and attendants needed for officers, nurses, litter
cases, and mentals (not formed in detachments).
4. Requisitions:
(1) Records of patients from various hospitals (Form E-1).
(2) Detachment commanders and attendants to be furnished l>v personnel adju-
tant (Form E-4).
(3) Hospital train from regulator of hospital trains and supplies, a copy of the
requisition to R. T. O., Savenay, also for baggage car (Form E-5).
(4) Retiuisition patients (Form E-2).
5. Record envelopes to be brought to evacuation center by evacuation officers of several
hospitals, and histories and records checked at this time. Check passenger list.
6. Send copies of passenger list to various hospitals and tag patients.
(1) Duty of "taggers" from center to note any colored men tagged and not so
marked on passenger list.
(2) To check patients requiring dressings, and see that they are properly tagged.
(Exception: Passenger list will be delivered to Base Hospital No. 214, but the
patients are not checked or tagged by evacuation center.)
7. Submit data for special orders to orders department.
(1) Patients, officers, nurses, enlisted men.
(2) Data of attendants and detachment commanders to orders department from
personnel adjutant at same time it is sent to evacuation center.
8. Notify quartermaster of several hospitals by phone and memo to commanding offi-
cers of several hospitals of number of car and place of loading baggage (Form E-3). No
baggage to be loaded unless checker is present from the evacuation center.
9. Block out convoy for the several trains on block (Form E-6).
(1) Confer with commanding officer of train as to any reasons for not loading as
blocked.
HOSPITALS
601
10. Loading .of train:
: " [ ' (1) (ap. Evacuation officers will instruct ambulatory patients before coming to
evacuation center to .entrain to look for the corresponding number of their little
tag.^on the block at e^eh stall in the evacuation center; for example, Car A-1, Nos.
A-1 to A-36. This stall would include all patients numbered A-1 up to A-37.
(6) That when they are placed in the stall, to remain there. When going aboard
the train remain in the same numerical order to facilitate detraining
(c) To remain in line and not wander about or lean on rail during inspection,
but to cover off in column of twos and stand at attention while being inspected.
(d) To be quiet and orderly and assist in hastening their departure.
(e) That there will positivelv be no smoking while waiting to entrain.
(2) Load.
11. Record check.
(1) Pull out record envelopes of cross-offs.
(2) Correct Navy copy.
(3) Correct base surgeon's copy.
(4) Correct train commander's copy.
(5) Correct commanding officer of detachment's copy.
(6) Send 16 uncorrected copies of port personnel adjutant with memorandum of
serial number of cross-offs on St. Nazaire convoy. (Send only 6 corrected copies
to Brest with memorandum to commanding officer, hospital center, Kerhoun, of
serial number of cross-offs.)
(7) Send memorandum to Navy officer on second train, giving serial numljcr
of cross-offs, if part of a detachment has gone on a previous train.
(8) Place aboard all records of complete detachments loaded. (If a part of a
detachment is loaded, all records will go on train on which remainder of this detach-
ment is completed.)
(9) Complete train commander's block of train.
(10) Complete detraining officer's block of train.
(11) Complete senior detachment commander's l:)lock of train.
(12) Furnish all information required by inspectors as to detachments and
number of patients loaded.
12. Report to orders department exact number of cases leaving on train for telegram
wiien convoy goes to Brest. Call Brest by telephone.
*******
The work of the hospital center, instead of decreasing after the armistice
began, was greatly augumented because of the closure or contraction of base
liospitals farther forward and the evacuation of casualties toward base ports
with a view to their return to the United States. Hospitals composing this
center were therefore filled. This condition continued until the month of
March, 1919, when there began to be some diminution in the number of patients.
This center was in effect an evacuation hospital for the American Expeditionary
Forces and cleared a much larger number of patients than did any other for-
mation which was engaged in this service.
The following table gives the number of patients evacuated from the
hospital center at Savenay, to and including July 31, 1919.
St. Na-
zaire
Brest
Bor-
deaux
St. Na-
zaire
Brest
Bor-
deaux
1917
November
3
234
83
239
350
202
384
90
35
510
1918
January
1, 172
3,531
6,410
5,022
5,092
4,449
4,518
5, 019
3, 140
60
2, 571
4,205
989
3, 885
5, 332
6,048
4, 807
3, 578
4,731
251
1918
January.
Do
Do
Do
1919
Do
Do
February
124
Do
March
Do
April
Do ......
692
1,590
2, 680
May
Do
June... ---
Do
July
Grand total of 82,026 patients to the United States. To duty and replacement through this center, 8,696.
602
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The chief consultant of the medical service, under date of letter of June 6,
organized teams for treatment of gassed cases. These were designated gas
teams and consisted of 1 medical officer, 2 nurses, and 2 enlisted men. August
17 it was decided to use these permanently for treatment of surgical shock and
should consist of 1 medical officer, 1 nurse, and 1 enlisted man. On September
5 this designation was changed to emergency medical teams.
Surgical teams were furnished for the front and for hospitals in the center.
Infected cases were isolated in tents; also suspects and observation cases. Tent
colony plan was for infected cases. Labratory and X ray was used and many
patients were returned to duty. Class D cases were evacuated to the United
States. A tuberculosis camp was erected and taken over by Base Hospital No.
118, on January 25, 1919.
ORTHOPEDIC DIVISION
The designation of Savenay as a center through which all orthopedic
patients must be sent from the American Expeditionary Forces to the United
States had a considerable effect in determining nearly all of the activities in that
specialty in this area. An orthopedic department of the surgical division was
established in this center in February, 1918. At the beginning Base Hospital
No. 8 was called upon to perform such hospital duties as ordinarily fell to a base
hospital. In making the first response to demands for convoys to the United
States, patients were evacuated in much the same way as from other base hos-
pitals. It w^as soon discovered, however, that special preparation would be
necessary in the case of patients with battle casualties who were to travel to
the United States — that at least certain types of treatment must be given
beforehand, and that certain provision must be made against discomfort and
danger of complications on the way across.
Because of the character of the wounds and the condition in which patients
arrived at a point as far from the front line as Savenay, it was subsequently de-
cided by the chief surgeon that special responsibility for these patients should be
given to the orthopedic department. The entire policy was not determined at
once, but after about August 1, 1918, a detailed scheme w^as worked out in which
the Savenay hospital center had a principal part. Thereafter patients received
the treatment necessary and were prepared in such a w^ay that many thousands
were transferred w^ith comfort and safety from Savenay to hospitals in the
United States.
During August a more comprehensive plan than that which had been in
operation theretofore for orthopedic cases was established. A change in policy
with regard to classes of patients to be evacuated to the United States was
inaugurated. Changes in staff were effected, and it w^as directed from head-
quarters, August 20, 1918 (Circular No. 46, office of the chief surgeon, A. E. F.),
that the orthopedic department should be responsible for the surgical treat-
ment, corrective and otherwise, of all bone and joint injuries, amputations,
tendon injuries or inflammations, flatfeet, spine injuries, and general bad posture.
The bone and joint injuries included fractures. The orthopedic department
was made responsible for the necessary treatment, but more particularly for
the adjustment and splinting of all such cases, so that the patients could be
transferred to the United States.
HOSPITALS
603
During the first two weeks under the new regime about 400 orthopedic
patients had to be splinted and consigned to convoys for transfer.
One effect of this was to exhaust at once the supply of splints available in
Base Hospital No. 8. Splints were almost impossible to obtain at the moment,
and improvised splints and plaster of Paris had to be used. The situation was
greatly ameliorated by the voluntarj" efforts of a number of the patients who,
under the direction of two of the enlisted men of the Medical Department,
made hundreds of hand cock-up splints, splints for the support of drop-foot and
even the more complicated finger extension and flexion splints and airplane
splints.
These splints were made mostly of wood, but the salvage department was
called upon to furnish shoes and other necessities. The iron bars of mosquito-
bar supports which had been condemned were converted into splints, entirely
satisfactory in every way, except that they lacked the finished appearance of
the usual article.
Base Hospital No. 8 now accommodated about 3,000 patients. Immediate
segregation of orthopedic patients being apparently impossible, one of the first
requirements of the department was a system by means of which all such
patients could be located and cared for. This was undertaken both for the
benefit of the patient and to avoid delay in making up passenger lists for con-
voys. The four features found necessary to establish in this connectoin were
as follows: (1) The cataloguing and inspection of every orthopedic patient as
he entered the hospital; (2) the written opinion of every medical officer on the
patients that he saw; (3) the centralized splint and plaster-of-Paris room, to
which walking patients w^ere brought for treatment; (4) a card index catalogue
with a follow-up system by which recommendations made by medical officers
were checked up and controlled until the patient was pronounced fit for transfer.
The first centralized splint room or dispensary, established about September
1, 1918, proved one of the most helpful features. In the course of a few days
it reached a capacity of from 30 to 50 patients daily. On one Sunday, after
receiving a large convoy, over 100 patients were splinted and had plaster casts
applied during the day. Walking patients principally, but also a few cot
cases, were brought to the splint room from all the wards and cared for by
the surgeons in attendance, as in any dispensary clinic. At this time the
number of new orthopedic patients arriving at Savenay was about 70 per day.
From the beginning, patients were rechecked as they were sent to the
trains leaving the hospital. Occasional defects in splinting were in this way
caught up and remedied as the patients departed. After the first fortnight
practically every patient in each convoy had been carefully and adequately
splinted, whether for the needs of immediate treatment or for protection
during the journey to the United States.
Also, by w^ay of suggestion to medical officers and nurses into whose
hands the patients passed on their way home, tags were printed and attached
to the splints on the patients' departure from the hospital. The following are
given as illustrations:
604
ADMINISTRATION, AIMERICAN EXPEDITIONARY FORCES
Tag 1, for Thomas humerus traction splints:
The arm is to be kept securely bandaged into splint at all times. Only the bandage
immediately over the wound is to be removed for dressings. The hand is to be kept in
supination and dorsiflexed. The elbow is to be kept at or slightly beyond a right angle.
Tag 2, for Thomas femur traction sphnts:
Please do not release the traction or lift the leg out of the splint for dressings. Heniuve
bandages only immediately over the wound and keep all others and the traction tight and neat.
The exact methods employed in dealing with patients on admission may
best be illustrated by quoting from a circular which was published from the
headquarters of the orthopedic department October 15, 1918. The circular
was published following the completion of a plan by which an extensive segre-
gation of patients according to diagnosis had been made and the patients
placed in groups in special wards. The first special wards to be provided were
those for fractures of the femur and for amputations. These were provided
during September. The obvious advantages of this plan led to the approval
by the commanding officer early in October of a larger plan, by means of which
more than 1,400 beds were set aside in Base Hospital No. 8, with special wards
for leg fractures below the knee (64 beds), battle injuries of the knee-joint
(32 beds), gunshot wounds and fractures of the upper extremities (256 beds),
gunshot fractures of the femur (196 beds), and amputations (250 beds), etc.
The following is the plan outlined in the circular issued October 13, 1918,
to be used in receiving patients:
(a) Patients will be admitted from the receiving room to wards A-1 to A-15 and to
ward 5 in the following groups.
(b) No patients are to be admitted to the B wards. These will be reserved for patients
who arc ready for transfer to the United States.
A-1 (64 beds) : Miscellaneous (for cases in regard to the diagnosis of which the receiving
office is in doubt).
A-2 and 3 (98 beds) : Amputation cases.
A-4 (32 beds) : Knee-joint injuries.
A-5 (64 beds): All injuries of the upper extremities, including shoulder injuries.
A-10, 11, 12 (196 beds): Fractures of the femur. (Femur cases will be evacuated
direct from these wards to the train.)
A-15 (64 beds): Foot injuries.
Ward No. 5: Will remain, at present, a ward for miscellaneous orthopedic cases.
On the morning following the patients' admission to Savenay, special buff cards for
the orthopedic service will be distributed. They will contain the patient's name, number,
unit, date of admission here, and diagnosis. They are to be completed in the manner indicated
by the following:
[Sample card]
"Yes" or " No"
Name, Doe, John. Rank, Pvt.
Date, Oct. 15/18. No. 1,000,000. Unit, Co. I, 10 Inf.
Diagnosis G. S. W. left leg with F. C. C. femur and injury to sciatic nerve. (Diagnosis
number) 27-31.
Condition 1, 2, 3, (4). (Notes) No splint. A. B. C, (D). Treatment: Thomas splint.
(Initials of medical officer.)
Hospital: 1 2 3. B. H. 4.
Condition as to readiness for transfer is indicated by writing on the margin of the card,
as follows:
"Yes," if no treatment is required and case is ready for immediate transfer.
HOSPITALS
605
"No," if splinting is reqviired and case will be ready for immediate transfer after the
required splinting is completed.
"No," if prolonged treatment is required to prepare case for evacuation.
Diagnosis numbers are entered in accordance with charts of diagnosis numbers already
])repared (an arbitrary code).
Condition: (1) No splint required and wearing none; (2) wearing satisfactory splint;
(3) wearing unsatisfactory splint; (4) wearing no splint, but needing one.
A, B, C, D: Classification as to nature of disability.
Hospital: Number of hospital through which patients have successively passed should
be entered here, space (3) being for hospital from which cases have been transferred to this
center. These slips must be finished and returned to the orthopedic office before noon of
the same day. There must be no exceptions to this rule.
Patients admitted during the preceding 24 hours, who are found to require radical
clianges of splint or other application of new splints, may be sent at once or during the
afternoon from 1.30 to 4.30 to the plaster of Paris and splint room, where special medical
officers will be on duty to deal with them. The splint or plaster cast recommended should
he indicated on the special splint prepared for this purpose and should accompany the patient.
In case of doubt, regarding the exact operation or procedure to be used in the treatment of
any patient, it is expected that the services of the orthopedic consultant or some one desig-
nated by him will be called for. Certain standard methods have been evolved for dealing
with these conditions; but in this center, particularly with both treatment and evacuation
in mind, careful judgment must be used in order that the best interests of the patients may be
served.
During the period of waiting for evacuation for most of the patients and during the stay
in the hospital, extensiveuseisto be made of the services of the reconstruction aides. Walking
patients are to have exercise and massage in groups and must be sent to the orthopedic
department with special notes as to treatment suggested, at certain hours, as indicated in
the following schedule:
(o) Patients with median, musclospiral, and ulnar nerve injuries, 10.30 to 11.30 every
morning.
{b) Patients with knee-joint injuries for knee-joint, thigh, or leg massage, 1.30 to
2.30 p. m.
(c) Patients with sciatic, external popliteal, or other nerve injuries of the lower extrem-
ities, 2.30 to 3.30 p. m.
(d) Patients with elbow injuries for forearm, hand or finger exercises, 3.30 to 4.30 p. m.
Other reconstruction aides (occupational) will be available for directing the employment
of bed patients. Any note directed to the consultant in orthopedic surgery on this subject,
as to dealing with the individual patients or wards as a whole will receive prompt attention.
These points with regard to the records of these patients must be strictly complied with:
(a) The admission cards must be completed before noon of the day following the
])atients' arrival at the hospital, and the cards must be sent to the orthopedic office.
(6) The patient's condition, when admitted, and the first recommendations must be
entered the same day on the field medical card so that the field medical cards, as the patients
proceed from admitting wards to the evacuating wards, will be complete in so far as Base
Hopsital No. 8 is concerned.
id) The orthopedic office must be supplied at 9 o'clock each morning by the medical
officer or the luirse in charge of each ward with names, identification numbers, and organiza-
tions of all patients admitted to or discharged from the wards, above mentioned, during the
24 hours up to midnight of the day preceding. Lists of the wards will be checked every
morning in the orthopedic office as to whether or not these reports have been received, and
the reports must be sent before 9 o'clock without fail.
The care of patients with battle injuries was always so large a problem,
especially at this center, that it was important to lay aside all personal and
departmental considerations. To a large extent this was so successfully accom-
plished that it was considered one of the principal reasons for much of the work
done at Savenay.
606
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
One of the earliest, as well as one of the most important features of the
orthopedic service at Base Hospital No. 8 was the installation of the amputa-
tion service. Three principal features were to be noted in the inauf^uratioii
and development of this service: (1) The treatment of all unhealed stumps by
skin traction devices in an effort to preserve the length of the existing stump.
This plan did away immediately with many reamputations and contributed
greatly to the comfort and welfare of patients with stumps that were not heal-
ing properly. (2) The organization of physical training classes. In these
men were taught balancing to strengthen the remaining portions of the ampu-
tated extremities, and to protect themselves against the tendency toward con-
tracture deformities. (3) The application of provisional artificial limbs to
accomplish the immediate replacing of a man on his feet, the exercise and shrink-
age of stumps, and the preparation in all other ways of the men for the perma-
nent prosthetic device to be applied upon his return to the United States.
In undertaking to provide provisional artificial limbs for all the patients
with leg amputations, the American Expeditionary Forces took an advanced
position. The amputation department of Savenay hospital center undertook
to apply to every man with leg amputation a provisional artificial limb before
he left for the United States. Such limbs were prepared in a manner first
popularized by the Belgians more than two years previously and since exten-
sively used by the British. In American hospitals, however, these artificial
limbs were fitted earlier and more universally. Ready-made devices were sup-
plied for both above and below knee amputations. These were fitted to the
stump by the construction of a plaster-of-Paris bucket. This was made on the
patient himself and the mechanical devices were built into the bucket as it was
applied. In the case of amputation above the knee, the artificial extremity
had a crude knee joint, which enabled the man to bend the leg when he sat
down. This was locked without removing the clothing when he arose from a
sitting position. During September about 75 of these artificial legs were applied.
About October 1, however, the number had grown to average about five a day,
and in every convoy a very considerable number of men were being sent with
these temporary artificial limbs, upon which they were walking very well.
During the first four weeks of the operation of the orthopedic service,
1 ,904 patients passed through the department. These were received from about
50 base hospitals, camp hospitals, and other medical organizations throughout
France. Thirteen hundred were splint patients, of whom a few more than one
thousand had splints readjusted or applied for the first time at Base Hospital
No. 8. Five hundred and eighty-one had their splints applied for the first
time at this hospital. Twelve hospitals sent more than 100 patients each to
Base Hospital No. 8 on their way home to the United States.
Of the 1,904 patients, about 500 had wounds of the upper extremity and
about 350 wounds of the lower extremity. These consisted chiefly of com-
pound fractures, although a considerable number had wounds of the soft parts
including nerve injuries without bone damage. There were about 100 with
injury of the median, musculospiral, or ulnar nerves and about 50 with injuries
of the sciatic and external popliteal nerves.
HOSPITALS
607
The conditions most commonly presenting themselves for operative or
splint treatment were in general as follows: (1) Adduction deformity in upper
arm and shoulder injuries; (2) fixation of the elbow, usually with the arm in
extension; (3) drop- wrist in musculospiral injuries; (4) fixation of the hand
and fingers, usually in extension in gun-shot wounds of the wrist and carpus;
(5) femur shortening (in a number of cases as much as seven or eight cm.);
(6) malunion of both femur and leg fractures; (7) drop-foot due both to nerve
injuries and to leg, ankle and tarsal injuries; (8) flexion contractures of all
sorts due to soft part wounds.
Separate wards, about 180 beds, for compound femur fractures and 160
for amputations w^ere set aside. Other orthopedic conditions were treated in
other wards as they came. Staff meetings of the entire surgical staff and the
hearty cooperation of other departments made improvement in the care and
transfer of the patients rapid and fairly easy. In the case of some of the
larger convoys, surgical officers were detailed to accompany patients to their
port of debarkation for the United States or even to the other side.
The attitude of the orthopedic service at Savenay hospital center toward
convoys of its patients going to the United States were largely determined
by the visit of the chief consultant in orthopedic surgery to certain convoys
leaving Brest about the middle of August, 1918.
During September, at the request of the commanding officer of the center,
one of the transports leaving St. Nazaire was visited and inspected. The
following letter is a report of that visit :
American Expeditionary Forces,
Base Hospital No. 8,
September 15, 1918.
From: Chief of the orthopedic service.
To: The commanding officer.
Subject: Condition of patients for transfer to the United States.
Reporting on the condition of patients on board the , visited on your instructions
this afternoon, the following is respectfully submitted:
1. Patients leaving the hospital at 10 p. m. last evening were placed on the boat between
the hours of 0 and 10 this morning. Splints and apparatus were in good condition. No
surgical dressings had been done since the patients left the hospital.
2. All splints had tags of instructions attached. The medical officer on the boat had
deferred the surgical dressings until our arrival. He was in doubt as to the method of dealing
with surgical dressings for patients in splints (samples of tag instructions are attached hereto
for your information).
3. A number of the bed patients should have been dressed this morning. The ambu-
latory patients were all in good condition.
4. No medical officer or Hospital Corps men were found who had previous experience
in dealing with this class of patients, a considerable number of whom were elaborately splinted
and required daily surgical dressing. For these patients to travel in comfort and safety
it is necessary that the dressings be done without disturbing the splints and that the staff
of surgeons and orderlies be adequate even under unfavorable conditions.
5. It is suggested that hereafter a medical officer accompany these patients until the}-
are on board the boats, and at least until they have had their first surgical attention. Also
that arrangements be made so that in the case of larger convoys a medical officer from the
hospital, with special experience in dealing with this class of patients, should accompany
them to their destination.
13901—27 39
608
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Thereafter medical officers, one or more, were assigned to almost every
convoy. During January, 1919, instructions from headquarters provided
that every 150 patients must be accompanied by a medical officer in charge.
When other hospitals were located in the Savenay hospital center, the
lessons that had been learned by the experiences of Base Hospital No. 8 were
applied to the new organizations. Admission slips were completed in the
same way. Patients were examined promptly and as far as possible dealt
with immediately. Tab reports upon the condition of patients as they arrived
at the boats for transportation and even the reports upon the condition of
patients as they landed in the United States were studied for suggestions as
to the best methods of treatment, splinting, etc., to be employed in dealing
with these patients during the period which they spent in Savenay preliminary
to departure.
In the meantime, also, statistics had been compiled with a view of deter-
mining particularly the incidence of the different casualties and the condition
in which they presented themselves at Savenay. It was found that consider-
able numbers of patients, in some instances as high as 40 or 50 per cent, required
extensive alterations of position, with new splinting, or even operation, by way
of preparation for transfer to the United States. This was due, of course, to
the extraordinarily difficult conditions under which many of the base hospitals
were compelled to operate, but it also served to emphasize the importance
of just such an organization as had been built up at Savenay for dealing with
these patients at the stage and in the condition in which they arrived.
The service of reconstruction aides had been planned in the United States
during 1917, but none reported for duty in France until the end of the summer
of 1918. As an active part in the Savenay hospital center, however, they
fortunately arrived fairly early. Three principal forms of activity were
employed by this service, massage and occupational therapy in the wards, a
massage clinic in dispensary fashion, and an occupational (curative) work-
shop. The combination of these three has regularly exercised an influence
upon from 500 to 1,000 men per week in the Savenay hospital center. The
amount contributed by these activities to the more rapid recovery of stiffened,
contracted, and slowly recovering extremities can hardly be measured. The
results are more rapid in the case of hands and fingers, which often under the
influence of such treatment make more progress in a few days than had been
made in weeks preceding.
NEUROPSYCHIATRIC SERVICE
Until November 6, 1918, the neuropsychiatric service at Savenay was
under the direction of the commanding officer of Base Hospital No. 8. It
functioned separately, with a chief of service, medical staff, and special per-
sonnel. For the first six months relatively few cases were admitted, from
January 1 to June 1, 1918, the admission being 369. Two wooden barracks
of 90 beds each were used during this period, but inmates had their meals
with other patients. One ward was partitioned off, one end being used for
disturbed patients.
After June 1, 1918, the admission rate rapidly increased and additional
wards became necessary. Three more wooden barracks were used as required
HOSPITALS
609
for this service, providing accommodations for about 500 patients. In the
meantime, wards of special construction, designed by the chief surgeon, had
been erected for this service in a locality some distance from the main hospital.
These 11 wards, situated on a slight elevation of ground, consisted of the
administration building, a ward for officer patients, a mess hall, a barracks
for enlisted personnel, and a ward for disturbed patients, the remaining wards
being of uniform type, with a large day room, shower baths, and running
water. This unit was occupied the latter part of August, 1918. There were
accommodations for something less than 200 patients, but by using officers'
barracks and enlisted men's barracks, the capacity was expanded to over 250.
During this period, however, the barracks connected with Base Hospital No. 8
vv'ere still retained.
In October, 1918, 4 additional buildings of concrete block were added to
the 11 wards above mentioned. When these were completed, the original
barracks of Base Hospital No. 8 were relinquished. No diminution in the
admission rate after the cessation of hostilities occurred, and therefore the unit
as finally constructed proved inadquate. Indeed, in the late fall of 1918,
admissions were so rapid that the commanding officer of the center found it
necessary temporarily to designate wards from two adjacent units — i. e..
Base Hospital No. 69 and Base Hospital No. 113 — for the use of the neuro-
psychiatric service.
On November 6, 1918, the neuropsychiatric service was organized as an
independent unit, taking over the quarters already occupied. The former
chief of service was designated as commanding officer.
During the latter part of December, evacuation had been so rapid and
admissions delayed to such an extent that for a short time there were but 65
patients in the hospital. Admissions, however, soon increased so that early
in January, 1919, the population exceeded 700 patients, including 40 officers.
This was quite in excess of the capacity, especially since, except as a temporary
expedient, the use of the wards of adjacent units was not feasible. Under
these circumstances the commanding officer of the center gave directions that
one of the new 1,000 bed units be taken over as a neuropsychiatric hospital.
During the period that this organization was changed from the neuro-
psychiatric service of Base Hospital No. 8 to an independent unit and during
the transfer subsequently of the hospital to its present site, considerable admin-
istrative work was necessary. The responsibility of this reorganizing, and of
the subsequent transfer of the patients and property, as well as opening and
equipping the new unit, rested particularly with the chief of the service, the
(|uartermaster, and the officer in charge of administrative details.
The new unit was occupied January 21, 1919. The construction was not
completed and special construction was necessary, this being done chiefly by
patients. A sitting room was made in one end of the officers' ward, and. fur-
nished by the American Red Cross. A similar sitting room for nurses was
arranged in another ward. A staff conference room was constructed in the
officers' barracks. A diet kitchen, furnished by the American Red Cross, was
installed in the building used for occupational therapy. Four wards were
constituted closed wards, with screened windows, and in these wards parti-
610
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tions were constructed in such a way as to make patients' day rooms. One
ward building was utilized for a Red Cross recreation hut and appropriately
furnished.
The large building adjacent to the mess, used in other units for surgery
and dressings, was fitted up for a workshop. This workshop was especially
well equipped. It had the advantage of the use of material formerly used at
Base Hospital No. 117, consisting of brass-work tools, lathes, carpentering sets,
and an acetylene welding apparatus. Looms for weaving were made by the
patients, and woven bags, belts, and mats were manufactured. A forge was
made by one of the patients. A supply of salvage material for use in the
shop w^as secured from the salvage department at Tours. Six aides, under a
director, were engaged in giving instruction. The average number of patients
engaged daily was 42. A large amount of material of various kinds was manu-
factured in this shop. Much of this material, such as benches, tables, chairs,
cabinets, and office furnishings, was used to equip the administration build-
ings and wards of the unit. In the metal department rings, trays, and other
souvenirs were made in great number. Much of the material made was taken
home by the patients.
Personnel. — Prior to June 1, 1918, the neuropsychiatric service at Base
Hospital No. 8 was under the direction of a chief of service, who had from two
to three assistants. He succeeded in securing the services of nurses and enlisted
men with special training in this work. On June 8, 1918, Base Hospital No.
117 arrived at Savenay from the United States, en route for la Fauche. A
part of the personnel, namely, 3 medical officers, 28 nurses, and 33 enlisted
men remained at Savenay to take charge of the service.
After June 1, 1918, the admission rate increased rapidly. In June, 256
cases were admitted; in July, 405; in August, 588; in September, 887; in
October, 658; in November, 809; in December, 412; in January 1919, 885;
and in February, 824.
The organization received the cases, classified them, afforded appropriate
care and treatment and furnished medical officers and personnel to transport
them to the United States. Moreover, the trained personnel was sent to
convoy patients to Savenay from other centers and organizations.
For purposes of classification all patients were admitted to one large
admitting room of 90 beds. A special nursing force was maintained here,
and observations for classifications were made at once. All patients, upon
admission, were seen by the receiving officer and assigned to proper wards.
The acute psychoses, cases of chronic alcoholism, and the delinquents were
sent at once to closed wards. Mild psychoses, epileptics, and mental defec-
tives were kept in open wards under supervision. Cases of psychoneuroses
were sent to separate wards and, as soon as space was available, to the specially
constructed wards mentioned above.
By examining and classifying at once every case administrative diffi-
culties were reduced to a minimum. During this period but two serious
accidents occurred, although delinquents of every description came through
the service. At the same time patients w^ere given as much liberty as possible—
indeed, liberties which in civil life would have been considered impossible.
HOSPITALS
611
There was no separate mess for many months, patients going to the general mess.
The center American Red Cross recreation hut was used by all, and the con-
valescent patients from the neuropsychiatric service often contributed very
considerably to the entertainments.
As previously stated, supervision of transportation of these cases to America
was rendered by this organization to the extent of furnishing medical officers
and enlisted personnel. The convoys consisted as a rule of from 50 to 200
cases and occasionally more. They went by train to Brest or St. Nazaire
for embarkation, patients being loaded in cars especially designated, with
acute cases loaded in one special car. The number of attendants sent varied
according to the type of patients. The train left the hospital under charge
of a designated medical officer, who exercised supervision until patients were
delivered to their destination in the United States. Since such conveys drew
heavily upon the personnel, this work could not have been carried on had not
the personnel been supplemented from the hospital center.
BLIND PATIENTS
All of the blind patients whose blindness resulted from battle casualties
in the American Expeditionary Forces passed through Savenay and were
handled in its hospitals, where they received a certain amount of training.
The general nursing care was given by the ward nurses, while the social and
educational part of the treatment was given by trained teachers. Certain
of the American Red Cross workers who were here for the special purpose
of looking after blind patients also gave special instruction.
A school was established in the rear of ward A-15. of Base Hospital No. 8.
In the morning the program included work in the schoolroom and the teaching
of Braille and typewriting. In the afternoon on fine days the patients were
taken for walks, or else games and readings and other forms of entertainment
were conducted in the schoolroom or ward. This program was also continued
during the evening, varied usually by the reading of the evening paper. On
Sundays the men were conducted to church in the morning.
A pleasant variation of the work as conducted by the women of the
American Red Cross was the arrangement of parties for the blind patients,
the invitations to which were written in Braille, and a considerable part of
the enjoyment of the party consisted of the reading of the invitation and
the pleasant anticipation.
Patients who were unable to go to the schoolroom were taught at the
bedside, and there were also bedside readings and games.
LABORATORY SERVICE
Each unit in the center had a laboratory which was subsidiary to the
center laboratory. Supplies for these laboratories were issued by the center
hihoratory officer on memorandum receipt. The center laboratory performed
the more technical and nonroutine work, such as serology, histology, autopsy,
bacteriological type determinations, and surveys in epidemiology.
612 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The center laboratory was divided into the following departments:
(») Administration and supply:
(1) Administration
(2) Supply ...
(3) Media preparation and sterilization.
(4) Glassware preparation and fatigue..
(6) Pathology
(f) Bacteriology (general)
(d) Wound bacteriology
(e) Epidemiology.--
(!) Serology
{g) Chemistry (and water analysis) -
Total -
Officers
Noncom-
mis-
sioned
officers
or tech-
nicians
Private
or
privates,
first class
1
3
l,"" 1
' 1
■ Major.
'Sergeant, first class.
'Clerk.
Undertaker.
CONVALESCENT CAMP
A convalescent camp was in operation at Savenay as early as April, 1918,
in connection with base hospital No. 8, where 50 beds were set aside for conva-
lescent patients.
On August 21, 1918, orders were received from the chief surgeon's office to
establish a convalescent camp as a unit separate from the hospital. In com-
pliance with this, a site was selected where the parade ground measured some-
thing like 1,800 by 1,600 feet. Fifty pyramidal tents were put up and 300
French beds placed in the tents for use of the men. This change from hospital
to convalescent camp was made in one day, the patients being transferred froiu
hospital to camp, and returns made from the camp as a separate organization.
The duty personnel consisted of 1 officer and 1 enlisted man. From the first,
patients were selected to act as noncommissioned officers, selection being made
with care in order to get men who were responsible and who took an interest in
the work.
Under Circular 11-A, 1918, chief surgeon's office, A. E. F., all patients in
convalescent camps were placed on a duty status, and consequently returns were
those of line organizations. This was changed after a few weeks and patients
were again put on a hospital basis, necessitating again a change in forms.
In fair weather the following schedule was adhered to : The entire battalion
participated in the morning exercises. These were ordinary setting up exercises
and lasted for 15 minutes. Then the medical officer of each company made an
inspection of his company; patients who were found not fit for further exercise
were required to fall out and return to their quarters. The exercises were then
continued for 30 minutes and another inspection was made, with the same pro-
cedure. After this, games were played for 5 to 10 minutes and then the com-
panies were dismissed. At 10 o'clock the entire battalion was drilled in squads,
platoons, or companies, depending upon the advancement of the soldiers. This
drill lasted until 10:45.
At 2 o'clock all men w^ere required to be on the athletic field for games,
football, basket bah, indoor baseball, and volley ball, which were played until
3.45. Regimental parade was held every afternoon at 4.30. The schedule was
HOSPITALS
613
SO arranged that each enUsted man was required to take a routine march once
or twice a week; four companies going on consecutive days until Friday when
the entire battalion formed and marched for an hour and a quarter to band
music. Each Saturday afternoon competitive games, consisting of tugs of war
between companies, baseball, obstacle races, potato races, relay races, boxing con-
tests, and battle royals were held on the athletic field. For each event prizes were
given varying from 3 pounds of candy to 1 or 2 cartons of cigarettes, the company
winning most events being given a pennant. These games were always enthu-
siastically attended and competitors showed great interest in them.
Schools were established in connection with the camp, preliminary for the
education of illiterates, but after the armistice began classes soon increased. All
classes were voluntarily attended, but once a man volunteered for a course, he
was required to be present at all classes of his course unless evacuated. Those
who volunteered for courses were excused from other duties which interfered
with their work. Teachers were detailed and the subjects taught ranged from
those suitable to an illiterate foreigner to those for a high-school graduate.
Instruction was given in arithmetic, reading, spelling, writing, grammar. United
States history, civil government, geography, physical geography, European
history, and French. The following schools also were established: Tinsmithing,
motor mechanics, commercial branches, woodworking, sign painting, and
dramatics.
The hours for each subject extended from 8.30 to 11 a. m., and from 1 p. m.
to 4.30 p. m. A man worked the whole day on a course until he completed it.
Many made astonishing progress; some men, unable at first to write their names,
were able within 12 days to write short letters home. The classes were kept
small, the largest number taking a course numbering 90. A total of 200 men
were enrolled in the tinsmithing course and averaged six hours daily.
THE CENTER FARM
The center farm consisted of 98 acres of land leased by the American Red
Cross, through which agency also were obtained implements necessary to start
work. The farm proved not only of value as an adjunct to the mess facilities
of the center, but also monetarily; during the summer of 1918 the sale of pro-
duce each week exceeded the farm rental for a full month. In addition, the
farm proved of great benefit in the reconstruction work.
WELFARE
The American Red Cross assisted in giving surgical dressings, clothing,
personal equipment of nurses and secretaries, games, novels, and a portable
laundry, and huts including a nurses' and officers' hut and an auditorium for
1,650 people. It leased and equipped an experimental farm, maintained a
staff of searchers, published a local newspaper, promoted recreation, distributed
personal gifts such as socks, scarfs, helmets, etc., and conducted a library.
The Young Men's Christian Association conducted religious services and
I'litertainments, including moving pictures, and gave canteen service.
614
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
COMMANDING OFFICER
Col. Wibb E. Cooper, M. C.
JUSTICE HOSPITAL CENTER, TOUL '
This group of hospitals was organized primarily for the purpose of taking
care of the casualties in the St. Mihiel operation (April 12-16, 1918) . A number
of base and evacuation hospitals were ordered to Toul, where they took over
permanent military barracks, just west of the city. The group consisted of
the following barracks: Caserne Lamarche, Lamarche Annex, Caserne Perrin,
Brichambault, Caserne Tavier, Caserne A. R., and Caserne Luxembourg.
With the exception of the last, these barracks were situated very close together,
on Rue de Justice, about a mile from the center of Toul. The buildings were
of stone and concrete construction and the rooms were fairly well suited for
purposes of hospitalization. There were no bathrooms, no means of disposing
of waste in the buildings, and running water was to be found in but one or
two rooms in each building.
There were two sources of water, one being individual wells and the other
the Moselle River. The water was apportioned to the various hospitals at
daily periods and regulated through a system of valves. It was impossible,
however, to furnish any storage, as any irregularity in apportionment inter-
fered with the supply of the other areas. The sewerage system consisted of a
series of pipe lines and drains, which received the liquids from kitchens and
baths.
The latrines were of the can type and none were in the buildings themselves.
All the excreta of the bed patients had to be carried to these latrines, and these
were often located at some distance from the wards. In the same manner
all the waste liquids, bath water, etc., had to be carried from the buildings
and emptied into the sewers.
The center was organized on August 27, 1918. At this time the following
units had arrived: Base Hospitals Nos. 45 and 51, American Red Cross Mili-
tary Hospital No. 114, and Evacuation Hospitals Nos. 3 and 14. Later,
Base Hospitals Nos. 82, 55, 78, 87, and 210 arrived and Evacuation Hospitals
Nos. 3 and 14 were relieved from the center. In addition to these, gas, con-
tagious, and neurological hospitals were organized. When completely organ-
ized the center had a capacity of 15,250 beds.
The center staff was organized into the following divisions: Adjutant,
consultants in medicine and surgery, quartermaster, evacuation officer, labora-
tory officer, sanitary officer, transport officer, medical supply officer, and
chaplain.
The supply depot was established on September 8, 1918, in one of the
permanent barracks of the center. Prior to this time all supplies had to be
obtained from the First Army depot.
The office of the Quartermaster Department began functioning on Sep-
tember 8, 1918, when the first carload of supplies was received. During the
'The statements of fact appearing herein are based on the "History of the Justice^io^ital center " prepared
under the direction of the commanding officer by members of his staff. The material used by these officers in the com-
pilation of the history comprised official reports from the various divisions of the hospital center The historv on file
in the Historical Division, S. G. O.-Ed. ^ °
HOSPITALS
615
month of September, the work of this department was very much handicapped
on account of the difficulty in obtaining supplies. This was due to the con-
gestion at the railhead during the activities in the St. Mihiel sector. A large
riding hall in one of the barracks was used as a warehouse and afforded ample
Space. On November 20, 1918, Bakery Company No. 11 was established,
and for the first time the bread supplied to the center was made at that port.
The greater part of the laundry work was done at the large laundries in
Toul and Nancy. Each unit had one or more French hand laundries, but
the amount of work these could do was too small to be of material help. A
group disinfecting plant, consisting of three steam disinfectors, was operated
for all the hospitals.
Evacuation Ambulance Co. No. 7, which arrived on August 28, 1918,
handled all transportation until September 21, 1918, when a center motor
transport service was established.
The office of the group chaplain was organized on September 21, 1918.
In addition to the regular duties of a chaplain, this officer also had charge of
all the entertainments furnished through the cooperation of the Y. M. C. A.
A post school was established by the chaplain on March 10, 1919, with a class
of about 28, but due to the many changes occurring in the personnel it soon
became extinct.
Surgical cases usuallj^ were treated in Base Hospitals Nos. 45, 51, 82,
55, and 78; however, in October and November these hospitals received
medical cases also. During the St. Mihiel operation and immediately after,
this center received a large percentage of the total casualties for the First
Army. During the period September 12-25, 8,340 surgical cases were admit-
ted, and the base hospitals temporarily functioned as field and evacuation
hospitals. After September 26, the group did not receive any considerable
number of battle casualties direct. The surgical services suft'ered, especially
during the early active period, from lack of surgical instruments and trained
personnel. In January, 1919, all surgical cases were transferred to and cared
for in Base Hospital No. 45.
The medical service did not receive many patients until the latter part
of September, 1918. After this time, however, the influenza epidemic assumed
large proportions and the service soon became overcrowded. A contagious
hospital was opened, with a bed capacity of 600. AH cases were held here
until over their infectious period.
A neurological hospital was opened on September 7, 1918, with a bed
capacity of 1,000. It was well outfitted, in large part by the American Red
Cross. The hospital was designated Neurological Hospital No. 2. It acted
very much in the manner of an evacuation hospital, with an equipment and
staff of an elaborate base for nervous cases. Of 259 cases treated there during
the first month, 63 per cent were returned to duty. Other evacuations were
made by ambulance to Base Hospital No. 116, at Bazoilles, and to Base Hospital
No. 117, at La Fauche.
A large center laboratory was established in Caserne Lamarche on Sep-
tember 23, 1918. It occupied excellent quarters and consisted of six rooms.
This laboratory made all the special bacteriological examinations, Wasser-
616
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
inann tests, colloidal gold tests, and dark field examinations, made cultures,
and prepared media, solutions, and sera. The individual hospitals made
post-mortem examinations, routine clinical, pathological, and bacteriological
examinations.
The majority of patients were transported to the center from the front
by ambulances. Prior to November, 1918, there was no central triage, and
the hospitals were designated to receive cases arbitrarily as regards location,
personnel, and equipment. This caused considerable difficulty and confusion.
About the middle of November a center triage was organized, consisting of 10
Bessonneau tents. All incoming ambulances were directed to this central
point by road signs and guides. Two officers, two noncommissioned officers,
and twenty privates, selected from the various hospitals, were on duty at all
times. It was the duty of the triage officer to have the ambulances unloaded,
examine all patients and field cards (and if necessary make a provisional change
in diagnosis), and direct patients to designated hospitals. This system neces-
sitated a change in the staffs of the various hospitals so that they more readily
might treat the types of cases sent to them. Evacuation of all patients was
made from the hospitals, as there was no convalescent camp in this center.
Evacuation of class A patients was made either through replacement battalions
or regulating stations, though some class A patients w^ere evacuated directly
to their organizations. Reclassified patients were sent to the 1st Depot Divi-
sion at St. Aignan, with the exception of class D patients, who were sent
directly to the hospital center at Savenay. All mental and neurological cases
were sent in ambulance convoys to Base Hospitals Nos. 116 and 117. All
patients evacuated to the rear were transported in American and French
hospital trains. A consolidated list of patients to be evacuated w^as telephoned
to the regulating officer at St. Dizier twice a day, who, in turn, dispatched
trains as necessity called for them. The evacuating officer usually received
from 2 to 12 hours' notice as to when a train would arrive at the center and
made requests for litter bearers on the hospitals which were to evacuate lying
cases.
The American Red Cross furnished the center large quantities of instru-
ments, drugs, and hospital equipment. It also distributed literature and
many special articles not furnished by the Army to the patients. To each
hospital was assigned a searcher whose duty it was to trace soldiers reported
missing, and perform special services for patients, such as writing letters,
sending telegrams, etc.
Recreation rooms for nurses and enlisted men w^ere established in each
hospital, where theatricals, concerts, and moving-picture shows w^ere produced.
COMMANDING OFFICER
Col. Henry C. Maddox, M. C, August 27, 1918, to November 13, 1918.
Col. Robert M. Thornburgh, M. C, November 14, 1918, to discontinuance
of center.
HOSPITALS
617
HOSPITAL CENTER. VANNES •
This center came into existence officially on November 3, 1918, when 1
officer and 50 men of the Medical Department arrived and took over certain
buildings requisitioned from the French. Geographically the center embraced
Vannes, Auray, Plouharnel, Carnac, and Quiberon, covering an area of 30
miles.
Headquarters of the center were organized November 11, 1918, at Vannes.
Here large barrack buildings, known as the Quartier Senarmont, were taken
over. This caserne, following the general plan of the French Army barracks,
was surrounded by a wall inclosing a compound measuring 760 by 860 feet.
Within this area were three large four-story barracks, kitchens, guardhouse,
stables, veterinary hospital, and other buildings. It was planned that 2,300
patients could be cared for in this inclosure. The buildings were in very
poor repair, and the only advantages provided were ample space, a site free
from mud, and an abundant supply of good water. Considerable construction
was effected in this caserne, such as extending water pipes to the upper floors,
placing of sinks, etc.
In Carnac the United States Government leased a hotel and five villas.
The hotel, which accommodated about 200 patients, was at the beach of Baie
de Quiberon, about 2 miles from Carnac. It was used for convalescent
respiratory cases, who rapidly improved in health at this point.
In Quiberon the hospitalization consisted of 12 small hotels and villas,
only 2 holding more than 100 beds. The hotels were not modern and lacked
adequate facilities for light, heat, and bathing. The distance of this group
from headquarters of the center made difficult its supply and control; therefore,
the properties were given up on January 18, 1919.
Near Plouharnel, a large three-story monastery, the Abbey St. Michiel,
with a bed capacity of 500, was taken over, but was used only once for patients,
and then for a short time only.
Hospitalization at Auray consisted of 2 hotels with a capacity of 350 beds.
These were unsatisfactory and were never used for patients, leases on them
being given up in December, 1918.
Base Hospitals Nos. 136 and 236 operated in this center and up to March 1,
1919, admitted a total of 3,224 patients.
In February, 1919, Base Hospitals Nos. 4, 5, 10, 1^2, and 21 were ordered
to this center for quarters, awaiting transportation to the United States.
This hospital center was discontinued in June, 1919.
COMMANDING OFFICER
Col. Robert M. Blanchard, M. C.
' The statements of fact appearing herein are based on the " Flistory of the Vannes hospital center," prepared under
the direction of the commanding officer by members of his staff. The material used by these officers in the compilation
of the history comprised official reports from the various divisions of the hospital center. The history is on file in the
Historical Division, S. G. O.—Ed.
618
ADMINISTBATION, AMEEICAN EXPEDITIONARY FORCES
HOSPITAL CENTER, VICHY'
The hospital center at Vichy, though planned early in 1918, was not organ-
ized officially until August 12, 1918. Two base hospital units, Nos. 1 and 19,
were then operating. The French Medical Department had been using many of
the larger hotels in Vichy as hospitals since the beginning of the war in 1914.
Twenty-eight of these were turned over to the United States Army, and later
additional hotels were leased from private owners, so that eventually 86 hotels,
large and small, were utilized by the center, the total bed capacity of the center
at its maximum being 19,000. In addition, 13 garages, and laundries were
taken over for use.
The following units operated in the Vichy center before the armistice:
Base Hospitals Nos. 1, 19, 115, 76, Hospital Train Unit No. 41, and Hospital
Unit D. After the armistice began the following units arrived : Base Hospital
No. 109, Evacuation Hospitals Nos. 25, 33, and Convalescent Camp Co. No. 9.
The latter organization never functioned as a convalescent camp.
Vichy had many advantages as a hospital center. The location, although
apparently somewhat distant from the battle lines, was well chosen owing to
favorable railroad connections. Patients were received in some instances within
24 to 36 hours after receipt of injuries, and frequently they arrived with their
original dressings, although a very large proportion of the patients had passed
through evacuation or base hospitals.
Vichy, being a famous watering resort, established for many years, was a
well-developed small city. The streets were well paved and well lighted, thus
greatly facilitating the handling of patients arriving on trains at night. There
also was an excellent water supply; gas and electric current were obtainable
in abundance.
The Grande Etablissement Thermal et Physiotherapeutique, which we
used, was well equipped with electrical. X-ray, and orthopedic appliances that
were of value in the treatment of orthopedic and nerve injuries during our
occupancy. The hotels on the whole were well adapted for hospital use, the
larger, first-class ones being well equipped with bathing facilities and modern
kitchens. On the other hand, the smaller hotels were not so well suited, but were
used to great advantage for the walking cases and the less seriously wounded.
The Quartermaster Department was divided into finance, subsistence,
property, clothing, and piiscellaneous sections. Another officer was assigned to
the building department, which was charged with maintenance and repair of
approximately 90 buildings. A force for this last purpose was organized from
among the different base hospital units. Requests for repairs averaged 70 a
day. As the center grew a railway transport officer, a motor transport officer,
and an engineer officer were assigned to the center. A quartermaster officer was
assigned to the bakery and another to the laundry.
Motor transport of various types and makes was provided. Part of the
personnel to operate this was furnished by the motor transport officer and pait
was composed of convalescents and other personnel at the center.
' The statements of fact appearing herein are basei on the "History of the Vichy h jspital center," prepared under
the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of
the hist ory comprised official reports from the various divisions of the hospital center . The history is on file in the Historical
Division, S. G. O.—Ed.
Fig. 118— Hole !des Bains, part of Vichy hospital center
620
ADMINISTRATION, A:MERICAN EXPEDITIONARY FORCES
The problems connected with the mess arrangement for the center were
most difficult. By the end of October 15,000 persons were being subsisted.
During the period of greatest stress there were 36 messes in operation. Though
each hospital unit had its own mess officer, a group mess xDfficer, assisted by 10
clerks, managed the messes from the beginning of the center imtil its closure. In
this way a central purchasing department was maintained and the messes through-
out the center were coordinated. The central mess office procured and issued
not only food suppUes but also mess equipment. The walking patients, who
occupied many of the 86 buildings, were marched under a noncommissioned
officer to a close-by mess.
Fig. 119.— Hotel Lilas, pan ol \ ivliy hospital center
For a time, bread was made by local French bakers, who were furnished
American flour; however, on July 10, 1918, three units of Bakery Company
No. 12 arrived with complete equipment and thereafter baked all bread required
by the center. During the period November 1 to 10, 1918, this organization
produced 11,050 pounds of bread daily.
Laundry was done, prior to the organization of the center, by a civilian
laundry. This arrangement soon proved inadequate, and on August 20, 1918,
the Quartermaster Department leased a laundry in Bellerive, near Vichy, and
Laundry Company No. 302, consisting of seven men, was placed in charge.
This company supervised a day and night shift of French civilian help. When
this laundry proved inadequate another, the Les Bains, was leased and placed
in charge of Laundry Company No. 509. In order to avoid any danger of infec-
tion, all underclothes, uniforms, and linen which had been in contact with incom-
HOSPITALS
621
ing patients were sent to the Les Bains laundry, all other hospital linen being
sent to the Bellerive laundry. A salvage department was inaugurated in con-
junction with the laundry.
A bathing establishment was secured on October 14, 1918, by contract
from the French, to provide proper bathing facilities for the patients upon
admission. All walking cases were taken there immediately from the train and
bathed. New clothing was issued to them before they were sent to a hospital;
their old clothing was sent to a delousing station. In this way it was possible to
keep practically every one of the 86 buildings in operation free from infection.
This establishment was used also for the walking cases and the personnel of
the center. The heating system was excellent, allowing over 200 baths a day
to be given. The number of baths given at this establishment from October
14, 1918, to January 15, 1919, was 61,854.
Fig. 120— a ward, Base Hospital No. 1, Vichy hospital center
Kach of the base hospital units in the center occupied on the average of
over 20 buildings, each building being in charge of a medical officer who was
responsible to the commanding officer of his unit for the professional service,
both medical and surgical, and the discipline and police of the building of which
he was in charge. The commanding officer of the unit was in turn responsible
to the commanding officer of the center.
Ma.xillofacial and neurosurgical cases were sent to this center, especially
after September 6. Base Hospital No. 115, which then arrived, was soon charged
with the care of such cases as well as general surgical cases.
Evacuation of patients was made as soon as the patients were reported
readv. They were classified and reported as in various classes fit for evacua-
622
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tion. Each week the commanding officer of each hospital was sent a statement
of the percentage of patients evacuated in each of these classes, by the center
and by each base hospital, in order that the commanding officer might know
whether his ward surgeons were taking advantage of all evacuations possible.
The American Red Cross at Vichy provided a warehouse for materials and
distribution, a canteen, including a hall for dancing, a theater, reading and
writing rooms, and a diet kitchen and a serving room for French. An officers'
club, a noncommissioned officers' club, a nurses' club, and a gymnasium were
Fig. 121.— OfBcers' mess at the Hotel Sevigne, Vichy hospital center
provided. It leased a building for a nurses' club over which a representative
of the Y. W. C. A. presided. The Red Cross furnished hundreds of cases of
supplies, provided many entertainments, and conducted, through searchers, a
home-communication service.
Be ginning on February 1, 1919, some of the hotels were returned to their
owners and the center was discontinued in April, 1919.
COMMANDING OFFICER
Col. Walter D. Webb, M. C.
HOSPITALS
623
HOSPITAL CENTER, VITTEL-CONTREXEVILLE »
The hospital center at Vittel-Contrexeville was located in the small towns
of Vittel and Contrexeville. Vittel is about 60 kms. east of Chaumont and about
90 kms. west of the Alsace border. Contrexeville is 4 kms. southwest of Vittel.
Both towns had been well-known watering places, situated in the foothills
of the Vosges Mountains. Being at a considerable altitude, they had a cold,
rigorous climate, with winter coming early and remaining long, accompanied
by much snowfall. All industries of both places were connected with the serv-
ice of their hotels and springs. The waters in no way influenced the selection
of this location for hospitals, and they were not used in the hospitals of the
center, except by those who desired to do so.
Fig. 122. — Casino used as the ollicers' club, Vicliy hospital center
Vittel has an excellent water supply derived from the springs in the hills
above the town, which, though at times taxed to the utmost, was beyond sus-
picion as to purity. A total of 100,000 gallons per day was allowed for the
hospitals, which, with proper care, was sufficient. Contrexeville was not so
fortunately situated with respect to its water supply. No large springs were
available and each hotel had its own more or less shallow well. Being intended
only for summer use, all piping was exposed, causing endless trouble from freez-
ing during cold weather. Practically all water in Contrexeville was determined
to be nonpotable.
» The statements of fact appearing herein are based on the "History of the Vittel-Contrexeville hospital center,"
prepared under the direction of the commanding officer by members of his staff. The material used by these officers in
the compilation of the history comprised official reports from the various divisions of the hospital center. The history is
on file in the Uislorical Division, S. G. O.—Ed.
13901—27 40
624
ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
Fig. 123— Building used as the noncommissioned oilii 1 1>' chil>, X'ieliy hospital center
HOSPITALS g25
Both towns had fairly satisfactory electric lighting plants, of sufficient
capacity both for lighting purposes and for the operation of X-ray equipment
There was also a well-defined park system, especially so in Vittel This
together with the privilege of the tennis courts and golf links, made a very
valuable adjunct to the center.
Prior to the arrival of the Americans and for a short time after the establish-
ment of our hospitals at Vittel and Contrexeville, in the winter of 1917-18, the
French occupied some of the hotel buildings for hospital purposes. These
buildings were turned over to us by the French. All other buildings were
leased from their owners; in case of refusal on the part of the owner, they were
Fii.. ]2l. — Two small hotels used for the enlisted men, Vichy hospital center
requisitioned. In this w^ay, by November 17, 1917, buildings for 5,500 beds
had been acquired; and eventually 74 hotels, villas, and other buildings were
occupied by the hospital units. The bed capacity at its height was 11,075,
including crisis expansion and beds in the convalescent camp, which, however,
were never occupied. In compensation for beds allotted us at other points,
2,700 beds were reserved for French patients. Villas were leased for officers
and nurses, the casino for enlisted men; garages were provided for the military
police, storeroom, and medical supply. All buildings were of concrete and
stone construction and more or less fireproof in some cases; in others, especially
in Contrexeville, veritable firetraps. The hotels were from three to five stories
high, with from 40 to 300 rooms, some of which were reserved for storage. No
buildings had heating plants that were adequate. Heating was very unsatis-
626 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
factory, and it was early realized that proper heating was not to be obtained.
Seven thousand French stoves were received shortly after the arrival of the
units and were installed. The labor involved in caring for this number of
stoves, the carrying of the coal and ashes, four to five flights, was enormous.
Practically every hotel building had its own kitchen range installed and in fair
working condition.
All buildings were piped for water, and had a sewerage system that was
wholly inadequate for the number of patients in each during crisis expansion.
Cesspools were situated under the kitchen floor, and whenever the capacity of
the cesspool was exceeded the inevitable result was a flooding of the floor of the
kitchen. By continually pumping over the cesspool this was reduced to a
minimum.
Four base hospital units were assigned to Vittel and Contrexeville. These
were Base Hospitals Nos. 23, 36, 32, and 31 to ContrexeviUe, the first one arriv-
ing December 17, 1917, and the last one January 1, 1918. On March 13, 1918,
three hospital units, B, R, and G, arrived and reinforced the hospitals. Prior
to the organization of the center, each unit had its own quartermaster and
medical supply officer, submitted its own requisitions, and controlled its own
transportation.
On January 27, 1918, one officer of the group was placed in command of all
four hospital units, thus inaugurating the hospital-center system of coordinating
the activities of several hospital units grouped together. The organization of
the center at the height of its activity was as follows: Commanding officer,
adjutant, quartermaster, evacuating officer, sanitary officer, medical supply
officer, assistant provost marshal, air raid officer, motor transport officer, rail-
way transport officer, laboratory officer, professional consultants in surgery,
medicine, neuropsychiatry, orthopedics, and ophthalmology.
To a great extent the headquarters staff was organized by detailing officers
from several units. Each headquarters staff in organizing his department chose
personnel from the organizations which he knew were capable. It was realized
that these units were well supplied with especially qualified men, therefore no
request was made for an additional force to form a headquarters detachment.
The headquarters detachment was formed by details from the constituent
organizations, especially the base hospitals.
Certain special and technical units were organized as follows: Sanitary
squads, one in each town. A provisional ambulance company was organized
from personnel and ambulances belonging to the base hospitals. It was under
the control of the evacuation officer, who was responsible for the movement of
all patients. This arrangement was found more satisfactory than to have the
ambulances under the motor transport officer.
A laboratory was established in each town, under the control of the center
laboratory oflace. Each hospital, however, retained enough laboratory equip-
ment to perform routine clinical examinations.
As all organizations were well equipped with nonexpendable property, a
medical supply depot was not established A center storehouse was maintained,
and all requisitions were made out by the center supply officer.
HOSPITALS
627
A laundry plant was leased in a town about 4 km. from Vittel, which, after
being remodeled by the Army engineers, was satisfactory. A laundry company
of 1 officer and 16 men operated the plant.
At first bread was obtained from Is-sur-Tille. Later a section of a field
bakery was obtained, with two ovens. This, with another oven belonging to
one of the units, was sufficient to supply fresh bread to all organizations.
During quiet times the extra oven was used for pastry and other extras.
The quartermaster storehouse occupied two large garages at Vittel, centrally
located, and a small branch was established at Contrexeville. A well-stocked
sales commissary was kept, and organizations in surrounding towns were
supplied. There never was a shortage of subsistence articles.
An air raid officer was appointed who drew up such regulations as were
necessary for the protection of patients, personnel, and property. Windows
were kept screened at night, which was an extremely difficult matter, with the
thousands of windows in a single building, some of them so large and so situated
as to be almost impossible to cover. For some time the French kept a railroad
artillery train parked in the city, and considerable time was required to get it
removed. It was not considered in keeping with the provisions of the Geneva
convention to construct a cross for protection while these combat organizations
were within the city, but after they were ordered away the cross was constructed.
Although surrounding towns were repeatedly bombed this center fortunately
escaped.
During the winter of 1917-18 and spring of 1918 patients were admitted
principally from the surrounding training areas, and from Baccarat and Lune-
ville, where our troops were in the trenches. Numerous gas cases were
admitted to the center at this time.
The admission of French patients required a duplication of records and
necessitated a providing of the French ration, but was an excellent experience
for all the units at a time when there were not sufficient American patients to
keep the personnel busy. During this period of adjustment not many patients
were arriving and the keenest rivalry developed in obtaining patients. Later
a receiving office was established and all arriving ambulances were required to
report there. All distributions were made by direction of the commanding
officer of the center.
During the month of September steps were taken to establish a convalescent
camp of 1,200 capacity. This camp was ready for occupancy when the armi-
stice was signed, whereupon the project was abandoned.
A Red Cross hut was constructed at both Vittel and Contrexeville for the
enlisted men, and a well-stocked canteen was maintained at both places . A hut
for the nurses also was constructed and furnished in Vittel and a theater leased
in the Casino, where moving pictures and other entertainments were provided.
This organization also leased a bathing establishment, where hot an d cold baths
were available for personnel and patients at all times .
The Vittel-Contrexeville center was discontinued in January, 1919.
COMMANDING OFFICER
Col. Guy V. Rukke, M. C.
CHAPTER XXIV
BASE HOSPITALS"
BASE HOSPITAL NO. 1 *
Base Hospital No. 1 was organized in September, 1916, at the Belle viie
Hospital, New York City. The unit was mobilized on November 21, 1917,
at the 12th Re giment Armory, New York City, where it remained in training
until February 26, 1918, on which date it left New York on the Olympic, arriv-
ing in Liverpool, England, March 6, 1918. It left Liverpool March 6 for
Southampton, England, where officers and enlisted men remained in the rest
camp for three days prior to crossing to Le Havre, France, March 10, 1918.
It left Le Havre March 11 en route to Vichy, Department Allier, in the inter-
mediate section, A. E. F., where it arrived March 12, 1918. Upon arrival
at Vichy Base Hospital No. 1 took possession of nine hotels that had been
used by the French as hospitals since 1914, and on March 20, 1918, reported
that the hospital was ready to receive patients. The first patients, 252 French
wounded, arrived on April 9, and the first American patients, 358 in number,
were admitted April 11, 1918.
Base Hospital No. 1 functioned from April 9, 1918, to January 20, 1919,
during which time 8,142 surgical and 7,481 medical cases were treated. During
this period the unit maintained 12 separate messes and occupied over 20 hotels
in which sick and wounded were cared for. The unit left Vichy March 5,
1919, en route to St. Nazaire, for return to the United States; it sailed April
14, 1919, on the Princess MatoiJca, and arrived in Newport News, Va., April 27,
1919, where, at Camp Hill, the unit was demobilized.
PERSONNEL
COMMANDING OFFICER
Col. Walter D. Webb, M. C, October 16, 1917, to August 24, 1918.
Maj. Joseph McKee, M. C, August 25, 1918, to September 24, 1918.
Lieut. Col. Arthur W. W^right, M. C, September 25, 1918, to demobili-
zation.
CHIEF OF SURGICAL SERVICE
Maj. Richard T. Atkins, M. C.
CHIEF OF MEDICAL SERVICE
Maj. George B. Wallace, M. C.
" Only those base hospitals which operated as such in France are included in this chapter. This will account for
the absence of certain numbers in the series. — Ed.
'The statements of fact appearing herein are based on the "History, Base Hospital No. 1, A. E. F.," by Lieut.
C"ol. Arthur M. Wright, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O.. Washington, D. C.—Ed.
G29
630
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 2^
Base Hospital No. 2 was organized at the Presbyterian Hospital, Now
York City, during February, 1917. The unit was mobilized in May, 1917.
It sailed from New York on the St. Louis, on May 12, 1917, and arrived in
England on May 23, 1917. Upon arrival in England the unit was attached
to No. 1 General Hospital, British Expeditionary Force, at Etretat, France,
arriving at that station on June 2, 1917, where it remained until January,
1919. The organization sailed from Europe aboard the Agamemnon, March 3,
1919, arrived in the United States March 11, 1919, and was demobilized at
Camp Meade, Md., February 17, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Lucius L. Hopwood, M. C, May 9, 1917, to January, 1918.
Col. WilHam Darrach, M. C, January, 1918, to July 19, 1918.
Maj. Willard B. Soper, M. C, July 20, 1918, to demobilization.
BASE HOSPITAL NO. 3
Base Hospital No. 3 was organized in September, 1916, at the Mount
Sinai Hospital, New York City. It was called into active service November 14,
1917, the entire command being mustered into service by November 21, 1917.
The armory of the First Field Hospital, National Guard of New York, New York
City, was selected as the mobilization and training center. The nurses were mobi-
hzed January 15, 1918, at Ellis Island, N. Y. The unit remained in training at
the armory until February 6, 1918, when it embarked on the Lapland, leaving
New York the same date. The Lapland arrived in Halifax on February 8, and
left for Europe on February 13, 1918, reaching Glasgow, Scotland, February 25,
1918. The nurses of Base Hospital No. 3 were detached from the unit at
Glasgow, and sent by way of London to the casual depot at Blois, France, and
rejoined the unit April 18, 1918. The officers and enlisted men proceeded to
Southampton, England, arriving on February 26, 1918. On the following day
they crossed the English Channel on H. M. S. Hunslet, arriving at Le Havre,
France, February 28, 1918. The officers and enfisted men left Le Havre March
1, 1918, by train en route to Vauclaire, Department of Dordogne, base section
No. 2, their permanent station, arriving there March 3, 1918.
An old monastery, comprising numerous cement buildings, was turned over
to Base Hospital No. 3. In two months' time these had been converted to
hospital purposes, later being expanded to a hospital of 2,800-bed capacity.
The first patients arrived May 13, 1918, Hospital Train No. 53 bringing 104
patients from Base Hospital No. 9, Chateauroux. The railroad station was
2^2 miles from the hospital, but as ample motor transportation had been pro-
vided, evacuation of trains w^as never delayed. During its activity, May 13,
1918, to January 20, 1919, Base Hospital No. 3 cared for 9,127 patients, surgical
and medical. This hospital was designated by the chief surgeon, A. E. F., as
'The statements of fact appearing herein are based on the "History, Base Hospital No. 2, A E F " by the com
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D C —Ed
The statements of fact appearing herein are based on the "History, Base Hospital No 3 A E F ''bv Mai George
Baehr, M. C, while on duty as a member of the staff of that hospital. The history is on flle'in the Historirnl Tlivision
S. G. O., Washington, D. C.—Ed ^isioncaJ uivision.
HOSPITALS
631
one of the hospitals to receive cases of suspected pulmonary tuberculosis, 222
such cases being admitted during its period of activity. The largest number
of patients in hospital was November 5, 1918, when 2,765 sick and wounded
were being treated.
Base Hospital No. 3 ceased to function as a hospital on January 20, 1919,
having been relieved on that date by Base Hospital No. 71. The unit of Base
Hospital No. 3 left Vauclaire on March 7, 1919, and proceeded by rail to the
Beau Desert hospital center, to await transportation to the United States. It
sailed on the Pastores, March 14, 1919, and arrived at Newport News, Va.,
March 26, 1919. The entire unit was demobilized at Camp Upton, N. Y., on
April 4, 1919.
Fig. 125. — Base Hospital No. 3, Vauclaire
PERSONNEL
COMMANDING OFFICER
Col. Michael A. Dailey, M. C, August 23, 1917, to October 17, 1918.
Maj. Herbert L. Celler, M. C, October 18, 1918, to October 21, 1918.
Lieut. Col. George Baehr, M. C, October 22, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Howard Lillienthal, M. C.
Maj. John W. Means, M. C.
Maj. Walter M. Brickner, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Herbert L. Celler, M. C.
632
ADMINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 4 ^
Base Hospital No. 4 was organized at Lakeside Hospital, Cleveland, Ohio,
during August, 1916, and was mobilized at Cleveland about May 5, 1917. The
unit left Cleveland on May 6, 1917, arrived at New York and embarked on the
Orduna May 7, 1917. It sailed for Europe on May 8, 1917, arriving at Liver-
pool May 17, thus being the first unit of the United States Army to reach
Europe. After spending several days in London, it left there on May 24,
en route to Rouen, France, arriving at that station for duty on May 25, 1917.
It was one of the original six base hospitals sent to Europe for duty with the
British and remained with the British Expeditionary Force in France during
its entire overseas existence, operating as No. 9 General Hospital, British Expe-
ditionary Force. It ceased functioning about March 1, 1919, sailed from
Europe on the Agamemnon on March 31, arrived in the United States on April
7, 1919, and was demobilized shortly thereafter.
PERSONNEL
COMMANDING OFFICER
Col. Harry L. Gilchrist, M. C, May 3, 1917, to December 14, 1917.
Lieut. Col. William E. Lower, M. C, December 15, 1917, to April 30, 1918.
Capt. Allen Graham, M. C, May 1, 1918, to September 17, 1918.
Lieut. Col. Frank E. Bunts, M. C, September 18, 1918, to demobilization.
BASE HOSPITAL NO. 5^
Base Hospital No. 5 was organized in February, 1916, at the Harvard Univer-
sity, and was mobilized in May, 1917. The unit left New York May 11,
1917, on the Saxonia and arrived at Falmouth, England, May 22, 1917, and
at Boulogne, France on May 30, 1917. It was assigned to the British Expe-
ditionary Force in France and was ordered to take over British General Hos-
pital No. 11. This hospital was situated between the towns of Dannes and
Camiers, Department Pas de Calais. It functioned there until November 1,
1917, when it was transferred to Boulogne sur Mer, where it took over and
operated British General Hospital No. 13.
While at Dannes-Camiers, Base Hospital No. 5 frequently was attacked
by enemy aircraft, and on the night of September 4, 1917, suffered several
casualties. Lieut. William T. Fitzsimons, M. C, was killed, Lieuts. Rae
W. Whidden, Thaddeus D. Smith, and Clarence A. McGuire, M. C, were
wounded. Lieutenants Whidden and Smith subsequently died. Three
enlisted men were killed and five severely wounded; one nurse and twenty-
two patients were wounded. These deaths were the first among the American
Expeditionary Forces due to enemy activity.
The hospital occupied a large municipal building, the bed capacity of
which was 650. During its activity, June 1, 1917, to January 20, 1919, this
• The statements of fact appearing herein are based on the "mstory, Base Hospital No 4 \ E F " by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D C - Ed
/The statements of fact appearing herein are based on the "Historv, Base Hospita'l No .5 \ e'f " bv Mai
DMsLnTo'^^'w" ^•''"t ""'n^'r ^^^^^'"^^^ ''''' ^°«P'^-1- ^he history is on file in'the Historical
uivision, !3. (J. O., Washmgton, D. C. — Ed.
HOSPITALS
633
hospital cared for 45,837 patients, both surgical and medical. Of this number
41,015 were British and 4,822 Americans. The greatest number of patients
admitted in one day was 964.
The unit was relieved from duty with the British on January 20, 1919,
and sailed from Brest, France, April 7, 1919, on the Graf Waldersee, arriving
at New York April 20, 1919. The unit was demobilized May 2, 1919, at
Camp Devens, Mass.
PERSONNEL
COMMANDING OFFICER
Col. Robert U. Patterson, M. C, May 5, 1917, to February 27, 1918.
Lieut. Col. Roger I. Lee, M. C, February 28, 1918, to September 6, 1918.
Maj. Henry Lyman, M. C, September 7, 1918, to demobilization.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Roger I. Lee, M. C.
Maj. Reginald Fitz, M. C.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Horace Binney, M. C.
BASE HOSPITAL NO. 6"
Base Hospital No. 6 was organized in March, 1916, at the Massachusetts
General Hospital, Boston, and was mobilized May 24, 1917, at Boston. It
left there June 1, 1917, for Fort Strong, Mass., its training station, where it
remained until July 8, 1917, when it proceeded to New York, embarking the
next day on the Aurania. The entire unit sailed from New York July 9, 1917,
arriving at Liverpool, England, July 24, 1917. It left Liverpool immediately
by special train for Southampton, arriving there July 24, and sailed the same
night for Le Havre, France, on the Australian hospital ship Warilda. It
remained at Le Havre two days and proceeded, July 27, by rail to Bordeaux,
Department Gironde, base section No. 2, A. E. F., its permanent station.
Upon arrival at Bordeaux, July 28, the unit occupied French Hopital
Complementaire No. 25 (Petit Lycee de Bordeaux). A company of Engineers
was assigned to the hospital for construction purposes, and work started
September 8, 1917. A new kitchen, dining rooms, a warehouse, additional
wards and barracks for officers, enlisted men, and nurses were built. Some
of the buildings were not completed until June, 1918. The normal capacity
of hospital was 3,000 beds, and with "crisis expansion" 3,898 beds and cots,
including Red Cross huts and corridors. Patients first arrived August 21,
1917. The total number of patients treated, both surgical and medical, was
26,156, including 580 allied sick and wounded. The largest number of patients
in hospital was on September 7, 1918, 3,134 then being cared for.
On January 14, 1919, Base Hospital No. 6, was relieved by Base Hospital
No. 208, and ceased to function.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 6, A. E. F.," by Lieut.
Col. W. L. Babcock, M. C, while on duty as a member of the stafi of that hospital. The history is on file in the Histor-
ical Division, S. G. O., Washington, D. C.—Ed.
634
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The unit of Base Hospital No. 6 was transferred March 5, 1919, to tlio
Beau Desert hospital center, France, for transportation to the United States.
It sailed on the Antigone from Bordeaux, March 12, 1919, en route to New
York, arriving there March 24, 1919. After a delay of 12 days at Camp
Merritt, N. J., the organization was transferred to Camp Devens, Mass.,
arriving there April 6, 1919, and was mustered out of the service April 9, 1919.
PERSONNEL
COMMANDING OFFICER
Col. Frederick A. Washburn, M. C, May 29, 1917, to April 24, 1918.
Col. Warren L. Babcock, M. C, April 25, 1918, to January 18, 1919.
Lieut. Col. Lincoln Davis, M. C, January 19, 1919, to demobiUzation.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Addison G. Branizer, M. C.
CHIEF OF MEDICAL SERVICE
Col. Richard C. Cabot, M. C.
BASE HOSPITAL NO. 7
Base Hospital No. 7 was organized in December, 1916, at the Boston
City Hospital, Boston. The unit was mobilized in February, 1918, at Camp
Devens, Mass., where it remained in training until July 6, 1918, when it left
Camp Devens. It sailed from New York July 8, 1918, on the Leviathan;
arrived in Brest, France, July 15, 1918. After spending two weeks there it
was ordered to Joue-les-Tours, Department Indre et Loire, for station. Upon
arrival at Joue-les-Tours, July 30, 1918, Base Hospital No. 7 occupied one
type A unit, constructed by the engineers. Base Hospital No. 7, with a con-
valescent camp, formed the Joue-les-Tours hospital center. The first convoy
of sick and wounded was received on August 18, 1918; 3,518 surgical and
medical cases were received by convoys during its activity. In addition,
patients were treated from headquarters. Services of Supply, Tours.
On January 17, 1919, the hospital ceased to function, being on that date
relieved by Base Hospital No. 120. The personnel of Base Hospital No. 7
left France from St. Nazaire March 14, 1919, on the Manchuria, and arrived
at Camp Merritt, N. J., March 24, 1919. From Camp Merritt the unit was
transferred to Camp Devens, Mass., and there mustered out of the service
on April 14, 1919.
PERSONNEL
COMMANDING OFFICER
Col. A. M. Smith, M. C.
CHIEF OF SURGICAL SERVICE
Lieut. Col. E. H. Nichols, M. C.
CHIEF OF MEDICAL SERVICE
Maj. John J. Thomas, M. C.
* The statements of fact appearing herein are based on the " History, Base Hospital No. 7, A. E F "by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O. Washington D C —Ed
HOSPITALS
635
BASE HOSPITAL NO. 8 •
Base Hospital No. 8 was organized in November, 1916, at the Post-
Graduate Hospital, New York City. The unit was mobilized at Fort Jay,
N. Y., July 18, 1917. After 10 days of drilling and equipping the organization
embarked July 29, 1917, on the Saratoga. On July 30, shortly after midday
mess, the Saratoga, while at anchor in New York harbor, was rammed by the
Panama, and so badly damaged that all passengers were disembarked and
transported back to Governors Island. The unit lost most of its equipment
and personal property on the Saratoga, but after a week of reequipping em-
barked again on August 7, 1917, and sailed the same date on the Finland.
Fig. 126— Airplane view of Base Hospital No. 7, Joue-les-Toiirs.
The unit arrived at St. Nazaire, France, August 20, 1917, and next day
took station at Savenay, Department Loire Inferieure, base section No. 1.
Base Hospital No. 8 was the first hospital to arrive at Savenay, and formed
the nucleus of what was to be one of the largest and most important hospital
centers in France. It occupied the normal school of Savenay, a large, white-
stone building, which it transformed into a hospital. In addition to this a
number of wooden buildings and storehouses were built by the engineers, so
that the normal capacity of the hospital in November, 1918, was 2,460 beds.
This hospital received both medical and surgical cases, but from August, 1918,
•The statements of fact appearing herein are based on the "History, Base Hospital No. 8, A. E. F.," by Lieut.
L. O. Payson, S. C, while on duty as a member of the statT of that hospital. The history is on file in the Historical
Division. S. G. O.. Washington. 1). C.—Ed.
636
ADMINISTEATIOX, AMERICAN EXPEDITIONARY FORCES
was devoted entirely to the reception and preparation of cases for evacuation
to the United States.
The first patients were received September 22, 1917; 35,244 sick and
wounded were cared for during its activity. Base Hospital No. 69 relieved
Base Hospital No. 8 January 31, 1919, on w^hich date Base Hospital No. 8
ceased to function. The unit of Base Hospital No. 8 was broken up in March,
1919, and sent to the United States in charge of convoys of patients, and was
demobilized April 28, 1919, at Camp Lee, Va.
PERSONNEL
COMMANDING OFFICER
Col. J. F. Siler, M. C, July 17, 1917, to November 4, 1917.
Col. W. E. Cooper, M. C, November 5, 1917, to October 10, 1918.
Lieut. Col. R. J. Estill, M. C, October 11, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Col. Samuel Lloyd, M. C.
Maj. C. G. Heyd, M. C.
Maj. J. F. Connors, M. C.
Maj. H. W. Orr, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. R. J. Estill, M. C.
Maj. T. A. Martin, M. C.
BASE HOSPITAL NO. 9 '
Base Hospital No. 9 was organized in February, 1916, at the New York
Hospital, New York City, and was mobilized July 21, 1917, at Governors Island,
N. Y. After a short period of training the unit left New York August 7, 1917,
on the Finland, and arrived at St. Nazaire, France, August 20, 1917. It
remained at Savenay, quartered with Base Hospital No. 8, until September 1,
1917.
On September 2, the unit proceeded to Chateauroux, Department of Indre,
in the intermediate section, its permanent station. The unit occupied a number
of recently constructed buildings that had been intended for an insane asylum,
but had been taken over and used by the French as a military hospital. After
Base Hospital No. 9 occupied the buildings, a detachment of Engineers con-
structed a number of wooden wards and installed an X-ray plant. Later, when
patients began to arrive in large numbers and more beds W' ere required, the normal
school of Chateauroux w^as taken over by the hospital. The normal capacity of
the hospital was 1,926 beds, but in emergency as many as 2,250 patients were
treated at one time. Base Hospital No. 9 received both surgical and medical
cases, but in the spring of 1918 was designated as an orthopedic hospital. An
J The statements of fact appearing herein are based on the " History, Base Hospital No. 9 A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C. — Ed.
HOSPITALS
637
18-acre farm was leased and operated by convalescent patients, which gave
them a certahi amount of useful training and at the same time supplied messes
with staple vegetables and fresh pork. Though the first patient was admitted
on September 15, 1917, the first hospital train of patients did not arrive until
January 14, 1918. The hospital functioned from September 15, 1917, to Janu-
ary 13, 1919, when it was taken over by Base Hospital No. 63. During its
activity 15,219 sick and wounded were taken care of.
The unit sailed from St. Nazaire April 14, 1919, on the Princess Matoika.
It arrived in the United States April 27, 1919, and was demobilized at Camp
Upton, N. Y.
Fig. 127 —Base Hospital No. 9, Chateauroux
PERSONNEL
COMMANDING OFFICER
Col. Arthur W. Tasker, M. C, July 1, 1917, to June 5, 1918.
Lieut. Col. George W. Hawley, M. C, June 6, 1918, to January 18, 1919.
Maj. J. P. Erskine, M. C, January 19, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Eugene H. Pool, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Edward Cussler, M. C.
638
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 10 ^
Base Hospital No. 10 was orf^anized at the Pennsylvania Hospital, Phlla-
delphia, Pa., during February, 1917. It was mobilized at Philadelphia early in
May, 1917, and on May 19 sailed from the United States on the St. Paul,
arriving in England on May 28, 1917. After a few days' delay in England the
unit was assigned to station at Le Treport (Seine Inferieure), France, arriving at
that station on June 12, 1917. It was one of the original six hospitals assigned
to duty with the British and operated No. 16 General Hospital, British Elxpedi-
tionary Force. It remained at Le Treport, attached to the British during its
entire overseas existence. It ceased to function about February 27, 1919;
sailed from Brest, France, on the Kaiserine Augusta Victoria April 8, arrived in
the United States April 17, 1919, and was demobilized shortly thereafter.
PERSONNEL
COMMANDING OFFICER
Col. M. A. Delaney, M. C, May, 1917, to March 11, 1918.
Lieut. Col. Richard A. Harte, M. C, March 12, 1918, to November 3, 1918.
Lieut. Col. William J. Taylor, M. C, November 4, 1918, to December 24,
1918.
Lieut. Col. Charles F. Mitchell, M. C, December 25, 1918, to demobilization.
BASE HOSPITAL NO. 11 '
Base Hospital No. 11 was organized in July, 1916, at the St. Mary's, St.
Joseph's, and Augustana Hospitals, Chicago, 111. The unit was mobilized
March 4, 1918, at the St. Mary's Hospital, Chicago, and on April 2, 1918,
was transferred to Camp Dodge, Iowa, for instructions. After 11 weeks of
training at the base hospital at Camp Dodge, it proceeded, on June 18, 1918,
to Camp Mills, Long Island, w^here it remained until June 28, when it sailed
from Hoboken, N. J., for Europe, on the Matagama. It arrived at Liverpool,
England, June 10, 1918, and at Cherbourg, France, July 12, 1918. From
Cherbourg, the unit proceeded by train to Nantes, Department Loire Inferi-
eure, base section No. 1, where it arrived July 16, 1918.
Base Hospital No. 11 w^as the second hospital unit to arrive at Nantes,
where it functioned as a part of a small hospital center. It was assigned to a
type A, 1,000-bed hospital, with crisis expansion to 2,500. From July 25,
when the first patients were received, to the time the hospital was relieved, it
cared for 2,012 medical and 3,890 surgical cases. The greatest number of
patients in hospital was on October 15, when 2,386 were being cared for.
Base Hospital No. 11 was relieved by Evacuation Hospital No. 28, on
January 14, 1919, and sailed from St. Nazaire April 13, 1919, on the Rijndam.
It arrived at Newport News, Va., April 25, and was demobilized at Camp
Grant, 111., April 29, 1919.
* The statements of fact appearing herein are based on the "History, Base Hospital No. 10, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 11, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington' D. C— Ed.
HOSPITALS 639
PERSONNEL
COMMANDING OFFICER
Col. F. O. McFarland, M. C, April 2, 1918, to January 20, 1919.
Capt. I. R. Schmidt, M. C, January 21, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Nelson M. Percy, M. C.
Maj. R. C. Flannery, M. C.
CHIEF OF MEDICAL SERVICE
Maj. G. F. Dick, M. C.
Fui. 128.— A geiionil medical ward, exterior, Base Hospital No. 12, operating British General Hospital No. 18
BASE HOSPITAL NO. 12-
Base Hospital No. 12 was organized in July, 1916, at the Northwestern
University Medical Department, Chicago, 111. The officers and nurses were
appointed from the Mercy, Wesley, Cook County, and Evanston Hospitals;
the enlisted men were recruited largely from the undergraduates of the North-
western University. The unit was mobilized at Chicago on May 1, 1917. It
left Chicago May 16, 1917, arriving in New York May 18; boarded the Mon-
golia and sailed on the following day, May 19, 1917, for Europe. During target
practice May 20, two nurses accidentally were killed by shell fragments, and
the ship returned to New York, reaching there May 21. The Mongolia sailed
again on May 24 and docked at Falmouth, England, June 2.
The statements of fact appearing herein are based on the "History, Base Hospital No. 12, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C— Ed.
13901—27 41
640
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The unit proceeded by rail to London, whence it entrained, June 11, for
Folkstone, England. From Folkstone the unit proceeded to Boulogne, France,
and thence to Dannes-Camiers, Department of Seine Inferieure, where it took
over the British General Hospital No. 18. The hospital was of huts and tents,
with a capacity of 2,000 beds. Part of the British personnel remained long
enough to enable the personnel of Base Hospital No. 12 to become familiar with
the workings of a British hospital.
General Hospital No. 18 received convoys of wounded almost daily,
directly from the front, until the first of the year 1918. During its active
service with the British Expeditionary^ Force, Base Hospital No. 12 cared for
27,438 British and 2,229 American medical cases; for 30,010 British and 906
Fig. 129.— Exterior, sur«ir:il ward, Ba-r Hospiial No. 12
American surgical cases. Base Hospital No. 12 remained with the British
Expeditionary Force until March 8, 1919, when it entrained for Brest, sailing
thence March 26, 1919, on the Leviathan. It arrived in New York April 2, 1919,
and was demobilized at Camp Grant, 111., shortly afterwards.
PERSONNEL
COMMANDING OFFICER
Col. C. C. Collins, M. C, May 8, 1917, to September 1, 1918.
Maj. Martin R. Chase, M. C, September 2, 1918, to October 8, 1918.
Maj. Payson L. Nusbaum, M. C, October 9, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Kellog Speed, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Milton Mandell, M. C.
HOSPITALS
641
BASE HOSPITAL NO. 13 "
Base Hospital No. 13 was organized in July, 1916, at the Presbyterian
Hospital, Chicago, 111. On January 11, 1918, the unit was mobilized in
Chicago, and proceeded January 19, 1918, to Fort McPherson, Ga., for train-
ing and equipment. The organization left Fort McPherson May 1, 1918,
for Camp Merritt, N. J., and embarked May 19, on the Saturnia for Europe.
It arrived in Le Havre, France, May 31, 1918, and proceeded on June 8 to
its permanent station at Limoges, Department of Haute Vienne, base section
No. 2. It arrived at Limoges June 10, and formed a part of what was to be
the hospital center there.
The unit occupied 52 wooden buildings, constructed by the engineers,
located in a park near the center of the city. The normal capacity of the
hospital was 1,500 beds, but in October and November, 1918, it was expanded
to 2,300 beds. The first patients arrived July 19, 1918; the total number
cared for was 6,267, of which 3,648 were surgical and 2,619 medical cases,
with 965 operations. The largest number of patients in hospital was 2,323
sick and wounded on November 13, 1918.
The hospital ceased to function on January 18, 1919, when it was relieved
by Evacuation Hospital No. 32. It sailed from Bordeaux, France, March 25,
1919, on the Wilhemina, arriving at Camp Mills, N. Y., April 5, 1919, and was
demobilized at Camp Grant, 111., April 23, 1919.
PERSONNEL
COMMANDING OFFICER
Col. C. P. Robbins, M. C.
CHIEF OF SURGICAL SERVICE
Lieut. Col. D. D. Lewis, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. R. C. Brown, M. C.
BASE HOSPITAL NO. 14 "
Base Hospital No. 14 was organized in July, 1916, at the St. Luke and
Michael Reese Hospital, Chicago, 111. The unit was mobilized March 1,
1918, at the 8th Regiment Armory, Chicago, 111. On April 1, 1918, it was
transferred to Camp Custer, Mich., for training and equipping. It left Camp
Custer July 6, en route to Camp Merritt, N. J. It left New York July 15,
1918, on the Melbourne, arriving in Halifax, Nova Scotia, Canada, July 18,
leaving there July 20, 1918. It reached Liverpool, England, July 31, and
arrived at Cherbourg, France, August 3, 1918.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 13, A. E. F.," by Col.
C. P. Robbins, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C.—Ed.
0 The statements of fact appearing herein are base ! on the "History, Base Hospital No. 14, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O.. Washington, D. il.—Ed.
642
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
On August 4, the organization was ordered to Mars-sur-Allier, Depart-
ment Nievre, in the intermediate section, A. E. F., where it arrived August
7, 1918. Base Hospital No. 14, was the third hospital to arrive at Mars,
where it formed a part of one of the largest hospital centers in France. The
unit occupied a type A hospital, and on August 20, 1918, began to receive its
first patients. The normal capacity of the hospital was 2,000 beds; the largest
number of patients in hospital was 1,751, on November 15, 1918. It cared
for 5,534 sick and wounded, of which 3,330 were medical and 2,204 surgical
cases.
On January 15, 1919, Base Hospital No. 14 was relieved by Base Hospital
No. 131, and sailed from Brest April 7, 1919, on the Graf Waldersee, arriving
in Hoboken April 20, 1919. The organization was demobilized at Camp
Grant, 111., on May 2, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. William W. Vaughan, M. C, April 22, 1918, to January ;^20,
1919.
Maj. Thomas L. Dagg, M. C, Januaiy 22, 1919, to March 4, 1919.
Capt. Hubert B. Blaydes, M. C, March 5, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. Samuel C. Plummer, M. C.
CHIEF OF MEDICAL SERVICE
Maj. John H. McClellan, M. C.
BASE HOSPITAL NO. 15 "
Base Hospital No. 15 was organized at Roosevelt Hospital, New York,
N. Y., on April 12, 1917, and was mobilized at New York City in June, 1917. It
sailed from New York for Europe on the Lapland on July 2, 1917, arriving in
Europe on July 12, 1917. It was the first base hospital to arrive overseas for
duty with the American Expeditionary Forces and was stationed at Chaumont,
Haute Marne, France, where it arrived on July 16, 1917.
It ceased operating on January 15, 1919; sailed for the United States on
the Olympic February 18, 1919; arrived in the United States on February 24,
1919, and was demobilized shortly thereafter.
PERSONNEL
COMMANDING OFFICER
Col. H. S. Hansell, M. C, from date of organization to June 18, 1918.
Lieut. Col. Rolfe Floyd, M. C, June 19, 1918, to February 3, 1919.
p The statements of fact appearing herein are based on the " History, Base Hospital No. 15, A. E. F.," by the com-
manding oflBcer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
643
BASE HOSPITAL NO. 17 «
Base Hospital No. 17 was organized in September, 1916, at the Harper
Hospital, Detroit, Mich., and was mobilized there on June 28, 1917. On July
3, 1917, the organization was transferred to Allentown, Pa., leaving there July 11,
for New York, w^here it embarked on the Mongolia and sailed July 13, 1917. It
arrived at Southampton, England, July 24, by way of Plymouth, England, and
at Le Havre, France, July 25, 1917. It remained at Le Havre until July 28,
when it proceeded by rail to its final destination, Dijon, Department Cote D'or,
in the advance section, arriving there July 29, 1917.
Base Hospital No. 17 was the first American organization to arrive at that
station, where it functioned as an independent hospital, until January 8, 1919.
At Dijon the unit was assigned the Hospital St. Ignace (French Auxilliary
Hospital No. 77), then operated by the French Army. The French had about
Fig. 130.— Base Hospital No. 15, Chaumont
230 patients in the hospital when the unit arrived, the evacuation of which was
not completed until August 18, 1917. It began receiving American patients on
August 21, 1917, but the hospital was not officially turned over to the command-
ing officer until September 2, 1917.
In June 1918, when the capacity of the hospital proved inadequate, a
French seminary was taken over at Plombiers, about 3}4 miles from the main
hospital, and was operated as an annex. The seminary was a large stone
l)uilding, of 800-bed capacity, and was used largely for convalescent and minor
surgical cases.
Base Hospital No. 17 ceased to function January 8, 1919; the unit sailed
fiom St. Nazaire April 14, 1919, on the Princess MatoiJca, arriving at Newport
News, Va., April 27, 1919, and was demobilized at Camp Custer, Mich., May 9,
1919.
« The statements of fact appearing herein are based on the "History, Base Hospital No. 17, A. E. F.," by the com-
manding officer of that hospital The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
644
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL
COMMANDING OFFICER
Col. Henry C. Coburn, M. C, June 6, 1917, to May 12, 1918.
Col. Angus McLean, M. C, May 13, 1918, to March 24, 1919.
Maj. Thomas K. Gruber, M. C, March 25, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Henry N. Torrey, M. C.
CHIEF OF MEDICAL SERVICE
Maj. George E. McKean, M. C.
Fig. 131— Base Hospital No. 17, Dijon
BASE HOSPITAL NO. 18 '
Base Hospital No. 18 was organized in November, 1916, at Johns Hopkins
Hospital, Baltimore. The unit was mobilized May 24, 1917, at Baltimore,
and on June 6, proceeded to New York for transportation to Europe. The
organization embarked on the Finland June 9, 1917. The transport remained
in the harbor until June 13, when it left en route to St. Nazaire, arriving there
June 28, 1917. On June 30, the unit proceeded to Savenay, Department
Loire Inferieure, where it was quartered in the normal-school building of Save-
nay, and while waiting for assignment to a station underwent a certain amount
of military training. Part of the unit was detached on July 5 and sent to St.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 18, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington. D. C— £"d-
HOSPITALS
645
Nazaire, where it took over and operated a hospital, which at first was known
as United States Army Hospital No. 1 and later was designated as Base
Hospital No. 101.
Toward the end of July, 1917, the unit proceeded to Bazoilles sur Meuse,
Department of Vosges, in the advance section, where it arrived July 26, 1917.
Base Hospital No. 18 was the first hospital unit to arrive at that station and
was the farthest advanced hospital in the American Expeditionary Forces at
that time. It functioned independently until July 1, 1918, when it became
a part of a large and very important hospital center. At Bazoilles, the unit
took over from the French Medical Department an estate comprising a stone
hunting lodge, several groups of stone outbuildings, and a 25-acre tract of
forested land. A number of frame buildings were erected, with a total bed
capacity of 1,000, which later was increased by tent expansion to 1,300 beds.
Base Hospital No. 18 operated an optical and ophthalmological depart-
ment. It was designated as a special hospital for chest and abdominal surgical
cases, and received all contagious disease cases coming to the center.
During its active service, August 1, 1917, to January 9, 1919, the hospital
treated a total of 14,179 medical and surgical cases.
Among the enhsted men of the unit were 32 third-year medical students,
who completed their last scholastic year in France, received their degrees,
and commissions in the Medical Reserve Corps.
On January 9, 1919, the hospital turned over its patients and property
to Provisional Hospital No. 1, and left for St. Nazaire January 12, 1919. On
January 31, 1919, the organization boarded the Finland at St. Nazaire and
arrived in New York February 14, 1919. On February 25, 1919, it was demo-
bilized at Camp Upton, Long Island, N. Y., and thus the Johns Hopkins unit
ceased to exist.
PERSONNEL
COMMANDING OFFICER
Col. J. D. Heysinger, M. C, June 7, 1917, to August 18, 1917.
Col. George M. Edwards, M. C, August 19, 1917, to July 14, 1918.
Lieut. Col. H. H. Van Kirk, M. C, July 15, 1918, to October 19, 1918.
Maj. Bertram M. Bernheim, M. C, October 20, 1918, to December 5, 1918.
Lieut. Col. H. H. Van Kirk, M. C, December 6, 1918, to January 18, 1919.
Maj. Harvey B. Stone, M. C, January 19, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. Harvey B. Stone, M. C.
CHIEF OF MEDICAL SERVICE
Capt. C. G. Guthrie, M. C.
646
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 19 •
Base Hospital No. 19 was organized in March, 1916, at Rochester, N. Y.,
and was mobihzed in the 3d Regiment Armory, that City, on December 17,
1917, where it trained for five months. On June 4, 1918, the organization
left New York on the Baltic, arriving in Liverpool, England, June 16, 1918,
and in Le Havre, France, June 18. It left Le Havre, June 20, en route to
Vichy, Department of Alher, in the intermediate section, arriving there June
22, 1918. This hospital, the second hospital to arrive in Vichy, later formed
a part of the hospital center there. It operated in 22 hotels and conducted
12 messes. It began receiving patients July 12, 1918. The normal capacity
of the hospital was 3,629, beds, which in crisis emergency could be expanded
to 4,114 beds and cots. Largest number of sick and wounded treated at one
time was 3,517, on November 12, 1918. This hospital received both surgical
and medical cases, the total number cared for being 11,071.
On January 20, 1919, the hospital transferred all its remaining patients
and ceased to function. The unit sailed from St. Nazaire on the Freedom,
April 13, 1919, arriving in the United States April 28, 1919, and was demobi-
lized at Camp Upton, N. Y., on May 7, 1919.
PERSONNEL
COMMANDING OFFICER
Col. George A. Skinner, M. C, December 23, 1917, to July 19, 1918.
Lieut. Col. John M. Swan, M. C, July 20, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. Charles W. Hennington, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. WilHam V. Evers, M.C.
BASE HOSPITAL NO. 20 '
Base Hospital No. 20 was organized in September, 1916, at the University
of Pennsylvania, Philadelphia, and was mobilized November 30, 1917, at
Philadelphia. It received training until April 1, 1918, when it left for Camp
Merritt, N. J., where it remained, completing its equipment, until April 21,
1918. On April 24, 1918, it sailed from New York on the Leviathan, arriving
at Brest, France, May 2, 1918. It proceeded from Brest to its final destination,
Chatel Guyon, Department of Puy-de-Dome, in the intermediate section, reach-
ing there on May 7. Chatel Guyon is a summer health resort, situated in the
Auvergne Mountains, and there the unit took over various summer hotels,
villas, and garages, a total of 33 buildings with a bed capacity of 2,500.
• The statements of fact appearing herein are based on the "History, Base Hospital Ko. 19, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C—
' The statements of fact appearing herein are based on the "History, Base Hospital No. 20, A. E. F.," by Lieut. Col.
John B. Carnett, M.C, while on duty as a member of she staff of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C—Ed.
HOSPITALS
647
Base Hospital No. 20 was designated as one of the hospitals in the American
Expeditionary Forces for the observation of suspected cases of tuberculosis.
It cared for 8,706 surgical and medical cases; the greatest number of patients
in hospital at one time was 2,253, on October 10, 1918. It ceased to function
on January 20, 1919, all patients remaining in hospital on that date being
transferred to other hospitals. The personnel left St. Nazaire on the Freedom,
April 13, 1919, and reached New York, April 28, 1919. From New York
the unit proceeded to Camp Dix, N. J., where it was demobilized on May
5, 1919.
PERSONNEL
COMMANDING OFFICER
Col. Thomas H. Johnson, M. C, November 30, 1917, to July 28, 1918.
Lieut. Col. George M. Piersol, M. C, July 29, 1918, to November 3, 1918.
Lieut. Col. John M. Carnett, M. C, November 4, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Eldridge L. Eliason, M. C.
Capt. John E. Kelly, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. George M. Piersol, M. C.
Maj. J. H. Musser, jr., M. C.
BASE HOSPITAL NO. 21 "
Base Hospital No. 21 was organized in July, 1916, at the Washington
University School of Medicine, St. Louis, Mo., and mobilized April 27, 1917,
at St. Louis. On May 17 it was transferred to New York; thence it sailed
on the St. Paul, May 19, 1917. It arrived at Liverpool, England, May 28,
1917, and was assigned to duty with the British Expeditionary Forces. On
June 10, the unit landed at Le Havre, France. On the following day it
entrained for Rouen, Department of Seine Inferieure, where it took over
and operated British General Hospital No. 12. The latter hospital had been
in existence since August, 1914, and was one of the 14 hospitals and conva-
lescent camps maintained by the British in the Rouen area. When first
taken over by the American unit, the hospital practically consisted of tents;
later, however, a number of Adrian type buildings and Nisson huts were erected.
The capacity of the hospital was 1,350 beds, but in October, 1918, as
many as 1,950 patients were cared for at one time. It received 29,706 surgical
and 31,837 medical cases. Of these, 2,833 were American, the remainder
being British patients. During the German offensive operations in the spring
of 1918, great numbers of wounded were received directly from the field.
The hospital ceased to function January 22, 1919, and on February 11, 1919,
the personnel proceeded to Vannes (Morbihan) to await transportation to
the United States. On April 7, 1919, the organization sailed from Brest
on the Graf Waldersee, arriving in New York April 20. On May 3, 1919,
it was demoblized at Camp Funston, Kans.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 21, A. E. F.," by Maj. Walter
Fischel, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical Division ,
S. G. O., Washington. D. C.—Ed.
648
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL
COMMANDING OFFICER
Col. James D. Fife, M. C, May 12, 1917, to October 18, 1917.
Col. Fred T. Murphy, M. C, October 19, 1917, to May 15, 1918.
Lieut. Col. Borden S. Veeder, M. C, May 16, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Malvern B. Clompton, M. C.
Maj. W. R. Rainey, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Walter Fischel, M. C.
Fig. 132.— a view of part of Base Hospital Xo. 21, operating British General Hospital No. 12, Rouen
BASE HOSPITAL NO. 22 '
Base Hospital No. 22 was organized in July, 1916, at Milwaukee, Wis.,
and was mobilized on January 7, 1918, at the Light Horse Squadron Armory,
Milwaukee, where it was trained and equipped until May 19, 1918, when it
left for Camp Merritt, N. J. From May 21 until June 3, it remained at Camp
Merritt, then it proceeded to New York, and embarked on the Baltic. It
departed from New York on June 4, and arrived at Liverpool, England, June
• The statements of fact appearing herein are based on the "History, Base Hospital No. 22, A. E. F.," by Lieut.
Col. Curtis A. Evans, M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. G. O., Washington, D. C— Ed.
HOSPITALS
649
16, and crossed to Le Havre, France, June 18. It left Le Havre June 20 by
rail for Beau Desert, Department of Gironde, in base section No. 2, where it
arrived on June 22, 1918, and was the first hospital of a group that later became
the hospital center.
The hospital occupied a type A unit, with a bed capacity of 1,000, but
(luring the stress of work in the fall of 1918 the hospital expanded to surround-
ing vacant units, until on November 10, 1918, 5,098 cases were under treatment.
In December, 1918, this hospital was designated as a hospital for evacuations
only, other hospitals in the center acting as receiving hospitals. During its
activity, July 22, 1918, to January 25, 1919, this organization cared for 17,202
cases, both medical and surgical.
The unit was relieved by Evacuation Hospital No. 20, on January 25, 1919,
and sailed from Bordeaux on the Santa Maria, February 17, 1919. It arrived
in New York on March 5, 1919, and w^as demobilized at Camp Grant, 111 ,
March 16, 1919.
PERSONNEL
COMMANDING OFFICER
Col. T. J. Kirkpatrick, M. C, December 19, 1917, to July 6, 1918.
Maj. Thomas L. Gore, M. C, July 7, 1918, to January 27, 1919.
Lieut. Col. C. A. Evans, M. C, January 28, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. C. A. Evans, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Robert C. Brown, M. C.
BASE HOSPITAL NO. 23 ">
Base Hospital No. 23 was organized in January, 1917, at the General Hos-
pital, Buffalo, N. Y., and was mobilized at Fort Porter, N. Y., August 21, 1917,
where the organization w^as trained and equipped. On November 21, 1917,
after three months of training, the unit left Fort Porter en route to New York,
arriving there November 22, 1917. It embarked on the Carpathia November
22, and left New York the same day en route to Europe, by way of Halifax,
Canada. It arrived in Liverpool, England, December 8, 1917, and Le Havre,
France, December 14, 1917. After a two days' rest at Le Havre, the unit pro-
ceeded to Vittel, Department of Vosges, in the advance section, its permanent
station, arriving there December 19, 1917. It was the second hospital to
arrive at Vittel, and later became a part of the hospital center there. The
hospital occupied in Vittel 21 buildings, comprising hotels, villas, and garages,
with a bed capacity of 1,800, which could be expanded in emergency to 2,800.
The first patients were received January 8, 1918. By February 6, 1919, when
the hospital ceased to function, 11,625 surgical and medical cases had been
cared for.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 23, A. E. F.," by Capt.
F. May, M. C, while on duty as a member of the stall of that hospital. The history is on file in the Historical Division,
S. 0.0., Washington, D. C.— Ed.
650
ADMINISTRATION, AMERICAN EXPEDITIONARY P^ORCES
On February 6, 1919, all remaining patients were transferred to the hos-
pital center at Bazoilles, and Base Hospital No. 23 ceased to function on that
date. On April 20, 1919, the organization left Brest on the Finland, arriving
in New York May 1, 1919. It was demobilized at Camp Upton, N. Y., shortly
afterwards.
PERSONNEL
COMMANDING OFFICER
Col. Guy V. Rukke, M. C, August 24, 1917, to August 7, 1918.
Maj. Samuel E. Getty, M. C, August 8, 1918, to November 26, 1918.
Lieut. Col. Marshall Clinton, M. C, November 27, 1818, to January 22,
1919.
Maj. Joseph Betts, M. C, January 23, 1919, to demobilization.
CHIEF SURGICAL SERVICE
Lieut. Col. Marshall Clinton, M. C.
CHIEF MEDICAL SERVICE
Maj. Nelson G. Russell, M. C.
BASE HOSPITAL NO. 24 ^
Base Hospital No. 24 was organized in January, 1917, at Tulane Univer-
sity, New Orleans, La., and was mobilized August 31, 1917, at Jackson Barracks,
La. On September 3, 1917, the organization was transferred to Camp Grccn-
leaf, Ga., where it was trained and equipped.
On February 16, 1918, after five months of training, the organization
sailed from New York on the Carmania. It arrived in Liverpool, England,
March 4, 1918, and proceeded by way of Southampton and Le Havre to Limoges,
Department of Haute Vienne, in base section No. 2, reaching there March
15, 1918. It was the second hospital to arrive at that station, where it formed
a part of a three-unit hospital center. The hospital was located in a factory
plant, which previously had been occupied by Mobile Hospital No. 39. In
addition to the factory plant, there were 14 wooden barracks, used as wards
and as quarters. In October, 1918, the Ecole d' Institutrices was taken over
and operated as annex to Base Hospital No. 24.
The capacity of the hospital was 1,200 beds, but during the stress of
work in November, 1918, this was increased to 1,740 beds by using the quar-
ters as wards. During its activity, March 16, 1918, to January 10, 1919,
3,503 surgical and 3,858 medical cases were admitted.
The hospital ceased to function on January 10, 1919, and the personnel
sailed from St. Nazaire on the Walter A. Luckenhach, April 9, 1919, arriving
in New York April 19, 1919. The unit was demobilized at Camp Shelby,
Miss., on May 3, 1919.
» The stitenents of fact appearing herein are based on the "History, Base Hospital No. 24, A. E. F. " by Lieut .
Col. Charles E. McBrayer, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
651
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Charles E. McBrayer, M. C.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Urban Maes, M. C.
Capt. John Smyth, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. John B. Elliott, M. C.
Maj. John T. Halsey, M. C.
BASE HOSPITAL NO. 25 "
Base Hospital No. 25 was organized in March, 1916, at the General Hos-
pital, Cincinnati, Ohio, and was mobilized March 7, 1918, at Camp Sherman,
Ohio, where it underwent training for three months. The organization left
Camp Sherman, June 19, 1918, for Camp Mills, Long Island, N. Y. It em-
barked June 27, 1918, on the Lapland, and sailed the next. day for Liverpool:
It arrived at Liverpool, England, July 10, 1918, and at Cherbourg, France,
July 12, 1918. From Cherbourg the unit proceeded to Allerey, Department
Saone et Loire, in the intermediate section, reaching there July 15, 1918.
Base Hospital No. 25 was the second hospital to arrive at that station, and
formed a part of what later became a large hospital center. The hospital
occupied a type A unit, augmented by 36 marquee tents, bringing the capac-
ity of the hospital to 1,750 beds. The first convoy of patients arrived July
30, 1918; the highest number of patients in hospital at one time was 1,815,
in November, 1918. This hospital received all the psychoneurosis cases in the
center. During its activity, July 30, 1918, to January 11, 1919, the hospital
cared for 2,822 surgical and 3,038 medical cases.
The hospital ceased to function on January 11, 1919. The unit sailed
from St. Nazaire for New York, April 13, 1919, on the Freedom. It arrived
in the United States April 28, 1919, and was demobilized at Camp Taylor, Ky.,
Mav 7, 1919.
PERSONNEL
COMMANDING OFFICER
Col. Edward G. Huber, M. C, April 5, 1918, to September 13, 1918.
Lieut. Col. WiUiam Gillespie, M. C, September 14, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. Charles M. Paul, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Henry L. Woodward, M. C.
» The statements of fact appearing herein are based on the "History, Base Hospital No. 25, A. E. F.," by Lieut.
Col. Wilham Gillespie, M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. G. O., Washington, D. C.—Ed.
652
ad:^iixistration, American expeditionary forces
BASE HOSPITAL NO. 26 '
Base Hospital No. 26 was organized in May, 1917, at the University of
Minnesota, Minneapolis, and was mobilized at Minneapolis on December 13,
1917. On December 28, 1917, the unit entrained for Fort McPherson, Ga.,
where it arrived on the 31st. It remained there in training until the middle of
May, 1918, when it proceeded to Camp Merritt, N. J., to prepare for embarka-
tion. It left Hoboken June 5, 1918, on the Adriatic, arriving in Liverpool,
England, June 16, 1918, and at Le Havre, France, within a day or two. It
reached Allerey, Department Saone et Loire, in the intermediate section, June
20, 1918, being the first unit to reach this station, later the location of a large
hospital center. It furnished the personnel for much the greater part of the
center staff.
The hospital was housed in a type A unit, augmented by a number of mar-
quee tents, the total capacity of the hospital being 2,000 beds. The first convoy
of patients arrived on July 23, and the second on July 30; the second convoy
came directly from evacuation hospitals at the front and brought many wounded
that had not been operated on. This hospital was designated by the command-
ing office of the hospital center to receive all ophthalmic cases for the center.
It established a clinic for all ambulatory ocular cases of the center. During the
service of this department, 818 refractions were made.
Base Hospital No. 26 ceased to function on January 10, 1919, and the
organization sailed from St. Nazaire on the Rijndam, April 13, 1919, arriving at
Newport News, Va., April 25, 1919. The entire unit was demobilized at Camp
Grant, 111., Mav 13, 1919.
PERSONNEL
COMMANDING OFFICER
Col. J. H. Ford, M. C, December 17, 1917, to June 23, 1918.
Col. A. A. Law, M. C, June 24, 1918, to December 26, 1918.
Lieut. Col. John S. Staley, M. C, December 27, 1918, to demobiUzation.
CHIEF OF SURGICAL SERVICE
Lieut. Col. John S. Staley, M. C.
Col. A. A. Law, M. C.
Maj. E. C. Moore, M. C.
Maj. M. E. Lott, M. C.
CHIEF OF MEDICAL SERVICE
Maj. S. M. White, M. C.
Capt. David M. Berkman, M. C.
» The statements of fact appearing herein are based on the "History, Base Hospital No. 26, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
653
BASE HOSPITAL NO. 27 <»
Base Hospital No. 27 was organized in April, 1916, at the Medical School
of the University of Pittsburgh, Pa., and was mobilized at Pittsburgh, on
August 18, 1917. Three days later, the unit entrained for Allentown, Pa.,
where it arrived August 22, 1917, and spent five weeks in training. On Septem-
ber 27, 1917, the unit left New York on the Lapland. It reached HaHfax,
Canada, September 29, and left the same day for Liverpool, England, reachino-
there October 11, 1917. From Liverpool it proceeded by rail to Southampton",
arriving there October 12, and remained there in a rest camp until October 16,
1917, when it crossed the English Channel and disembarked at Le Havre, France,
October 17. After spending a day in the rest camp at Le Havre, the organiza-
FiG. 133.— A view of part of the temporary buildings, Base Hospital No. 27, Angers
tion proceeded to its permanent station at Angers, Department Maine et Loire,
base section No. 1, arriving there October 19, 1917. The hospital occupied the
Mongazon seminary, a large three-story masonry structure, which was readily
converted into a hospital. In addition, numerous wards of wooden construc-
tion were erected; these wards were of the Grandum (frame) type and of the
Bessonneau (frame plastered) type. In August 1918, the Grand Seminaire, a
large modern three-story building, was taken over and operated as an annex for
the treatment of convalescing patients. The hospital began to receive patients
November 9, 1917. Its normal capacity was 2,800 beds; and in emergencies this
was expanded to 4,100. This expansion extended into a number of marquee
tents.
° The statements of fact appearing herein are based on the "History, Base Hospital No. 27, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C.—Ed.
654
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
During the week ending October 17, 1918, Angers was designated a hospital
center; however, it was not until after the armistice was signed that Provisional
Base Hospital No. 1 was organized there, from personnel comprising Base Hospi-
tal No. 27.
The hospital cared for 19,522 patients; of these 10,455 were medical and
9,067 surgical cases.
On January 5, 1919, Base Hospital No. 27 was relieved by Base Hospital
No. 85, and on March 14, 1919, sailed from St. Nazaire on the Manchuria, and
arrived at New York November 24. It was demobiUzed at Camp Dix, N. J.,
March 25, 1919.
Fig. 134.— Base Hospital No. 28, part of Limoges hospital center
PERSONNEL
COMMANDING OFFICER
Col. Royal Reynolds, M. C, July, 1917, to January 8, 1919.
Maj. Stanley S. Smith, M. C, January 9, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Robert T. Miller, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. J. D. Heard, M. C.
HOSPITALS
655
BASE HOSPITAL NO. 28
Base Hospital No. 28 was organized in April, 1917, at the Christian Church
Hospital, Kansas City, Mo., and was mobilized January 21, 1918, at Kansas
City, Mo., where it received its preliminary training and equipment. On
February 23, 1918, the organization was transferred to Fort McPherson, Ga.,
where it continued its training at General Hospital No. 6. On June 2, 1918,
the organization left for Camp Merritt, N. J., arriving there June 4, 1918, and
sailed on the Meganic, June 12, 1918. It disembarked at Liverpool, England,
June 25, and proceeded immediately to Southampton, leavmg there June 28
for Cherbourg, France. It arrived at Limoges, Department of Haute Vienne,
base section No. 2, on July 2, 1918. It was the third and last hospital to report
at the Limoges hospital center. The unit occupied a type A hospital and also
took over from the French a large school building, the Belaire Seminary. The
normal capacity of the hospital was 1,780 beds, which in emergency was
increased to 2,965. The first patients were received July 23; the total number
received was 9,954, of which 6,087 were medical and 3,867 surgical cases.
On February 1, 1919, Base Hospital No. 28 was reheved by Base Hospital
No. 98, and on April 19, 1919, it returned to the United States on the Mercury,
from St. Nazaire. It arrived in the United States on April 30, and was mus-
tered out of the service at Camp Dix, N. J., on May 2, 1919.
PERSONNEL
COMMANDING OFFICER
Col. William B. Banister, M. C, February 22, 1918, to July 15, 1918.
Lieut. Col. Lindsay S. Milne, M. C, July 16, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. J. F. Binnie, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. George H. Hoxie, M. C.
BASE HOSPITAL NO. 29^
Base Hospital No. 29 was organized at City and County Hospital, Denver.
Colo., on April 5, 1917, and was mobilized at Camp Cody, N. Mex., during
March, 1918. The unit trained at Camp Cody and at Camp Crane, Allentown,
Pa., until July 5, 1918, when it left for Hoboken, N. J., arriving there on July
6, 1918, when it embarked on the Empress of Russia, and sailed the same date
for Europe. The unit arrived in England on July 17, 1918, and was assigned
to duty at North Eastern Fever Hospital, London, where it arrived on the
night of July 19, 1918. It took over the hospital from the British on August 1,
1918. The hospital cared for 3,976 cases, of which 2,351 were surgical and
1,625 were medical.
» The statements of fact appearing herein are based on the " History, Base Hospital No. 28, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the " History, Base Hospital No. 29, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed
13901—27 42
656
ADMINISTKATION, AMERICAN EXPEDITIONARY FORCES
Base Hospital No. 29 ceased operating on January 12, 1919; sailed for the
United States on the Olympic, February 18, 1919; arrived in the United States
on Februarj^ 24, 1919, and was demobilized at Fort Logan, Colo., on March 13,
1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. John B. Anderson, M. C.
CHIEF OF SURGICAL SERVICE
Maj. Edward F. Dean, M. C.
Capt. Robert Ferguson, M. C.
Fig. 135.— Surgical building, Base Uospital No. 29
CHIEF OF MEDICAL SERVICE
Maj. John M. Amesse, M. C.
Maj. William W. Williams, M. C.
BASE HOSPITAL NO. 30''
Base Hospital No. 30 was organized in March, 1917, at the University of
Cahfornia, San Francisco, and was mobilized November 20, 1917, at Fort
Mason, Calif. After three months of training and equipping the organiza-
tion sailed from Fort Mason, March 1, 1918, on the Northern IPaciiic for New
^ The statements of fact appearing herein are based on the " History, Base Hospital No. 30, \ E F " bv the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D C —Ed
HOSPITALS
657
York via Panama, arriving at New York March 17. The unit remained at
Camp Merritt, N. J., until April 22, when it embarked at Hoboken on the
Leviathan and sailed April 24. It arrived at Brest, France, May 2, 1918, and
at Roy at, Department Puy de Dome, in the intermediate section. May 7.
Royat is a small town situated in the Auvergne Mountains, and is a popular
health and watering resort. There was no other hospital at Royat, and until
shortly before the armistice Base Hospital No. 30 functioned independently.
For a short time it was a part of the Clermont-Ferrand hospital center. The
hospital occupied 16 hotels and a garage, with a total normal bed capacity of
2,400. Difficulty was experienced with the sewerage system; all buildings
were dependent on cesspolls, which on account of shortage of wagons and men
Fig. 136— Airplane view, Base Hospital No. 30, Royat
could not be emptied as often as required. Cesspools were located directly
under the buildings and, when they overflowed, flooded the basements and
kitchens.
The first patients were received on June 12; the total number of cases
treated in hospital from June 12, 1918, to January 20, 1919, was 7,562, of which
2,415 were surgical and 5,147 medical cases.
On January 20, 1919, all remaining patients were transferred and Base
Hospital No. 30 ceased to function on that date. The unit was transferred to
St. Nazaire, whence it sailed on April 13, 1919, on the Freedom, for the United
States. Upon arrival in the United States on April 28 the organization was
ordered to Presidio of San Francisco, Calif., where it arrived on May 15 and
was demobilized on May 26, 1919.
658
ad:ministration, American expeditionary forces^
PERSONNEL
COMMANDING OFFICER
Col. Elmer A. Dean, M. C, November 21, 1917, to June 15, 1918.
Lieut. Col. E. S. Kilgore, M. C, June 16, 1918, to November 11, 1918.
Maj. Alanson Weeks, M. C, November 12, 1918, to November 22, 1918.
Col. L. D. Carter, M. C, November 23, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. Alanson Weeks, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. E. S. Kilgore, M.C.
BASE HOSPITAL NO. 3V
Base Hospital No. 31 was organized March 26, 1917, at the Youngstovvn
City Hospital, Youngstown, Ohio, and was mobilized at Youngstown, September
7, 1917. On September 8, it entrained for Camp Crane, Allen town. Pa., to
undergo training and equipping. It remained in training at Camp Crane
until November 21, 1917, when it was transferred to Camp Mills, Long Island,
where it remamed until December 14, 1917, preparing for embarkation. It
sailed from New York on the Leviathan, on December 15; arrived at Liver-
pool, England, on December 25 and at Le Havre, France, December 26. After
three days at the Le Havre rest camp, the unit entrained December 30 for
Contrexeville, Vosges, in the advance section, arriving there January 1, 1918.
Contrexeville was one of the two towns comprising the Vittel-Contrexeville
hospital center. Base Hospital No. 31 was the fourth and last hospital to
arrive at Contrexeville, which, like Vittel, is a summer health resort, with
numerous hotels; eight of these were assigned to Base Hospital No. 31.
Because of the numerous changes in buildings that had to be made, and
of the nonarrival of equipment, the hospital did not begin to function until
March 23, 1918, when the first patients were received. The normal capacity
of the hospital was 1,200 beds; the crisis expansion, 2,000 beds. One ward
of this hospital contained 250 beds. The largest number of patients in hos-
pital was 1,786 on October 18, 1918. The hospital treated 3,413 medical and
4,585 surgical cases.
On February 3, 1919, all remaining patients were transferred and Base
Hospital No. 31 was officially closed. The unit proceeded to St. Nazaire.
whence it sailed on the Mercury, April 19, 1919. It arrived in the United
States on April 30, 1919, and was demobilized at Camp Dix, N. J., May 2, 1919.
• The statements of fact appearing herein are based on the "History, Base Hospital No. 31, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
659
PERSONNEL
COMMANDING OFFICER
Col. Adam E. Schlanser, M. C, August 30, 1917, to June 16, 1918.
Lieut. Col. Colin R. Clark, M. C, June 17, 1918, to July 18, 1918.
Maj. A. E. Brant, M. C, July 19, 1918, to September 30, 1918.
Maj. John L. Washburn, M. C, October 1, 1918, to November 24, 1918.
Lieut. Col. J. A. Sherbondy, M. C, November 25, 1918, to January 2, 1919.
Maj. John L. Washburn, M. C, January 3, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. J. A. Sherbondy, M. C.
Lieut. Col. E. S. Van Duyn, M. C.
Maj. A. E. Brant, M. C.
Maj. C. E. Coon, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Colin R. Clark, M. C.
Maj. C. C. Wolferth, M. C.
BASE HOSPITAL NO. 32 '
Base Hospital No. 32 was organized in February, 1917, at Indianapolis,
Ind., and was mobilized at Fort Benjamin Harrison, Ind., September 1, 1917.
After three months of training and equipping there, the unit left December 1,
1917, for Hoboken, N. J. It embarked on the George Washington, December 3,
and sailed the following day for Brest, France, 'arriving there December 21.
After three days rest, the unit left for Contrexeville, Vosges, advance section,
where it arrived on December 26, 1917. Eight hotels were assigned to Base
Hospital No. 32; various other buildings were used as warehouses, etc. Be-
cause numerous changes had to be made in these hotels, the unit did not begin
to function until March 23, 1918, when the first convoy of patients was received.
This organization was the first to arrive at Contrexeville, but third to arrive
ill the Vittel-Contrexeville group. The normal bed capacity was 1,300, which
in emergency was increased to 1,900. During its activity, March 23, 1918,
to January 12, 1919, the hospital cared for 9,698 medical and surgical cases.
The hospital was officially closed on January 12, 1918. The unit then
was transferred to St. Nazaire for transportation to the United States. It
sailed April 13, 1919, on the Freedom and was demobilized at Camp Taylor,
Ky., May 7, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Harry R. Beery, M. C, August 27, 1917, to March 1, 1918.
Lieut. Col. Edmund D. Clark, M. C, March 2, 1918, to March 6, 1918.
Lieut. Col. H. H. Van Kirk, M. C, March 7, 1918, to July 14, 1918.
Lieut. Col. Edmund D. Clark, M. C, July 15, 1918, to January 14, 1919.
Maj. James F. Clark, M. C, January 15, 1919, to demobilization.
^The statements of fact appearing herein are based on the "History, Base Hospital No. 32, A. E. F.," by the
coiiunanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.— Ed.
660
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CHIEF OF SURGICAL SERVICE
Lieut. Col. Edmund D. Clark, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Bernays Kennedy, M. C.
BASE HOSPITAL NO. 33"
Base Hospital No. 33 was organized in June, 1917, at the Albany Hospital,
Albany, N. Y., and was mobilized November 19, 1917, at Troop B Armory,
Albany, N. Y., where it remained in training for five months. On April 26,
Fig. 137.— Base Hospital No. 33, Pcrtsmouth, England
1918, the organization entrained for Camp Merritt, N. J., where it remained
until May 2. It embarked May 3 on the Carmania, leaving the same day
for Liverpool, England, where it arrived May 16, 1918. It left immediately
for the rest camp at Knotty Ash, where it remained for two days and was
then transferred to the American rest camp, Winnall Down, Winchester. At
Winnall Down the unit remained awaiting permanent assignment until June
3, 1918. The majority of the personnel during this time were assigned to
duty in hospitals and camps in England. On June 3 the unit was assigned
» The statements of fact appearing herein are based on the "History, Base Hospital No. 33, A. E. F.," by Lieut.
Col. Erastus Corning M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. G. O., Washington, D. C. — Ed.
HOSPITALS
661
station at Portsmouth, England, and took over a portion of the Fifth Southern
General Hospital, known as Fawcett Road section. On July 8, 1918, the
unit was transferred to the Portsmouth Borough Asylum, which was in greater
readiness for immediate use. The asylum buildings were of modern con-
struction, brick and stone, in the center of an 83-acre tract, and were capable
of housing 1,000 patients.
The capacity of the hospital was to be increased by construction of addi-
tional wards, about 70 in number. These buildings were about 35 per cent
complete on November 23, 1918, when orders were received to abandon further
construction. On August 5, 1918, the chief surgeon, A. E. F., designated
Base Hospital No. 33 a special hospital for war neuroses; 160 of these cases
were handled by this hospital. The first patients were received on July 24,
1918; largest number of sick and wounded in hospital was on November
17, 1918, when 1,586 were being cared for. From July 24 to December 31,
1918, the hospital treated 1,782 medical and 1,765 surgical cases.
On January 1, 1919, all remaining patients were evacuated and the hos-
pital ceased to function on that date. The unit sailed from Brest February
18, 1919, on the Olympic. It arrived in New York February 24, 1919, and
was demobilized at Camp Upton, N. Y., March 5, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. x\lleyne von Schrader, M. C, September, 1917, to August 2,
1918.
Lieut. Col. Erastus Corning, M. C, August 3, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. A. W. Elting, M. C.
Maj. Charles G. McMullen, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Clinton B. Hawn, M. C.
BASE HOSPITAL NO. 34
Base Hospital No. 34 was organized in April, 1917, at the Episcopal
Hospital, Philadelphia, Pa., and was mobilized there on September 7, 1917.
On September 8, the organization proceeded to Camp Crane, Allentown,
Pa., where it was trained and equipped. On November 21, the unit was
transferred to Camp Mills, Long Island, N. Y., to await transportation abroad.
It embarked December 14 on the Leviathan, leaving New York the next day
for Liverpool, England, where it arrived December 25, 1917. It proceeded
from Liverpool by rail to Southampton and crossed the channel on the night
of December 25, arriving in Le Havre, France, December 26. From Le Havre
the unit was sent to Blois, France, for further orders; from there it was as-
* The statements of fact appearing herein are based on the "History, Base Hospital No. 34, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C. — Ed.
662
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
signed to its permanent station at Nantes, Loire Inferieure, in base section
No. 1. It arrived at Nantes January 8, 1918, and took over Grand Seniinaire,
a four-story brick structure, which before the war had been used as a Catholic
seminary. In addition to this, numerous wooden buildings were erected,
and later when more space was required a normal-school building was leased
and opened October 19, 1918. This latter addition was used as an annex
for sick and wounded officers.
Of the four hospitals that formed the Nantes hospital center, Base Ho.s-
pital No. 34 was the first to arrive. It acted independently until July 29,
1918, when the hospital center was organized The first patients were received
April 2, 1918; from then until January 16, 1919, 9,080 sick and wounded
were treated. The normal capacity of the hospital was 1,300 beds; the
largest number of patients in hospital was 1,527 on November 6, 1918.
On January 16, 1919, Evacuation Hospital No. 36 relieved Base Hos-
pital No. 34. The unit of Base Hospital No. 34 sailed from St. Nazaire on
the Walter A. Luckenhach, April 9, 1919. It arrived in the United States
April 19, 1919, and was demobilized at Camp Dix, N. J., April 27, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Ralph G. DeVoe, M. C.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Emory G. Alexander, M. C.
CHIEF OF MEDICAL SERVICE
Maj. John B. Carson, M. C.
Capt. W. H. Long, M. C.
Maj. Ohver H. P. Pepper, M. C.
Maj. Charles Fife, M. C.
BASE HOSPITAL NO. 35 '
Base Hospital No. 35 was organized in April, 1917, at the Good Samaritan
Hospital, Los Angeles, Calif., and was mobilized in Los Angeles, Calif., March
14, 1918. The organization trained and was equipped at Camp Kearny,
Calif., until July 4, 1918, on which date it left for Camp Merritt, N. J., arriving
there July 9. On July 15, 1918, it sailed from New York on the Port Melbourne,
arriving at England, July 31, 1918, and at Le Havre, France, August 7. It
entrained August 7 for Mars-sur-Allier, Department of Nievre, in the inter-
mediate section, arriving there August 10, 1918.
Base Hospital No. 35 was the fourth unit to arrive in Mars, and became
a part of one of the largest and important hospital centers in the American
Expeditionary Forces. The organization occupied a set of type A wooden
barracks, and began to receive patients on September 2, 1918, over 500 being
» The statements of fact appearing herein are based on the "History, Base Hospital No. 35, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C.— Ed.
HOSPITALS
663
admitted on that day. Its normal bed capacity was 2,000, but as many as
2,800 sick and wounded were taken care of at one time. During its activity,
September 2, 1918, to January 15, 1919, the hospital cared for 3,401 medical
and 3,117 surgical cases, with 500 operations.
On January 15, 1919, Evacuation Hospital No. 30 reheved Base Hospital
No. 35, the latter organization leaving February 14 for St. Nazaire to await
transportation to the United States. .
The unit sailed from St. Nazaire April 13, on the Rijndam, arriving in
Newport News, April 25, and was demobilized at Camp Kearny, Calif., May
6, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Geo. F. Lull, M. C, June 5, 1918, to January 14, 1919.
Maj. J. A. Van Kaathoven, M. C, January 15, 1919, to February 13, 1919.
Maj. Eliot Alden, M. C, February 14, 1919, to May 6, 1919.
CHIEF OF SURGICAL SERVICE
Maj. J. A. Van Kaathoven, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Charles R. Sowder, M. C.
Capt. George C. Hunter, M. C.
BASE HOSPITAL NO. 36'
Base Hospital No. 36 was organized in April, 1917, at the Detroit College
of Medicine, Detroit, Mich., and was mobilized at Detroit, August 23, 1917.
The unit remained in training there for two months and sailed from New York
on the Orduna, October 27, 1917, arriving in France on November 11, 1917,
and at Vittel, its permanent station, on November 17. It was the first unit
to arrive at Vittel, later forming a part of the Vittel-Contrexeville hospital
center. It occupied 16 hotels and villas and had a total bed capacity of 1,650.
The first patients were received December 8, 1917. During its activity,
December 8, 1917, to January 14, 1919, the hospital cared for 14,114 medical
and surgical cases, of which 1,376 were allied sick and wounded.
On January 14, 1919, all remaining patients were evacuated and the
hospital ceased to function. The unit sailed from St. Nazaire, April 13, 1919,
ou the Rijndam, arriving at Newport News, Va., April 25, 1919, and was
demobilized at Camp Custer, Mich., May 4, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Hiram A. Phillips, M. C, April 19, 1917, to September 13, 1918.
Lieut. Col. B. R. Shurly, M. C, September 14, 1918, to January 22, 1919.
Lieut. Col. Henry G. Berry, M. C, January 23, 1919, to May 4, 1919.
'■ The statements of fact appearing herein are based on the "History, Base Hospital No. 36, A. E. F.," by the
■timniaiuling ofTicer of thnt hospitiil. The history is on file in the Historical Division, S. G. 0., Washington, D. C.— Ed.
664
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CHIEF OF SURGICAL SERVICE
Maj. Frank B. Walker, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Theodore A. McGraw, M. C.
BASE HOSPITAL NO. 37 *
Base Hospital No. 37 was organized in July, 1917, at the Kings County
Hospital, Brooklyn, N. Y. On January 4, 1918, the unit was called into active
service and mobilized at the Twenty-third Regiment Armory, Brooklyn, N.
Y., later moving to the Fourteenth Regiment Armory, that city. On May
19, 1918, it left the port of New York on the Lapland, arriving in Liverpool,
England, on May 31. On June 1 it proceeded to the American Rest Camp
at Southampton, and on June 5 it left Rest Camp for Camp EfTord, Plymouth,
England, which was to be its permanent station. It was ordered on July 18,
1918, to proceed to Dartford, Kent, England, for station, where it occupied
a large hospital controlled by the British metropolitan asylums board.
The normal capacity of the hospital was 2,000 beds, but during November,
1918, tents had to be erected to accommodate the large number of patients
that were being admitted at that time. During its activity the hospital
cared for 3,111 surgical and 1,239 medical cases. On January 21, 1919, all
remaining patients were evacuated and the hospital was closed. The unit
sailed from Brest, France, on the Olympic, February 18, 1919. It arrived in
New York February 24, and was demobilized at Camp Upton, N. Y., March
5, 1919.
PERSONNEL
COMMANDING OFFICER
Col. B. H. Dutcher, M. C, December 13, 1917, to July 6, 1918.
Col. E. H. Fiske, M. C, July 7, 1918, to March 5, 1919.
CHIEF OF SURGICAL SERVICE
Col. E. H. Fiske, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Henry M. Moses, M. C.
BASE HOSPITAL NO. 38 '
Base Hospital No. 38 was organized in April, 1917, at the Jefferson Medi-
cal College, Philadelphia, Pa., and was mobilized October 15, 1917, at Phila-
delphia, Pa., where it remained in training until June 21, 1918. The unit
embarked on the Nopatkin, from Hoboken, June 22 and arrived at Brest,
* The statements of fact appearing herein are based on the " History, Base Hospital No. 37, A. E. F.," by 1st Lieut.
Arthur Springer, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C— Ed.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 38, A. E. F.," by the com-
manding officer of the hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C— EA-
HOSPITALS
665
France, June 5, 1918. It arrived at Nantes, Loire Inferieur, base section No. 1,
July 11, 1918, and occupied a set of wooden type A barracks. Base Hospital
No. 38 was the second unit to arrive at Nantes, where it later formed a part of
the hospital center there.
The hospital began receiving patients 11 days after its arrival. The nor-
mal bed capacity was 1,000, but during an emergency, when as high as 2,413
cases were under treatment, a number of ward buildings of an adjoining, unoc-
cupied hospital were taken over. It received both medical and surgical cases;
the total number treated during its activity, July 22, 1918, to January 26, 1919,
was 7,434.
On January 25, 1919, Evacuation Hospital No. 31 relieved Base Hospital
No. 38. The latter organization sailed from St. Nazaire on the Freedom, April
13, 1919, and arrived in the United States April 28, 1919. The unit was demobi-
lized at Camp Dix, N. J., on May 7, 1919.
PERSONNEL
COMMANDING OFFICER
Col. John S. Lambie, M. C, September 20, 1917, to September 2, 1918.
Lieut. Col. John E. Lowman, M. C, September 3, 1918, to February, 1919.
Maj. John R. Forst, M. C, February, 1919, to May 7, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Charles F. Nassau, M. C.
CHIEF OF MEDICAL SERVICE
Col. William M. L. Coplin, M. C.
BASE HOSPITAL NO. 39
Base Hospital No. 39 was changed to Mobile Hospital No. 39, soon after
its arrival in France, and never functioned as a base hospital. Since it operated
with troops at the front, its activities are recorded in Volume VIII (p. 191) of
this history.
BASE HOSPITAL NO. 40
Base Hospital No. 40 was organized in June, 1917, at the Good Samaritan
Hospital, Lexington, Ky., and was mobilized there February 23, 1918. March
1, 1918, it was transferred to Camp Taylor, Ky., where the personnel were
assigned to the local base hospital for training until June 18. On that date,
the organization entrained for Camp Mills, N. Y. It embarked at Hoboken,
N. J., July 6, and sailed the same day on the Scotian, arriving at Glasgow,
Scotland, July 17. It proceeded from Glasgow by train to the American rest
camp at Southampton, England, arriving July 19, and leaving July 22 for
Sarisbury Court, England, its permanent station. Upon arrival there a major-
ity of the personnel were detached and assigned to duty in English and American
hospitals in England and France. The unit was scattered and never at any
time functioned as a whole. At Sarisbury Court the remainder of the organi-
•» The statements of fact appearing herein are based on the "History, Base Hospital No. 40, A. E. F.," by Lieut.
Col. David Barrow, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. C, Washington, D. C.—Ed.
666
ADMINISTRATION, AMERICAN EXPEDITIONAHY FORCES
zation took over a mansion house of about 170-bod cai)acity and converted
it into a hospital. Patients were not received until September 27, 1918.
Additional wards were being built, but after the signing of the armistice, all
construction was stopped. The normal bed capacity was 500, but on Decem-
ber 31, 1918, there were available 800 beds. The operating room, laboratory,
and X-ray plant were not completed until December. The total number of sick
and wounded treated in this hospital was 1,300.
Base Hospital No. 40 ceased to function on February 24, 1919, and the
organization sailed from Brest, France, on the Aquitania, March 23, 1919.
It arrived in New York March 30, and was demobilized at Camp Taylor, Ky.,
April 16, 1919.
Fig. 138— Contagious disease ward, Base Hospital No. 4ii, .--aiithury Court, Hants, England
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Leonard S. Hughes, M. C, March 26, 1918, to Februarv 25,
1919.
Lieut. Col. David Barrow, M. C, February 26, 1919, to April 16, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. David Barrow, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Julian T. McClymonds, M. C.
HOSPITALS
667
BASE HOSPITAL NO. 41 "
Base Hospital No. 41 was organized in August, 1917, at the University
of Virginia, Charlottesville, and was mobihzed there February 26, 1918. On
March 5, 1918, the organization proceeded to Camp Sevier, S. C, where it
was trained at the camp base hospital for three months. On June 18, the unit
proceeded to Camp Mills, N. Y. It sailed for Europe July 6, on the Scotian;
arrived at Glasgow, Scotland, July 17; departed the following day by rail
for Southampton, England; sailed for Le Havre, France, July 22; and left
the latter port by rail for Paris on July 23.
The hospital arrived in Paris July 25, 1918, and was assigned to station
at St. Denis, Seine, occupying the buildings and grounds of the I'ficole de la
Fk;. 139.— a view of the grounds, Base Hospital No. 41, St. Denis, Paris
Legion d'Honneur, where it functioned under the jurisdiction of the surgeon
of the district of Paris. The school was converted into a hospital of 1,000-bed
capacity and began receiving patients on August 16, 1918. Later the capacity
of the hospital was increased by the construction of a number of w^ooden bar-
racks and the erection of 52 marquee and 13 double Bessonneau tents; the
chapel and hallways of the school were also converted into w^ards. With
these additions the capacity of the hospital was increased to 2,900 beds. During
its activity, August 16, 1918, to January 28, 1919, this hospital cared for 4,695
sick and wounded. From August 16, 1918, to October 7, 1918, it acted largely
as an evacuation hospital, receiving patients directly from the front, w^here
only first-aid treatment had been administered to them.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 41, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D.C— Ed,
668
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Base Hospital No. 41 ceased to function January 28, 1919; the unit
sailed from St. Nazaire April 13, 1919, on the Rijndam, arriving in New York
April 25, 1919, and was demobilized at Camp Lee, Va., May 7, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. J. M. Cabell, M. C, February 26, 1918, to May 7, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. WilHam H. Goodwin, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Herbert Old, M. C.
BASE HOSPITAL NO. 42 "
Base Hospital No. 42 was organized in June, 1917, at the University of
Maryland, Baltimore, Md., and on April 1, 1918, was mobilized at Camp
Meade, Md., where it was trained and equipped. On June 20, 1918, the
organization entrained for Camp Mills, N. Y., remaining there until June 27,
1918. On June 28, it left Hoboken, N. J., on the Metagama, for Liverpool,
England. Arriving there July 10, it entrained immediately for Southampton;
crossed the English Channel on the night of July 1 1 ; reached Cherbourg
France, July 12; entrained the following day for Bazoilles-sur-Meuse, Depart-
ment of Vosges, in the advance section, and arrived there on July 15, 1918.
This was the fifth hospital to arrive at Bazoilles, where it became a part of
the large hospital center there. The organization occupied one type A unit,
which was nearly completed, and began receiving patients on July 19. This
hospital was designated by the commanding officer of the center as a special
hospital for maxillofacial cases; it received also all cases of mumps and
measles. The normal capacity of the hospital was 1,000 beds; but with crisis
expansion in marquee tents, this was increased to 2,000 beds. During its
period of activity, July 19, 1918, to January 8, 1919, the hospital treated
2,593 surgical and 4,559 medical cases.
On January 8, 1919, Evacuation Hospital No. 21 relieved Base Hospital
No. 42; the latter organization proceeding on January 28 to the port of embarka-
tion; sailed from St. Nazaire on the Santa Paula, April 8, 1919. It arrived
in New York April 20, 1919, and w^as demobilized at Camp Meade, Md.,
May 2, 1919.
PERSONNEL
COMMANDING OFFICER
Col. Howard H. Johnson, M. C, April 1 to August 19, 1918.
Lieut. Col. A. C. Harrison, M. C, August 20, 1918, to May 2, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. A. C. Harrison, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Carey B. Gamble, M. C.
Capt. David C. Streett, M. C.
• The statements of fact appearing herein are based on the "History, Base Hospital Xo. 42, A. E. F., by Lieut.
Col. Archibald C. Harrison, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division. S. G. O., Washington, D. C. — Ed.
HOSPITALS
669
BASE HOSPITAL NO. 43 "
Base Hospital No. 43 was organized in June, 1917, at the Emory Uni-
versity, Atlanta, Ga., and was mobilized March 4, 1918, at Camp Gordon, Ga.
After three months of training and equipping, the command left Camp Gordon
for Camp Merritt, N. J., arriving there June 4, 1918. On June 14 the unit
embarked on the Olympic, leaving the same day for Southampton, England,
arriving there on June 21. It crossed the English Channel the night of
June 23; reached Le Havre, France, June 24; entrained at Le Havre, June 26,
for Blois, Department Loire at Cher, in the intermediate section, and arrived
at Blois on June 27. On July 3, it relieved Camp Hospital No. 25, and took
over seven buildings that had been operated as a hospital by the latter organiza-
Fic. 140— View of part of Base Hospital No. 43, Blois
tion. The buildings were widely scattered through the city, which necessi-
tated the use of a greater number of personnel than would have been necessary
otherwise. Each building functioned as a separate hospital, subject to the
commanding officer, with definite commissioned and enlisted personnel and
its quota of female nurses; but all patients arriving at the hospital passed
through a main receiving ward.
When first taken over, the hospital had a normal bed capacity of 1,000
and an emergency capacity of 1,397. In September and October, 1918, several
additional buildings were taken over from the French, and the normal capacity
rThe statements of fact appearing herein are based on the "History, Base Hospital No. 43, A. E. F." by the
commanding offlcerof that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C— £d.
670
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
was increased to 2,025 beds; emergency expansion to 2,300 beds. For a time
this hospital was used as a depot for casual nurses. During its period of activ-
ity, July 3, 1918, to January 20, 1919, 5,263 cases of disease and 4,002 of injury
were treated.
On January 20, 1919, Evacuation Hospital No. 35 relieved Base Hospital
No. 43, the latter organization leaving for the United States from St. Nazaire
on March 12 on the Kroonland. It arrived at Newport News, Va., March 24,
and was demobilized at Camp Gordon, Ga., shortly afterwards.
PERSONNEL
COMMANDING OFFICER
Col. S. U. Marietta, M. C, April 2, 1918, to January 31, 1919.
Col. Clyde S. Ford, M. C, February 1 to February 26, 1919.
Maj. John L. Haskins, M. C, February 27, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Frank K. Boland, M. C.
CHIEF OF MEDICAL SERVICE
Maj. John L. Haskins, M. C.
BASE HOSPITAL NO. 44 «
Base Hospital No. 44 was organized in March, 1917, at the Massachusetts
Homeopathic Hospital, Boston, Mass., and was mobilized at Boston March
10, 1918. On March 12, it was transferred to Camp Dix, N. J., where it
remained in training for four months. On July 6, the organization left
Hoboken, N. J., on the Ulysses for Liverpool, England, and arrived there on
July 17. The following day the command entrained for Southampton, arriving
there on July 19. The English Channel was crossed on the night of July 22,
and Le Havre, France, reached on July 23. On July 24 the unit proceeded
by train to its final destination, Pougues-les-Eaux, Department of Nievre, in
the intermediate section, and arrived on July 26. Upon arrival at Pougues,
the unit took over a number of hotels and various other buildings in that city
and converted them into a hospital, although a great many alterations were
necessary before they could be used as a hospital. The first patients were
received on August 10.
This hospital functioned as a part of the Mesves hospital center, which
was about 11 miles distant. On December 16, 1918, the hospital plant at
Pougues was abandoned and the unit transferred to Mesves, where it occu-
pied a set of type A barracks. The normal bed capacity of the hospital while
at Pougues was 1,000, with an emergency expansion to 1,750. The largest
number of patients under treatment at one time was in October, when 1,712
were being cared for. After its transfer to Mesves, the capacity of the hospi-
tal was reduced to 1,000 beds. Base Hospital No. 44 received both surgical
and medical cases; a total of 3,681 sick and wounded were admitted during
its period of activity.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 44, A. E. F.," by the
commanding ofHcer of that hospital. The history is on file in the Historical Division, S. Q. O., Washington D. C—Ed.
HOSPITALS
671
On January 18, 1919, Evacuation Hospital No. 29 relieved Base Hospi-
tal No. 44, The latter organization returned to the United States from Brest
April 7, 1919, on the Graj Waldersee; arrived in New York April 20, 1919,
and was demobilized at Camp Devens, Mass., on May 2, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Robert H. Wilds, M. C, March 10, 1918, to February 1,
1919.
Lieut. Col. William F. Wesselhoeft, M. C, February 2, 1919, to May 2,
1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. William F. Wesselhoeft, M. C.
CHIEF OF MEDICAL SERVICE
Maj. John H. Rockwell, M. C.
BASE HOSPITAL NO. 45 ^
Base Hospital No. 45 was organized in July, 1917, at the Medical Col-
lege of Virginia, Richmond, Va., and was mobilized in March, 1918, at Camp
Lee, Va., where it was trained and equipped. The organization remained at
Camp Lee until July, 1918, and then proceeded to Newport News, Va., whence
it sailed, July 10, 1918, on the Aeolus, reaching Brest, France, July 21. On
July 30 the command relieved Camp Hospital No. 47, at Autun, Department
of Saone et Loire, where it took over the Caserne Billard, which was an old
monastery that required much renovation. On August 19, this hospital site
was abandoned and the unit transferred to Toul, Department of Meurthe-et-
Moselle, in the advance section, where it became part of the Justice hospi-
tal center. At Toul Base Hospital No. 45 relieved Evacuation Hospital No.
14 and Field Hospital 355, taking over the Caserne La Marche and a con-
tagious annex half a mile distant. These buildings were four stories high,
without plumbing or lights, and required extensive overhauling.
On account of its advanced position Base Hospital No. 45 for many
weeks functioned as an evacuation hospital; during the St. Mihiel operation
the hospital received sick and wounded direct from the battle held. The bed
capacity of the hospital was 2,300. During its period of activity, August 19,
1918, to January 29, 1919, the hospital treated 17,438 sick and wounded;
of these, 5,241 were surgical, 1,379 gassed, and 10,818 medical cases.
On January 29, 1919, Base Hospital No. 82 relieved Base Hospital No.
45; the latter organization returned to the United States by way of St. Nazaire
on the Walter A. Luckenhach, April 9, 1919. It arrived in the United States
April 19, 1919, and was demobilized at Camp Lee, Va., shortly afterwards.
'The statements of fact appearing herein are based on the "History, Base Hospital No. 45, A. E. F.," by the
'Commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C—Ed.
13901—27 43
672
ADMINISTRATION, A:\IEEICAN EXPEDITIONARY FORCES
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Alexander Williams, M. C, March 30, 1918, to August 10,
1918.
Lieut. Col. Stuart McGuire, M. C, August 11, 1918, to January 21,
1919.
Maj. John G. Nelson, M. C, January 22, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. William L. Peple, M. C.
CHIEF OF MEDICAL SERVICE
Maj. John G. Nelson, M. C,
BASE HOSPITAL NO. 46 •
Base Hospital No. 46 was organized in May, 1917, at the Medical Depart-
ment of the University of Oregon, Portland, Oreg., and was mobilized, March 20,
1918, at Portland. On April 5, 1918, the unit was transferred to camp Lewis,
Wash., for training and equipping. It remained at Camp Lewis until May 31,
1918, when it left for Camp Merritt, N. J., arriving there June 5. On June 11,
it sailed from New York for Liverpool on the Missenahia; arrived there on June
25; Southampton was reached on the 26th; the English Channel crossed, June
27; Cherbourg, France, was reached on June 28. On the following day the
organization entrained for its final destination Bazoilles-sur-Meuse, Department
of Vosges, in the advance section, and arrived there on July 2, 1918. This was
the fourth hospital to arrive at Bazoilles-sur-Meuse, where it formed a part of
the large hospital center there. It occupied a set of type A wooden barracks,
which were not quite completed at the time of occupancy, and 72 sections of
marquee tents. The capacity of the hospital was 1,000 beds in barracks and
1,000 in tents, making a total bed capacity of 2,000; this was later increased to
2,300. Patients were first received on July 23, 1918. The largest number of
patients in hospital was on October 19, 1918, when 1,544 w^ere under treatment.
Base Hospital No. 46 was designated by the commanding officer of the hos-
pital center as a special hospital for neurosurgical cases. The operating room,
on account of nonarrival of equipment, did not begin to function until a month
after the opening of the hospital. The total number of patients treated in
hospital was 8,366; 3,422 were surgical cases, with 620 operations, and 4,944
medical cases.
On January 19, 1919, all remaining patients were evacuated, and Base
Hospital No. 46 ceased to function. The unit proceeded to St. Nazaire
and sailed from that port, on the Finland, for Newport News, Va., on April
20, 1919, and arrived May 1, 1919. On May 15 the organization left for
Camp Lewis, Wash., and was demobilized on May 21, 1919.
• The statements of fact appearing herein are based on the "History, Base Hospital No. 46, A. E. F., by Lieut. Col.
Robert C. Yenney, M. C, while on duty as a member of "'le staff of that hospital." The history is on file in the Historical
Division, S. G. O. Washington, D. C.—Ed.
HOSPITALS
673
PERSONNEL
COMMANDING OFFICER
Col. W. R. Davis, M. C, April 1, 1918, to July 31, 1918.
Lieut. Col. C. A. Betts, M. C, August 1, 1918, to August 31, 1918.
Maj. Thomas M. Joyce, M. C, September 1, 1919, to October 1, 1918.
Lieut. Col. Robert C. Yenney, M. C, October, 2, 1918, to May 21, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Thomas M. Joyce, M. C.
Maj. William H. Skene, M. C.
CHIEF OF MEDICAL SERVICE
Lieut Col. Robert C. Yenney, M. C.
Maj. William S. Knox, M. C.
Maj. Otis B. Wight, M. C.
BASE HOSPITAL NO. 47 '
Base Hospital No. 47 was organized in June, 1917, at the San Fransisco
Hospital, San Francisco, Calif., and was mobilized at Camp Fremont, Calif.,
December 5, 1917. After three months of training at Camp Fremont, the
unit on March 2 was ordered to Camp Greenleaf, Ga., for further training, and
remained at the latter camp until June 1, 1918. From there the command pro-
ceeded to Camp Crane, Allentown, Pa., where another month was spent in
drilling and preparation for oversea service. On July 5, the organization left
forHoboken, N. J., where, immediately upon arrival, it embarked on the Levia-
than, leaving the following day, July 8, for Europe. It arrived at Brest, France,
July 15, remained there in the rest camp for 12 days; entrained July 27, pro-
ceeded to its final distination, Beaune, Department Cote d'Or, in the advance
section, and arrived there on July 31. It was the first medical organization
to arrive at Baune, where it later formed a part of the hospital center there.
The unit occupied a set of type A barracks, which were incomplete at the time
of occupancy. The buildings were rapidly completed and furnished with such
equipment as was available, and the hospital was ready to receive patients by
September 1, 1918. The first convoy of patients arrived September 15. The
normal bed capacity of hospital was 1,000, with a crisis expansion of 1,000 in
marquee tents.
On January 23, 1919, Evacuation Hospital No. 22 relieved Base Hospital
No. 47. The latter organization sailed from St. Nazaire April 13, 1919, on the
Rijndam, arrived at Newport News, Va., April 25, 1919, and left for the Presidio
of San Francisco, Calif., April 28, 1919, where it demobilized May 10, 1919.
PERSONNEL
COMMANDING OFFICER
Col. C. J. Manly, M. C, December 5, 1917, to August 12, 1918.
Col. Charles G. Levison, M. C, August 13, 1918, to May 10, 1919.
' The statements offaet appearing herein are based on the "History, Base Hospital No. 47, A. E. F., by Capt. Joseph
Felsen, M. C, while on duty as a member of the staff of that hospital." The history is on file in the Historical Division,
S. Q. O., Washington, D. C.— Ed.
674
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CHIEF OF SURGICAL SERVICE
Capt. S. A. Bunnell, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Harold Sidebotham, M. C.
BASE HOSPITAL NO. 48 "
Base Hospital No. 48 was organized in November, 1917, at the Metro-
politan Hospital, New York City, N. Y. The unit was mobilized in New-
York City, March 6, 1918, and proceeded the same day to General Hospital
No. 2, Fort McHenry, Md., where it was trained and equipped until June 20,
when it was transferred to Camp Mills, N. Y. On July 4, the organization
boarded the Aquitania at New York, and the following day sailed for Liver-
pool, England, arriving there July 12, 1918. It proceeded immediately by
rail to Southampton, arrived July 13, crossed the English Channel the same
night, reaching Le Havre, France, July 14. It entrained the following day
for Roanne, Department of Loire Inferieure; however, after a stay there of
a few days, the unit was ordered, July 24, to proceed to the Mars hospital
center for duty. Arriving at Mars-sur-Allier, Department of Nievre, in the
intermediate section, July 25, it began to function as a part of that hospital
center.
This hospital was the second medical organization to arrive at Mars. It
occupied a set of type A barracks there, which were nearly completed when
taken over. The normal capacity of the hospital was 1,240 beds. The first
convoy of patients arrived August 2,1918; the total number of sick and wounded
treated during the active service of the hospital was 4,822, of whom 2,960
were surgical cases, with 332 operations, and 1,862 medical cases.
On January 15, 1919, Evacuation Hospital No. 37 relieved Base Hospital
No. 48, the latter organization leaving for Clisson, Department Loire Inferieure,
February 14, where it rested for two months, awaiting transportation to the
United States. It proceeded April 10, to St. Nazaire, leaving that port April
13, on the Freedom, and arrived in New York City, on April 28, 1919. The
entire organization was demobilized at Camp Upton, N. Y., by May 10, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. William D. Herbert, M. C, April 2, 1918, to February 1, 1919.
Lieut. Col. W. F. Honan, M. C, February 2, 1919, to May 10, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. W. F. Honan, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Frederick M. Dearborn, M. C.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 48, A. E. F.," by Lieut.
Col. Frederick M. Dearborn, M. C, while on duty as a member of the staff of that hospital. The history in on file in
the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
675
BASE HOSPITAL NO. 49 '
Base Hospital No. 49 was organized in September, 1917, at the Nebraska
University, Omaha, Nebr. The unit was mobilized in Omaha, Nebr., on
March 25, 1918, and was transferred to Fort Des Moines, Iowa, where it trained
until July 4, 1918. It then proceeded to Camp Mills, N. Y., and sailed July
14, 1918, for Liverpool, England, on the Karmalia, arriving there July 31.
Thence it traveled by rail to Southampton and, crossing the channel, arrived
at Cherbourg, France, August 3, 1918. It entrained for Allerey, Department
of Saone et Loire, in the intermediate section, and arrived there August 5,
being the third medical organization to arrive at that center. At Allerey the
unit occupied a section of type A wooden barracks, which were found very
incomplete, but by August 23 the hospital was ready for patients, and on
August 26 received its first convoy of sick and wounded.
The normal bed capacity of the hospital was 1,000, with an emergency
expansion of 1,000. The largest number of patients in hospital under treat-
ment was on November 10, 1918, when 1,950 were being cared for.
Base Hospital No. 49 was designated by the commanding officer of the
center as a special hospital for mental and nervous disorders. During its
period of activity, August 26, 1918, to January 20, 1919, the hospital cared
for 2,562 surgical cases (with 506 operations), 1,902 medical, and 430 gassed
cases.
Base Hospital No. 49 ceased to function on January 20, 1919, and the
organization sailed from Brest on the Manchuria, April 12, 1919, arriving in
New York April 23, 1919. The unit was transferred May 4, to Camp Dodge,
Iowa, where it was demobilized May 7, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Leopold Mitchell, M. C, March 30, 1918, to March 15, 1919.
Maj. Chas. A. Hull, M. C, March 16, 1919, to May 7, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Arthur C. Stokes, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Edson L. Bridges, M. C.
BASE HOSPITAL NO. 50 »
Base Hospital No. 50 was organized in October, 1917, at the University
of Washington, Seattle, Wash., and was mobilized on March 27, 1918, at
Fort Lawton, Wash. On April 6 the organization was transferred to Camp
Fremont, Calif., where it received three months of training at the camp base
hospital. At the expiration of this time the unit left Camp Fremont for Camp
•The statements of fact appeaiinR herein are based on the "History, Base Hospital No. 49, A. E. F.," by the
c'Oinmanding offieer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
•'The statements of fact appearing herein are based on the "History, Base Hospital Xo. 50, A. E. F.," by the com-
ninndini; ofTicor of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
676
ADMIXISTKATIOX, AMERICAN EXPEDITIONARY FORCES
Merritt, N. J., arriving at the latterstation on July 10. It boarded the Karmalm
on July 13, and sailed from New York on the following day; arrived in Liver-
pool, England, July 31, 1918, leaving next day by rail for Southampton; crossed
the English Channel on the night of August 2, arriving at Cherbourg, Franco,
August 3; entrained the following day for Mesves, Department of Nievre,
in the intermediate section, and arrived August 6. It was the third organi-
zation to arrive at Mesves, where it functioned as a part of one of our largest
and important hospital centers. The unit occupied a set of type A wooden
barracks, many of which were found to be in a state of incompletion upon
arrival. The first consignment of patients arrived on August 15.
This hospital received both surgical and medical cases and was a special
hospital for compound fractures and joint injuries. The total number of sick
and wounded treated was 7,399, with 1,135 operations. The normal bed
capacity of the hospital was 1,000, with crisis expansion to 1,950.
All remaining patients on January 20, 1919, were transferred to Base
Hospital No. 54, and Base Hospital No. 50 ceased to function on that date.
The organization sailed from Brest on the GraJ Waldersee, April 7, 1919, arrived
in New York April 20, 1919, and was demobilized at Camp Lewis, Wash.,
May 5, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Ray W. B ryan, M. C, April 8, 1918, to January, 1919.
Lieut. Col. Eugene H. Allen, M. C, January, 1919, to May 5, 1919.
CHIEF OF SURGICAL SERVICE
Maj. James B. Eagleson, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Edward P. Fick, M. C.
BASE HOSPITAL NO. 51 ^
Base Hospital No. 51 was organized on February 18, 1918, at Camp
Greenleaf, Ga. The first personnel were assigned to the hospital on April
10, 1918, when 200 recruits were sent from the recruit section, Camp Green-
leaf, to the base hospital at Camp Wheeler, Ga., for a course of training. At
Camp Wheeler the unit received its full quota of officers and enlisted men,
and remained there in training until July 29, 1918. On July 31 the organ-
ization arrived at Camp Upton, N. Y.; boarded the Olympic August 8; sailed
from New York Harbor the following day; arrived at Southampton, England,
August 17; crossed the English Channel on the night of August 18; arrived
at Cherbourg August 19. After spending three days in the rest camp at
Cherbourg, the organization proceeded by rail to Rimaucourt, Department
Haute Marne, in the advance section, where it was to have functioned as
a part of the hospital center there. Arriving at Rimaucourt on August 24
» The statements of fact appearing herein are based on the "History, Base Hospital No. 51, A. E. F.," by Second Lieut.
Charles H. Ross, Sanitary Corps, while on duty as a member of the staff of that hospital. ' The history is on file in the
Historical Division, S. G. 0., Washington, D. C.—Ed.
HOSPITALS
677
on the following day it was ordered to proceed to Toul, Department of Meurthe
et Moselle, in the advance section, for duty. It entrained for Toul August
27, and arrived there on the same day.
It was the second base hospital to arrive at that station and functioned
as a part of the Justice Hospital Center.
At Toul the organization was established in the "Caserne Febvier"
which consisted of three large four-story buildings, two administration build-
ings, numerous storehouses, quarters and laundries. Although handicapped
by the nonarrival of equippment and nurses, the hospital began to receive
patients on September 5, 1918, a week after its arrival. Due to the advanced
position, the hospital functioned during the early days of activities as an
evacuation hospital, receiving patients by ambulance, direct from the front.
The normal bed capacity of the hospital was 2,000. The total number of
sick and wounded treated was 12,505. Of these 8,670 w^ere medical, 3,231
surgical, 308 gassed, and 296 neurological cases.
Base Hospital No. 51 ceased to function on March 31, 1919, and the
personnel sailed from Marseille May 15, 1919, on the Canada; arrived in
the United States June 2, 1919, and the entire organization was demobilized
at Camp Dix, N. J., by June 12, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Frederick A. Tucker, M. C, May 10, 1918, to January 22,
1919.
Lieut. Col. Daniel M. Hoyt, M. C, January 23, 1919, to February 17,
1919.
Maj. Charles H. Wilson, M. C, February 18, 1919, to March 26, 1919.
Maj. John C. Howard, M. C, March 27, 1919, to June 12, 1919.
CHIEF OF SURGICAL SERVICE
Maj. John C. Howard, M. C.
Lieut. Col. Homer B. Smith, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Daniel M. Hoyt, M. C.
Maj. George W. Miller, M. C.
Lieut. Col. Harry W. Goodall, M. C.
Lieut. Col. John G. Nelson, M. C.
Capt. Richard S. Eustis, M. C.
BASE HOSPITAL NO. 52 "
Base Hospital No. 52 was organized at Camp Greenleaf, Ga., from recruits
of the recruit training battahon, at that station. The command w^as trans-
ferred April 11, 1918, to Camp Gordon, Ga., and there trained at the camp
base hospital. It left Camp Gordon, July 5, arriving at Camp Merritt, N. J.,
July 7; embarked July 13 on the Karmalia, leaving New York harbor the follow-
» The statements of fact appearing herein are based on the "History, Base Hospital No. 52, A. E. F.," by Col. David
Baker, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical Division
S. a. O., Washington, D. C.—Ed .
678
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
ing day, July 14, reaching Liverpool, England, July 31. On August 1, tho unit
proceeded by rail to Southampton; crossed the channel the following day,
arriving at Cherbourg, France, August 3; entrained, August 5, for Rimaucourt,
Department of Haute Marne, in the advance section, and arrived on August 8,
1918. It was the first medical organization to arrive at that station, and later
functioned as a part of the Rimaucourt hospital center. The hospital was
located in a section of type A unit, of 1,000 bed capacity, with additional 1,150
beds in marquee tents, making a total of 2,150 available beds. The first patient
arrived September 14; the total number of sick and wounded treated was 6,388,
of whom 3,327 were surgical and 2,128 medical cases.
Base Hospital No. 52 ceased to operate on January 22, 1919, and the unit
sailed from St. Nazaire on the Princess Matoika on April 14, 1919; arrived at
Newport News, Va., April 27, and was demobilized at Camp Sherman, Ohio,
shortly afterward.
PERSONNEL
COMMANDING OFFICER
Col. David Baker, M. C, June 14, 1918, to March 20, 1919.
Maj. Arthur F. Weyerbacker, M. C, March 21, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. William F. Verdi, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Willard C. Stoner, M. C.
BASE HOSPITAL NO. 53 ^
Base Hospital No. 53 w^as organized on April 10, 1918, at Camp Green-
leaf, Ga., from drafted enlisted personnel. On April 11, the entire command
was transferred to Camp Hancock, Ga., where it was trained at the camp base
hospital. On July 8, the unit left Camp Hancock for Camp Merritt, N. J.,
arriving on July 10; left New York harbor on the Karmalia, July 14, and reached
Liverpool, England, July 31. It entrained the following day for Southampton;
crossed the English Channel on the night of August 3; arrived at Cherbourg,
France, August 4; entrained the following day for Langres, Department of
Haute Marne, in the advance section; arrived August 7, 1918. It was the first
hospital unit to arrive at Langres, where later it formed a part of that hospital
center. The hospital occupied a section of type A w^ooden barracks, and began
receiving patients on September 16, 1918. It received both medical and sur-
gical cases; a total of 12,108 sick and wounded were treated during its period of
activity, September 16, 1918, to March 16, 1919. The normal bed capacity in
barracks w^as 1,000; 500 additional beds were in marquee tents.
Base Hospital No. 53 ceased to function May 31, 1919, and the unit pro-
ceeded to St. Nazaire, sailing thence, June 16, 1919, on the Julia Luckenhacli.
It arrived in New York, June 28, 1919, and w-as demobilized at Camp Sherman,
Ohio, July 5, 1919.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 53, A. E. F.," by Col. W.
Lee Hart, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical DivisioD,
S. G. O., Washington, D. C.—Ed.
HOSPITALS
679
PERSONNEL
COMMANDING OFFICER
Maj. Richard P. Bell, M. C, April 18, 1918, to May 8, 1918.
Lieut. Col. Daniel A. Sinclair, M. C, May 9, 1918, to November 5, 1918.
Col. W. Lee Hart, M. C, November 6, 1918, to July 5, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Albert Halstead, M. C.
Capt. Joseph W. Hooper, M. C.
CHIEF OF MEDICAL SERVICE
Maj. M. S. Goodkind, M. C.
Capt. Frank P. Strome, M. C.
Maj. James M. Stoddard, M. C.
BASE HOSPITAL NO. 54 "
Base Hospital No. 54 was organized in May, 1918, at Camp Greene, N. C,
from officers and enlisted men taken from the Army at large, and trained at the
Camp Greene base hospital. August 7, 1918, the command was transferred to
Newport New^s, Va.; left on the Patricia, August 14, 1918; arrived at Brest^
France, August 25, 1918; remained at the rest camp until September 3, 1918,
proceeded by rail to Mesves, Department of Nievre, intermediate section;
arrived September 6, 1918. This was the fourth hospital unit to arrive at
Mesves, where it functioned as a part of that hospital center. The hospital
occupied a set of type A wooden barracks, and a number of marquee tents for
crisis expansion. The normal bed capacity in barracks was 1,000 beds, with
emergency expansion to 2,000. The first patients were received on September
12, 1918, and the hospital functioned from that date until April 13, 1919. The
largest number of patients in hospital was October 26, 1918, when 2,288 were
under treatment. On January 20, 1919, it took over patients and property of
Base Hospital No. 50, the latter organization being relieved from further
service.
The organization left St. Nazaire on the Dalcotan, May 16, 1919; arrived in
Philadelphia, May 28, 1919, and w^as demobilized at Camp Grant, 111., May 30,
1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Wilham S. Sheep, M. C, May 2, 1918, to July 15, 1918.
Col. Henry Page, M. C, July 16, 1918, to September 6, 1918.
Lieut. Col. Jonathan \l. Wainw^right, M. C, September 7, 1918, to March,
1919.
Lieut. Col. Thomas J. Burrage, M. C, March, 1919, to May 30, 1919.
The statements of fact appearing herein are based on the "History, Base Hospital No. 54, A. E. F., by Lieut. Col.
.lonathan M. Wainwright, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. ()., AVashington, D. C.— Ed.
680
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CHIEF OF SURGICAL SERVICE
Lieut. Col. Jonathan M. Wainwright, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Thomas J. Burrage, M. C.
BASE HOSPITAL NO. 55 >>
Base Hospital No. 55 was organized in June, 1918, at Camp Greenleaf, Ga.,
the enlisted personnel being assigned from the recruit section of that camp.
The unit trained until August 22, 1918, when it proceeded to Camp Merritt,
N. J.; arrived on August 24; embarked on the Plattshurg, August 29; sailed
the following day, August 30, for France; arrived at Brest, France, September
12; remained in the rest camp until September 19; entrained for Mesves-sur-
Loire, Department of Nievre; arrived September 23. Two days later, Sep-
tember 25, the unit was ordered to proceed to Toul, Department of Meurthe-
et-Moselle, in the advance section, where it functioned as a part of the hos-
pital center there. It arrived at Toul on September 25, and was the fifth
medical organization to reach that station. It occupied the Caserne Thouve-
nat Annex, consisting of several one-story concrete barracks, located about a
mile from the other hospitals of the center. In addition to the barracks, a
number of marquee tents had been erected, bringing the normal capacity of the
hospital up to 1,600 beds. The total number of sick and wounded treated
during the period of activity of the hospital, October 1, 1918, to March 31, 1919,
was 4,459; of these, 161 were surgical, 3,815 medical, and 483 gassed cases.
Base Hospital No. 55 ceased to function on March 31, 1919. The unit
sailed from Marseille on the Canada, May 15, 1919, arrived in New York, June
2, 1919, and was demobilized at Camp Pike, Ark., June 11, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Damon B. Pfeiffer, M. C, August 18, 1918, to February 3, 1919.
Lieut. Col. Franklin B. Balch, M. C, February 4, 1919, to February 18,
1919.
Lieut. Col. Daniel M. Hoyt, M. C, February 19, 1919, to June 11, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Franklin B. Balch, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Daniel M. Hoyt, M. C.
Capt. Burton Hamilton, M. C.
The statements of fact appearing herein are based on the "History, Base Hospital No. 55, A. E. F.," by the com
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D. C.— Ed.
HOSPITALS
681
BASE HOSPITAL NO. 56 ^
Base Hospital No. 56 was organized June 13, 1918, at Camp Greenleaf,
Ga., from enlisted personnel of the recruit section of that camp. After several
weeks of drilling the unit was transferred to the base hospital at Camp Wads-
worth, S. C, for further training. On August 22 the organization entrained
for Camp Merritt, N. J.; arrived August 23; sailed from Hoboken, N. J.,
August 30, on the Kroonland, reached Brest, France, September 12, 1918;
remained five days in the rest camp at Brest, France, and on September 18,
1918, entrained for Allerey, Department of Saone et Loire, in the intermediate
section, its permanent station.
It arrived at Allerey on September 20 and was the fourth hospital to
reach that station. Upon arrival the unit immediately began to function as
a part of the Allerey hospital center, where it occupied a section of t^^pe A
wooden barracks, which at that time were being operated by a subunit from
Base Hospital No. 49, and had about 400 cases under treatment. The bed
capacity of the hospital was 1,800, in barracks and tents. This hospital
received both surgical and medical cases, and in addition received all geni-
tourinary and contagious disease cases in the center. The total number of
patients treated was 7,766.
Base Hospital No. 56 ceased to function February 1, 1919, and the per-
sonnel sailed from St. Nazaire for Newport News, Va., April 19, 1919, on the
Mercury; arrived April 30, 1919, and was demobilized at Camp Dix, N. J.,
May 3, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. George M. Coates, M. C, July 25, 1918, to October 14, 1918.
Lieut. Col. Leopold Mitchell, M. C, October 15, 1918, to November 17,
1918.
Col. Charles W. Decker, M. C, November 18, 1918, to May 3, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Thomas C. Witherspoon, M. C.
CHIEF OF MEDICAL SERVICE
Maj. James D. Pilcher, M. C.
BASE HOSPITAL NO. 57
Base Hospital No. 57 was organized April 2, 1918, at Camp Greenleaf,
Ga., from enlisted men of the recruit section of that camp; a majority of these
men were from a draft from Oil City, Pa. At Camp Greenleaf, the organiza-
tion was trained until July 21, when it proceeded to Camp Merritt, N. J.,
arriving there on July 23. On July 31, the unit embarked on the Madingo;
« The statements of fact appearing herein are based on the "History, Base Hospital No. 56, A. E. F.," by the
commanding oflRcer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C.—Ed.
The stiUonients of fact appearing herein are based on the "History, Base Hospital No. 57, A. E. F.," by Col.
Edward C. Mitchell, M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. Q. O., Washington, D. C.—Ed.
682
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
sailed on August 1, for Liverpool, England; arrived August 15, and the follow-
ing morning entrained for Southampton, where it spent three days in the rest
camp. On August 20 it embarked on the Londonderry and crossed the English
Channel; reached Le Havre, France, August 21; left Le Havre, August 23,
for Juilly, Department Seine et Marne; arrived on the same date. There,
the unit took over the hospital operated by Evacuation Hospital No. 8, which
had about 250 patients, mostly French battle casualties. The unit remained
at Juilly until September 16, 1918, when it was ordered to Paris to establish
a 1,000-bed hospital.
Fig. 141.— Base Hospital No. 57, Paris
In Paris, Base Hospital No. 57 took over a large school building and
functioned there as a part of the Paris district. There the normal bed capac-
ity of the hospital was 1,800, distributed in 75 wards; but during October,
1918, as many as 2,000 sick and wounded were in the hospital. This hospital
admitted both surgical and medical cases; the total number admitted was
8,505. The hospital also operated a central dental infirmary, which cared
for a majority of the dental cases in the district of Paris; 7,292 such patients
received treatment during its period of activity.
It sailed from Brest, France, August 13, 1919, and arrived in the United
States August 22, 1919, aboard the Kaiserine Augusta Victoria, and was
demobilized shortly afterwards.
HOSPITALS
683
PERSONNEL
COMMANDING OFFICER
Col. Edward C. Mitchell, M. C, April 2, 1918, to August 22, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Frank D. Smythe, M. C.
Maj. David M. Henning, M. C.
Lieut. Col. Junius Lynch, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Theodore L. Boutillier, M. C.
BASE HOSPITAL NO. 58 '
Base Hospital No. 58 was organized on June 3, 1918, at Camp Grant, 111.,
from recruits of the Army at large. The unit was trained at that camp until
August 16, 1918, when it left for Camp Upton, N. Y.; arrived, August 18;
sailed for France, August 23, on the Chicago, and arrived at Bordeaux, France,
September 5, 1918. It remained in the rest camp there until September 8,
when it entrained for Rimaucourt, Department Haute Marne, in the advance
section, and arrived September 12, 1918. It was the second hospital to arrive
at Rimaucourt, where it functioned as a part of that hospital center. It
occupied a section of type A wooden barracks, of 1,000-bed capacity; and
1,000 beds were available in marquee tents. It was designated as a special
hospital for respiratory infectious diseases only. It had every bed cubicled,
and no one was allowed to enter the wards of this hospital unmasked. The
first patients were received September 20, 1918; during its activity the hospital
admitted 4,588 cases.
The hospital ceased to function on January 25, 1919, and the unit sailed
from St. Nazaire April 14, 1919, on the Matoika; arrived at Newport News,
Va., April 27, 1919, and was demobilized at Camp Dix, N. J., May 5, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. WilHam H. Walsh, M. C, June 3, 1918, to November 1, 1918.
Col. David A. Baker, M. C, November 2, 1918, to November 26, 1918.
Lieut. Col. John W. Barksdale, M. C, November 27, 1918, to May 5, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. John W. Barksdale, M. C.
]Maj. Clarence B. Ingraham, M. C.
CHIEF OF MEDICAL SERVICE
Maj. David H. Haller, M. C.
Capt. Guy D. Griggs, M. C.
« The statements of fact appearing herein are Ijased on the "History, Base Hospital No. 58, A. E. F.," by Lieut.
Col. John W. Barksdale, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Ui.storicii] Division, S. Q. 0., Washington, D. C.—Ed.
684
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 59 ^
Base Hospital No. 59 was organized in April, 1918, at Camp Greenleaf,
Ga., from enlisted men of the recruit section of that camp and officers from
the Medical Reserve Corps at large. The unit was transferred to the base
hospital at Camp Shelby, Miss., for training. It left Camp Shelby August 28,
arriving at Camp Stewart, Newport News, Ya., August 31; embarked on
September 6 on the Madawaska; sailed from Norfolk, Va., September 8;
arrived at Brest, France, September 21, 1918; remained in the rest camp until
September 29; left by rail for its final destination, Rimaucourt, Department
of Haute Marne, in the advance section; arrived October 1. It was the fourth
hospital to reach that station, where it functioned as a part of the Rimaucourt
hospital center. It occupied a section of type A wooden barracks of 1,000-bed
capacit}^ with an additional 1,000 beds in marquee tents. This hospital
received only medical and gas cases. The first patients arrived October 8,
1918; the largest number of patients in hospital at one time was in October,
1918, when 1,660 were being cared for.
Base Hospital No. 59 ceased to function May 31, 1919, and the unit
sailed from Marseille June 12, 1919, on the Taormina; arrived in the United
States June 27, 1919, and was demobilized at Camp Dix, N. J., July 13, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Irvin Abell, M. C, April 16, 1918, to April 16, 1919.
Maj. Llewellyn P. Spears, M. C, April 17, 1919, to July 13, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Benjamin F. Zimmerman, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Sidney J. Meyers, M. C.
Maj. Llewellyn P. Spears, M. C. C-
BASE HOSPITAL NO. 60 "
Base Hospital No. 60 was organized in April, 1918, at Camp Greenleaf, Ga.,
from enlisted men of the recruit section at that camp and officers from the Army
at large. The unit was transferred April 14, 1918, to the base hospital at
Camp Jackson, S. C, for training. August 11 the unit proceeded to Newport
News, Va.; arrived the following day; remained at Camp Stewart, Va., until
August 22; left on that date for Europe on the Dante Aleghiers; arrived at
Brest, France, September 3; remained in the rest camp until September 11;
departed for its permanent station in the hospital center at Bazoilles-sur-Meuse,
Department of the Vosges, advance section; arrived September 15. It was
/The statements of fact appearing herein are based on the "History, Base Hospital No. 59, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington. D. C. — Ed.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 60, A. E. F.," by the com-
manding oflBcer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C. — Ed.
HOSPITALS
685
the fifth unit to reach that station and occupied a section of type A wooden
barracks of 1,000-bed capacity, with additional 1,000 beds in marquee tents.
The hospital opened for patients October 5, and during its period of activ-
ty treated 3,684 medical and 2,304 surgical cases, with 334 operations. On
March 31, 1919, all remaining patients w^ere transferred to other hospitals in
the center, and Base Hospital No. 60 ceased to function on that date. The
unit sailed from St. Nazaire June 15, 1919, on the Texan; arrived in United
States June 29, and was demobilized at Camp Sherman, Ohio, July 2, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. H. L. Dale, M. C, May 26, 1918, to April 23, 1919.
Maj. J. M. Hutcheson, M. C, April 24, 1919, to July 2, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. E. P. Quain, M. C.
Maj. Martin A. Reddan, M. C.
Capt. Harold K. Bell, M. C.
CHIEF OF MEDICAL SERVICE
Maj. James M. Hutcheson, M. C.
BASE HOSPITAL NO. 61
Base Hospital No. 61 was organized June 5, 1918, at Camp Greenleaf, Ga.,
from recruits of the Army at large, and was transfeiTed, June 30, to the Base
hospital at Camp Lee, Va., remaining there in training until August 21, when
it was ordered to Newport News, Va., for embarkation. It arrived on August
22; embarked and sailed on the same day, on the Lutetia, for Brest, France;
arrived September 3 ; rested at Brest for a w^eek, and then proceeded to its final
destination, Beaune, Department Cote d'Or, in the advance section; arrived
September 13. It was the second hospital unit to arrive at Beaune, where it
formed a part of the Beaune hospital center. The unit occupied a section of
type A wooden barracks of 1,000-bed capacity, with additional 600 beds in
marquee tents.
The first convoy of patients was received October 5, 1918. The largest
number of patients in hospital was on October 31, when 1,490 were being
treated. During its period of activity, October 5, 1918, to January 31, 1919,
the hospital admitted 1,183 medical and 1,626 surgical cases, with 555 opera-
tions. The dental department of the hospital performed all the dental work
for the entire hospital center.
January 31, 1919, all remaining patients were transferred to other hospitals
in the center, and Base Hospital No. 61 ceased to function as a hospital. The
unit sailed from St. Nazaire April 9, 1919, on the LucJcenhach, arrived in New
York April 19, 1919, and was demobilized at Camp Dix, N. J., April 27, 1919.
* Thestatementsof fact appearing herein are based on the " History, Base Hospital No. 61, A.E. F.,"by Maj. Royale
II. Fowler, M. C, while on duty as a member of the stafT of that hospital. The history is on file in the Historical Division,
J5. G. O., Washington, D. C.—Ed.
686
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Charles S. Lawrence, M. C, June 5, 1918, to April 27, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Charles A. Stevens, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Bernard S. Oppenheimer, M. C.
BASE HOSPITAL NO. 62 '
Base Hospital No. 62 was organized in June, 1918, at Camp Greenleaf,
Ga., from recruits of the Army at large. On June 29, the organization was
transferred to Camp Upton, Long Island, N. Y., for further training at the base
hospital of that camp. The unit left Camp Upton, August 29, for the port of
embarkation, Hoboken, N. J., where it boarded the Northern Pacific, for Brest,
France; arrived September 7; disembarked the following day and remained
for eight days in the rest camp at Pontanezen Barracks awaiting orders; en-
trained at Brest, September 16, for its final destination, Mars-sur-Alliers,
Department of Nievre, in the intermediate section; arrived September 19, 1918.
It was the fifth medical organization to arrive at Mars, where it formed a
part of the large hospital center there. The hospital occupied a section of
type A wooden barracks, with normal capacity of 1,000 beds, and began to
receive patients on October 5; 791 were admitted on that date.
During its period of activity, October 5, 1918, to February 15, 1919, the
organization cared for 3,631 sick and wounded; of these, 3,232 were medical
and 399 surgical cases.
On February 15, 1919, Base Hospital No. 62 ceased to function as a hos-
pital. Subsequently the unit proceeded to St. Nazaire and sailed from that
port May 17, 1919, on the Antigone, for Newport News, Va.; arrived May 29,
and was demobilized at Camp Dix, N. J., June 7, 1919.
PERSONNEL
COMMANDING OFFICER
Capt. Rufus H. Fisher, M. C, June 13, 1918, to August 2, 1918.
Lieut. Col. Richard L. Cook, M. C, August 3, 1918, to June 7, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Herbert B. Perry, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. David Bovaird, M. C.
• The statements of fact appearing herein are based on the "History, Base Hospital No. 62, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
687
BASE HOSPITAL NO. 63 '
Base Hospital No. 63 was organized in June, 1918, at Camp Greenleaf,
Ga., from enlisted men of the recruit section of that camp, and was transferred
June 30, to Camp McClellan, Ala., for further mobilization and training. The
unit trained at the base hospital at Camp McClellan until August 19, when it
proceeded to Camp Merritt, N. J., for embarkation; sailed from Hoboken,
N. J., on the Leviathan, August 31; arrived at Brest, France, September 7;
debarked the following day and marched to the rest camp at Pontanezen Bar-
racks, where it remained awaiting orders; September 12 it proceeded to Caen,
Department of Calvados, base section No. 4, and arrived September 13. It
was the first American organization to arrive at Caen and was to function as
an independent hospital. The unit took over a large stone building, and pro-
ceeded to convert it into a hospital. By the end of September, 1918, it was
ready to receive patients, with a bed capacity of about 300, but no patients
were ever sent there. In October and November, 1918, part of the unit was
ordered on detached service in different hospitals, and the building in which the
hospital operated was ordered abandoned. On December 15 the unit was
ordered to proceed to Chateauroux, Department of Indre, where it relieved
Base Hospital No. 9. It arrived at Chateauroux January 3, 1919, and assumed
operation of the hospital on January 14, 1919.
On March 21, 1919, Base Hospital No. 63 ceased to function as a hospital
and all of the personnel, with the exception of the commanding officer, 1 non-
commissioned officer, and 3 privates, were transferred to Camp Hospital No.
109 for duty. The skeletonized unit sailed from Brest i\.pril 16, 1919, and
arrived at Hoboken, N. J., April 25, 1919.
PERSONNEL
COMMANDING OFFICER
Col. Charles Willcox, M. C, June 1, 1918, to March 21, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Lucius E. Burch, M. C.
CHIEF OF MEDICAL SERVICE
Maj. William D. Alsever, M. C.
BASE HOSPITAL NO. 64 *
Base Hospital No. 64 was organized June 5, 1918, at Camp Greenleaf,
Ga., from enlisted men of the recruit section at that camp. The unit was
transferred June 28, to Camp Sevier, S. C, where it was trained at the camp
base hospital. The organization left Camp Sevier August 19; proceeded to
Camp Merritt, N. J.; arrived August 21; departed from port of embarkation
Hoboken, N. J., on the Belgic, September 1; arrived at Liverpool, England,
'■ The statements of fact appearing herein are based on the "History, Base Hospital No. 63, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C— £d.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 64, A. E. F.," by Lieut.
Col. Roy T. Morris, M. C, while on duty as a member of the stafif of that hospital The history is on file in the Historical
Division, S. G. O., Washington, D. C.—Ed.
13901—27 U
688
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
September 13; proceeded by rail to Southampton and crossed the Enghsh
Channel on September 16; reached Cherbourg, France, September 17. It
entrained the following day for its final destination, Rimaucourt, Department
Haute Marne, in the advance section of the American Expeditionary Forces;
arrived September 21 . This was the third hospital unit to arrive at Rimaucourt,
where it occupied a section of type A wooden barracks and functioned as a part
of that hospital center. The normal capacity of that hospital was 1,000
beds in barracks, with additional 1,500 beds in marquee tents. This hospital
was designated to receive all gas cases and infected surgical cases for the center.
The number of patients admitted from October 4, 1918, to January 28, 1919,
was 3,395.
The hospital ceased to function on April 21, 1919, and the unit was trans-
ferred to Brest, France, for return to the United States; sailed June 9, 1919,
on the Vermont for Newport News, Va.; arrived June 20, 1919, and the entire
organization was demobihzed at Camp Dix, N. J., June 25, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Roy T. Morris, M. C, June 5, 1918, to June 25, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. WilHam B. Reid, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Joseph H. Cattons, M. C.
Maj. Charles O. Moore, M. C.
BASE HOSPITAL NO. 65 '
Base Hospital No. 65 was organized in March, 1918, at Fort McPherson,
Ga., from enlisted men of the Army at large; the majority of these men were
from the State of North CaroHna. The organization was trained at Fort
McPherson, and received special instructions at General Hospital No. 6 there.
On August 9 the unit w^as ordered to Camp Upton, N. Y., where it arrived the
following day; left August 29 for Hoboken, N. J.; sailed August 30 on the
Kroonland; arrived at Brest, France, September 12; remained in the rest
camp at Brest until September 16, when it was ordered to proceed to the
Kerhuon hospital center near by for duty.
The hospital ceased to function July 15, 1919, and the unit sailed from
Brest for New York July 30, 1919, on the Leviathan; arrived August 6, 1919,
and was demobilized at Camp Lee, Va., August 13, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Frederick M. Hanes, M. C, March, 1918, to July 26, 1918.
Lieut. Col. W. E. Butler, M. C, July 27, 1918, to October 31, 1918.
Lieut. Col. Frederick M. Hanes, M. C, November 1, 1918, to April 12,
1919.
Lieut. Col. J. B. Anderson, M. C, April 13, 1918, to June 26, 1919.
Lieut. Col. Leopold Mitchell, M. C, June 27, 1919, to July 15, 1919.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 65, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C. Ed.
HOSPITALS
689
CHIEF OF SURGICAL SERVICE
Lieut. Col. John W. Long, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Frederick M. Hanes, M. C.
BASE HOSPITAL NO. 66 -
Base Hospital No. 66 was organized November 6, 1917, at Camp Merritt,
N. J., from officers and enlisted men of the Army at large. It was the first
base hospital organized from the Regular Army and was designated as a
genitourinary hospital; its commissioned personnel were selected with that
point in view. The unit underwent extensive training at Camp Merritt,
N. J., for a period of one month, and on December 17, 1917, embarked at New
York on the Orduna; left port on the following day, December 18, for Halifax,
Nova Scotia, where it remained for two days; sailed for Glasgow, Scotland;
arrived December 31, 1917. From Glasgow the organization proceeded
to the rest camp at Winchester, England; remained until January 14, 1918;
left for Southampton, England; crossed the English Channel on the night of
January 14; landed at Le Havre, France, January 15. On the following day
the unit proceeded by rail to its permanent station at Neufchateau, Depart-
ment Vosges, advance section, and arrived January 18, 1918.
It took over a 500-bed hospital located at the Rebeval Barracks, just
outside of Neufchateau, which at that time was being operated by Field Hos-
pitals Nos. 101 and 104, of the 26th Division. These barracks were typical old
French casernes, unsuitable for hospitalization. Base Hospital No. 66 as-
sumed charge of the hospital, which contained about 500 patients, on January
19, 1918, and began operations under very trying circumstances.
Shortly after the arrival of the unit the hospital was brought up to an ef-
ficient status and its capacity increased from 500 to 2,600 beds. Base Hos-
pital No. 66 operated independently of any hospital until August 11, 1918,
when it was placed under the hospital center at Bazoilles; but on November
10, 1918, it was again made independent.
Up to June, 1918, very few battle casualties were received. Practically
all of the patients admitted up to that time were from organizations stationed
around Neufchateau. During the time the unit functioned as a part of the
hospital center at Bazoilles it admitted 6,913 surgical and medical cases. Al-
though this unit was organized as a special hospital for venereal and genitouri-
nary work, it never functioned as such.
Base Hospital No. 66 ceased to operate on December 31, 1918, and re-
turned to the United States, sailing from St. Nazaire on the Princess Matoika
January 30, 1919. It arrived at Newport News, Va., February 11, 1919,
and was demobilized at Camp Devens, Mass., shortly afterwards.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 66, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. 0., Washington, D. C. — Ed.
690
AD^riXISTRATIOX, AMERICAN EXPKDl l 1« )N Ain FORCES
PERSONNEL
COMMANDING OFFICER
Col. H. C. Maddux, M. C, November 6, 1917, to June 17, 1918.
Capt. Blase Cole, M. C, June 18, 1918, to October 13, 1918.
Maj. Robert B. Hill, M. C, October 14, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Macy Brooks, M. C.
CHIEF OF MEDICAL SERVICE
Maj. George B. Wallace, M. C.
BASE HOSPITAL NO. 67 "
Base Hospital No. 67 was organized in April, 1918, at Camp Crane, Allen-
town, Pa., from officers and enlisted men of the Army at large. This hospital
was originally organized as a genitourinary unit, and its personnel were selected
with that point in view. Later it was decided that such a unit was not re-
quired abroad, and some alterations in the organization were made. The
unit was trained at Camp Crane, Pa., until July 5, when it proceeded to Hobo-
ken, N. J.; sailed from that port on the Leviathan, July 8. It arrived at Brest,
France, July 15, remained encamped near Pontanezen Barracks for two weeks.
On July 29 the organization was ordered to Mesves, Department of Nievre,
in the intermediate section, where it arrived August 1, and immediately began
to function as a part of the hospital center there. It was the first medical
unit to arrive at Mesves, where it occupied a set of type A wooden barracks.
The organization found 400 surgical cases in the wards of the hospital, who
had been received just an hour prior to its arrival at Mesves. It immediately
took hold of the work and in a few hours made itself ready for self-sustainment.
On the following day, 600 additional wounded arrived; thus within 24 hours
this hospital had a total of 1,075 patients, largely seriously wounded men from
the Chateau-Thierry operation.
The first few days the hospital staff was greatly handicapped by the lack
of adequate equipment to perform surgical work. The normal capacity of
hospital was 1,000 beds in barracks, with an additional 1,000 in marquee tents.
During the early part of October, 1918, as many as 2,370 patients were in the
hospital; beds and cots were placed in warehouses. Red Cross huts, and every
other available space. During its period of activity, August 1, 1918, to Janu-
ary 20, 1919, the hospital received 7,853 surgical and medical cases.
On January 20, 1919, Evacuation Hospital No. 24, took over patients of
Base Hospital No. 67, the latter organization returning to the United States.
Leaving St. Nazaire April 14, 1919, on the Princess Matoika for Newport News,
Va., it arrived in United States April 27, 1919, and was demobilized at Camp
Dix, N. J., and Camp Sherman, Ohio, by May 3, 1919.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 67, A. E. F.," by Lieut.
Col. H. O. Reik, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C. — Ed.
HOSPITALS
691
PERSONNEL
COMMANDING OFFICER
Lieut. Col. William Herschel Allen, M. C, April 26, 1918, to October 18,
1918.
Lieut. Col. Henry O. Reik, M. C, October 18, 1918, to February, 1919.
Maj. Thomas E. Chandler, M. C, February, 1919, to May 3, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. John A. Hawkins, M. C.
Maj. Jesse T. McDavid, M. C.
Maj. A. R. Stevens, M. C.
CHIEF OF MEDICAL SERVICE
Maj. H. Nail, M. C.
BASE HOSPITAL NO. 68°
Base Hospital No. 68 was organized in April, 1918, at Camp Crane, Allen-
town, Pa., from officers and enlisted men of the Army at large. The organi-
zation underwent training at that camp until July 7, when the unit proceeded
to the port of embarkation, Hoboken, N. J., arriving there and boarding the
Leviathan the same day. It sailed from Hoboken the following day, July 8;
arrived at Brest, France, July 15, 1919; marched to the rest camp at Pon-
tanezen Barracks, where it remained until July 22; entrained at Brest for its
final destination, Mars-sur-Allier, Department of Nievre, in the intermediate
section; arrived July 24. The unit occupied a set of type A wooden barracks,
and began receiving patients on August 2. It was the first hospital unit to
arrive at Mars, where it formed a part of the hospital center there.
The primary normal bed capacity of the hospital was 1,000; later, however,
another section of barracks was taken over by the hospital and the capacity
was increased to 3,500 beds, with an emergency expansion to 4,000. It received
both surgical and medical cases; the number admitted from August 2, 1918,
to November 20, 1918, was 7,021.
On January 20, 1919, Base Hospital No. 131 took over patients and
property of Base Hospital No. 68, the latter organization then ceasing to
function as a hospital. The unit proceeded to St. Nazaire, from which port
it sailed April 14, 1919, on the Princess Matoika for Newport News, Va.,
arriving in the United States April 27, 1919. Upon arrival at Newport News,
the unit was split up and sent to Camp Dix, N. J., and Camp Sherman, Ohio,
for demobilization. The entire unit was demobilized by May 5, 1919.
PERSONNEL
COMMANDING OFFICER
Col. Roy C. Hefiebower, M. C, April 17, 1918, to January 22, 1918.
Maj. Robert N. Severance, M. C, January 23, 1919, to May 5, 1919.
• The statements of fact appearing herein are based on the "History, Base Hospital No. 68, A. E. F.," by Col.
Scott D. Breckinridge, M. C, while on duty as a member of the staff of that hospital. The histoiy is on file in the His-
torical Division, S. Q. O., Washington, D. C.—Ed.
692
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CHIEF OF SURGICAL SERVICE
Lieut. Col. Elizah H. Sitar, M. C.
Lieut. Col. A. E. Halstead, M. C.
Maj. Robert N. Severance, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Walter H. Wood, M. C.
BASE HOSPITAL NO. 69 "
Base Hospital No. 69 was organized June 11, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. The unit was trans-
ferred to Camp Meade, Md., June 30, for training. On August 26, the organi-
zation entrained for the port of embarkation, Hoboken, N. J.; embarked on
the Susquehanna, sailing August 30, for overseas service; arrived at Brest,
France, September 12; proceeded to the rest camp at Pontanezen Barracks;
remained there awaiting orders until September 20, and entrained for its final
destination, Savenay, Department Loire Inferieure, in the base section No. 5,
where it arrived September 21. It was the second unit to arrive at that station
and immediately began to function as a part of the Savenay hospital center.
The organization was assigned to a hospital plant consisting of 68 buildings,
of the knock-down wooden barrack type, of which 55 had been completed.
The bed capacity was 2,500, and some of the wards were already filled with
patients when the unit arrived.
While originally designated to receive venereal cases and, later, urological
surgical cases, the demands had been such that the hospital cared for the
average type of patient of the more serious class evacuated to that center.
During its period of activity, September 21, 1918, to June 7, 1919, over 15,000
sick and wounded patients were admitted to the hospital.
On January 31, 1919, the unit took over Base Hospital No. 8, the latter
organization being ordered to prepare for return to the United States at the
same time. Base Hospital No. 88 took over the hospital plant and patients
of Base Hospital No. 69.
On June 7, 1919, the hospital was formally closed, and the unit sailed
from St. Nazaire July 6, 1919, on the Scranton; arrived in the United States
July 16, 1919, and was demobilized at Camp Grant, 111., July 21, 1919.
PERSONNEL
COMMANDING OFFICER
Col. Scott D. Breckinridge, M. C, July, 1918, to June 15, 1919.
Maj. Walter C. G. Kirchner, M. C, June 16, 1919, to July 21, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Jonathan E. Burns, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Oliver H. P. Pepper, M. C.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 69 A. E. F. " by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D. C—Ed.
HOSPITALS
693
BASE HOSPITAL NO. 70 «
Base Hospital No. 70 was organized May 29, 1918, at Fort Riley, Kans.,
from officers and enlisted men of the Army at large. The majority of the
enlisted men were casuals from the Medical Officers' Training Camp at Fort
Riley, and had been inducted into the service from the State of Oklahoma
in May, 1918. June 17 the organization was transferred to Fort Ontario,
N. Y., and was trained at General Hospital No. 5 there. The unit left Fort
Ontario, September 2, for the port of embarkation, Hoboken, N. J.; arrived
September 3; embarked on the Sihoney, September 4; sailed on the same day
for St. Nazaire, France; arrived at St. Nazaire, September 13; disembarked
and marched to Rest Camp No. 1, where it remained one week awaiting orders;
entrained September 19 for Allerey, Department of Saone et Loire, in the
intermediate section, and reached that station on September 22. This was
the fifth hospital unit to arrive at Allerey, where it functioned as a part of the
hospital center. The unit occupied a section of wooden, type A barracks,
and began to receive patients on October 4.
When organized this unit was designated as a venereal hospital, but on
arrival in France it did not function as such but received both surgical and
medical cases.
In October, 1918, a part of the personnel was detached and organized
into a subsidiary unit, called 70A. The bed capacity of hospital was 1,500,
with an emergency expansion to 2,200, while that of 70A was 1,700. The
largest number of patients cared for at one time was 1,448, on November 11,
in Base Hospital No. 70, and 1,432 on November 14, in 70A. The total number
of patients treated was 5,371. On December 17 unit 70A was taken over
by Base Hospital No. 97 and the personnel returned to Base Hospital No. 70.
Base Hospital No. 70 ceased to function on February 4, 1919, and the
unit sailed from St. Nazaire, April 13, 1919, on the Freedom, arriving at New
York, April 28, 1919. The entire unit was demobilized at Camp Pike, Ark.,
May 14, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. T. Victor Keen, M. C, July 18, 1918, to October 16, 1918.
Lieut. Col. Leopold Mitchell, M. C, October 17, 1918, to December 8, 1918.
Maj. Hugh S. Willson, M. C, December 9, 1918, to March, 1919.
Maj. Arthur D. West, M. C, March, 1919, to May 14, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Alexander Peacock, M. C.
Lieut. Col. Levi L. Reggin, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Hugh S. Willson, M. C.
Maj. John J. Cunningham, M. C.
« The statements of fact appearing herein are based on the "History, Base Hospital No. 70, A. E. F.," by the
commanding officer of the hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
694
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 71 ^
Base Hospital No. 71 was organized July 13, 1918, at Camp Grecnleaf,
Ga., from officers and enlisted men of the Army at large. The organization
was transferred, August 17, to Camp Beauregard, La., where it underwent
training. On October 26, the unit was ordered to Camp Upton, Long Island,
N. Y. ; arrived October 29; remained until November 10; proceeded to New
York and boarded the Empress oj Asia; sailed, November 12, for France;
arrived at Brest, France, November 22; encamped at Pontanezen Barracks,
and remained there awaiting orders until November 29; proceeded by rail to
Pau, Department Basses Pyrenees, base section No. 2, and arrived December
1, 1918. It was the first hospital unit to arrive at Pau, where it was to func-
tion as a part of what was to be a small hospital center. The organization
took over from the French four hotels and one school building, and made
preparations to convert them into a hospital. On December 30, before any
patients were admitted to the center, hospitalization at Pau was abandoned
and Base Hospital No. 71 was transferred, January 11, 1919, to Vauclaire,
Department of Dordogne, base section No. 2, to relieve Base Hospital No. 3.
On January 20, the unit took over patients and property of Base Hospital
No. 3, and immediately began to function as a hospital. There were about
400 patients in the hospital when the unit took charge, and during its two
months of active service at Vauclaire, 167 patients were admitted.
Base Hospital No. 71 ceased to function on March 20, 1919; part of the
unit was transferred to other stations for duty, and the remainder returned
to the United States, sailing from Bordeaux, May 12, on the Panaman. It
arrived in the United States May 23, 1919, and was demobilized at Camp
Shelby, Miss., May 31, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Henry Abraham, M. C, August 26, 1918, to September 28, 1919.
Col. Alexander C. Abbott, M. C, September 29, 1918, to January 26, 1919.
Maj. George W. Schwartz, M. C, January 27, 1919, to March 31, 1919.
First Lieut. John R. Ransom, M. C, April 1, 1919, to May 31, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Clarence Martin, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Henry Abrahm, M. C.
BASE HOSPITAL NO. 72 •
Base Hospital No. 72 was organized August 15, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. The organization was
transferred to Camp^orden, Ga., and there trained at the camp base hospital.
' The statements of fact appearing herein are based on Uie History, Base H^KpitalNanTTF " by the com-
manding officer of that hospital. The history is on file in the Historical Division, SCO wLhiniton D r
r,n. ^r i^'T'^'^T^'^^'' ^PPe^^rmg herein are based on the "History, base Hospital No. 72, A E F " Mai cTar-
S^~o:,W^;X^?^r"^"^^^ T^^ehistor^ison^^in^StS.
HOSPITALS
695
On October 19, the unit entrained for Camp Upton, Long Island, N. Y. •
arrived October 21 ; on October 26, it proceeded to New York; embarked on the
Maunganui; sailed on October 27 for Liverpool, England; arrived Novembers;
proceeded by rail to Southampton; crossed the English Channel and reached
Le Havre, France, November 11. The organization remained in the rest camp
at Le Havre until November 26, on which date it entrained for its final destina-
tion, the Mesves hospital center. It arrived at Mesves, Department of
Nievre, intermediate section, November 27; was assigned to a section of type
A wooden barracks. The hospital received some class A patients (men ready
for duty) on December 5, but during its active service at Mesves only 69
medical cases were admitted.
The hospital ceased to function on February 6, 1919; the unit was transferred
March 20, 1919, to Brest, from which port it sailed on April 7, 1919, on the
Graf Waldersee; arrived at Hoboken, N. J., April 20, 1919, and passed out of
existence at Camp Merritt, N. J., shortly afterwards.
PERSONNEL
COMMANDING OFFICER
Maj. Clarence M. Dollman, M. C, August 25, 1918, to February 26, 1919.
Maj. Albert M. Meads, M. C, February 27, 1919, to March 20, 1919.
Lieut. Col. Lipman M. Kahn, M. C, March 21, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. Victor N. Meddis, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Albert M. Meads, M. C.
BASE HOSPITAL NO. 76 '
Base Hospital No, 76 was organized June 4, 1918, at Camp Greenleaf, Ga.,
from ofl&cers and enlisted men of the Army at large. The organization was
transferred, June 29, 1918, to Camp Devens, Mass., where it arrived July 1, and
remained there in training until August 31. On September 1 the organization
sailed from New York harbor; arrived at Liverpool, England, September 13;
disembarked and marched to the rest camp at Knotty Ash; remained in the
rest camp until September 18; proceeded by rail to Southampton; crossed the
English Channel the night of September 19; reached Le Havre, France, Septem-
ber 20; entrained at Le Havre, September 21, for its final destination, the Vichy
hospital center, Department of Allier, in the intermediate section, and arrived
September 23.
Base Hospital No. 76 was the fourth hospital unit to arrive at that station,
where it functioned as a part of the hospital center there. The unit was assigned
18 hotels in Vichy, and proceeded to convert them into hospital wards. The
first ward was opened for patients October 7, and by November 6 all buildings
were receiving patients.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 76, A. E. F.," by First
Lieut. Horace Gray, M. C, while on duty as a member of the stafi of that hospital. The history is on file in the His-
torical Division, S. G. O., Washington, D. C.—Ed.
696
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The normal bed capacity of the hospital was 1,500. The greatest number
of sick and wounded in hospital at one time on November 30, when 1,860 were
under treatment. During its period of activity, October 7, 1918, to January 31,
1919, the hospital received 2,962 surgical and 2,251 medical cases.
Due to the fact that this hospital arrived late and was not fully equipped,
it received only the slightly wounded and sick; in fact, nearly all its patients
were walking cases.
Base Hospital No. 76 ceased to function on January 31, 1919, and the per-
sonnel sailed from Brest, April 13, 1919, on the Mobile, and arrived in New York
April 23, 1919. Part of the unit was demobilized at Camp Dix, N. J., May 3,
1919, and the remainder at Camp Upton, N. Y., May 12, 1919.
PERSONNEL
COMMANDING OFFICER
Capt. John McKowen, M. C, June 5, 1918, to August 11, 1918.
Lieut. Col. Lewis T. Griffith, M. C, August 12, 1918, to March 8, 1919.
Maj. Albert B. Davis, M. C, March 9, 1919, to May 12, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Roy B. Canfield, M. C.
CHIEF OF MEDICAL SERVICE
Maj. I. I. Lemann, M. C.
BASE HOSPITAL NO. 77 "
Base Hospital No. 77 was organized in June, 1918, at Camp Greenleaf,
Ga., from officers and. enlisted men of the Army at large. On June 30 the
organization was transferred to Camp Sherman, Ohio; arrived at that station
July 1, and remained in training until August 27. The unit left Camp Sherman
for Camp Upton, N. Y.; arrived August 29; embarked at New York on
the Baltic August 31; sailed for Europe September 1; arrived at Liverpool,
England, September 13; disembarked and proceeded by rail to Southampton
and arrived the same day. On the following day the unit crossed the English
Channel and landed at Le Havre, France, September 15. After spending
two days at the rest camp, the organization entrained, September 17, for
its final destination, Beaune, Department Cote d'Or, in the advance section,
and arrived September 19. It occupied a set of type A wooden barracks
of 1,000-bed capacity, with 500 additional beds in Marquee tents. This was
'the third hospital unit to arrive at that station, where it formed a part of
the Beaune hospital center, and began receiving patients on October 12. The
hospital received both surgical and medical cases; the total number of patients
admitted was 3,789, and of these, 3,505 w^ere medical cases. Base Hospital
No. 77 ceased to function March 6, 1919; part of the unit was converted
into Camp Hospital No. 107, which functioned for the American University
at Beaune, and another part was transferred to Allerey, where it operated
Camp Hospital No. 108.
" The statements of fact appearing herein are ba%ed on the "History, Base Hospital No. 77, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D C —Ed.
HOSPITALS
697
PERSONNEL
COMMANDING OFFICER
Lieut. Col. James P. Kerr, M. C. (during its entire service as a base
hospital).
CHIEF OF SURGICAL SERVICE
Maj. H. C. Pitts, M. C.
CHIEF OF MEDICAL SERVICE
Maj. T. W. Grayson, M. C.
BASE HOSPITAL NO. 78 "
Base Hospital No. 78 was organized in June, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. On June 30 the
organization was transferred to Fort McHenry, Md., where it underwent
training at General Hospital No. 2 there. On August 27 the unit entrained
for Camp Merritt, N. J., thence after three days it proceeded to New York
harbor; boarded the AncUses; left September 1 ; landed at Liverpool, England,
September 13; marched to the rest camp at Knotty Ash, and remained there
for four days. On September 17 the organization traveled by rail to South-
ampton; crossed the EngHsh Channel on the night of September 19; reached
Lc Havre, France, September 20; on the following day entrained for its
final destination, the Justice hospital group, at Toul, Department of Meuthe-
et-Moselle, in the advance section; arrived at Toul September 23, where
it became a part of that hospital center. Base Hospital No. 78 was the fourth
hospital unit to arrive at Toul and was assigned to the barracks of the French
1st Engineers. These barracks had a total capacity of 2,000 beds.
During the months of September and October, 1918, due to advanced
position of the hospital, its activities were practically those of an evacuation
hospital; the wounded were admitted directly from the field hospitals, and
some were received from evacuation and mobile hospitals. This hospital
was designated a surgical unit of the center, although during the influenza
epidemic of the fall of 1918 a large number of medical cases were admitted.
After January 30, 1919, the hospital cared for all genitourinary cases of the
center. The first patients were admitted September 29. During its activity
the hospital received 2,388 medical and 3,205 surgical cases, with 346 operations.
Base Hospital No. 78 ceased to function April 10, 1919, and its personnel
sailed from Marseille for New York, May 29, 1919; arrived in the United
States June 17, 1919, and were demobilized at Camp Dix, N. J., June 6, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. David A. Kraker, M. C, July, 1918, to February 6, 1919.
Lieut. Col. Robert Burns, M. C, February 7, 1919, to June 6, 1919.
•The statements of fact appearing herein are based on the "History, Base Hospital No. 78, A. E. F.," by Lieut.
Col. Robert Burns, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C.—Ed.
698
ADMINISTRATION, AIMERICAN EXPEDITIONARY FORCES
CHIEF OF SURGICAL SERVICE
Lieut. Col. Alfred P. Roope, M. C.
Lieut. Col. Robert Burns, M. C.
Maj. John B. Ferguson, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Albert J. Chatard, M. C.
Maj. Louis Poole, M. C.
BASE HOSPITAL NO. 79 »
Base Hospital No. 79 was organized in June, 1918, at Camp Greenleaf, Ga.,
from officers and enlisted men of the Army at large. The organization was
transferred June 28, 1918, to Fort Des Moines, Iowa, for training. On Sep-
tember 2, 1918, the unit proceeded to Camp Merritt, N. J., where it remained
until September 15. It then sailed from Hoboken, N. J., on the Martha Wash-
ington, and arrived at Brest, France, September 28. It was assigned to tem-
porary duty at Pontanezen Barracks, Brest, assisting Camp Hospital No. 33,
during the influenza epidemic. On October 13, the organization entrained for
its final destination, Bazoilles-sur-Meuse, Department Vosges, in the advance
section, and arrived October 16. It was the eighth hospital unit to reach
Bazoilles, where it functioned as a part of the hospital center there.
The unit was assigned a section of type A wooden barracks, of 1,000-bed
capacity, with emergency expansion in marquee tents to 1,600 beds. This
section was operated by the unit until January 31, 1919, on which date it took
over patients and equipment of Base Hospital No. 116. In addition to this,
a psychiatric unit that had been connected with Base Hospital No. 116 also
was taken over by Base Hospital No. 79. This psychiatric department had
been operating since July 20, 1918; it occupied 7 wooden barracks, with a capac-
ity of 80 beds; had its own trained personnel, and operated its own mess. From
the date of establishment, July 10, 1918, to April 30, 1919, this department
admitted 1,562 cases.
Base Hospital No. 79 ceased to function on May 1, 1919; the unit sailed
from St. Nazaire for Newport News, Va., on the Texan, June 15, 1919; arrived
in the United States June 27; and was demobilized at Camp Upton, N. Y., July
12, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. W. L. Vroom, M. C, July 30, 1918, to March 16, 1919.
Lieut. Col. Arthur S. Pendleton, M. C, March 17, 1919, to July 12, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Walter W. Crawford, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Patrick J. McDonnell, M. C.
" The statements of fact appearing herein are based on the " ffistory. Base Hospital No 79 A E F " bv the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D C —Ed
HOSPITALS
699
BASE HOSPITAL NO. 80^
Base Hospital No. 80 was organized June 25, 1918, at Camp Greenleaf, Ga.,
from officers and enlisted men of the Army at large. The Unit was transferred
to Camp Wheeler, Ga., and attached to the base hospital of that camp for
instruction. September 12 it left Camp Wheeler; arrived at Camp Upton,
N. Y., September 14, remained there five days, completing its equip-
ment for overseas service. On September 19, the organization boarded the
Agamemnon at Hoboken, N. J.; sailed September 20 for Europe; arrived at
Brest, France, September 29; remained at Pontanezen Barracks on temporary
duty at Canp Hospital No. 33 until October 6. On October 6, it proceeded to
the hospital center at Beaune, for duty. It arrived at Beaune, Department of
Cote d'Or, advance section, October 9.
Base Hospital No. 80 was the fourth hospital unit to arrive at that station,
where it functioned as a part of the hospital center. It occupied a set of type
A wooden barracks, of 1,000-bed capacity, with emergency expansion in marquee
tents to 1,500 beds. The first patients were received on October 19. During its
service at Beaune, the hospital admitted 2,479 medical, and 868 surgical cases.
On February 22, 1919, the unit was ordered to transfer its patients to Base
Hospital No. 77, and to proceed to the hospital center at Mars-sur-Allier,
Department of Nievre, for further duty. The organization left for its station
on February 24, and arrived the following day.
At Mars, the unit took over a hospital plant that had been operated by
Evacuation Hospital No. 37, and prior to that by Base Hospital No. 48. Dur-
ing its service at Mars no patients were received by Base Hospital No. 80.
This organization ceased to function on March 27, 1919; its personnel
sailed on the Santa Terese from St. Nazaire for New York, May 13, 1919;
arrived in the United States May 24, 1919, and the entire organization was
demobilized at Camp Upton, N. Y., May 31, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. James A. Mattison, M. C, June 25, 1918, to May 31, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Frank C. Kinsey, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Maurice W. K. Byrne, M. C.
Capt. Charles E. Sears, M. C.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 80, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
700
ADMIXISTRATIOX, AMERICAN EXPEDITIOXAEY FORCES
BASE HOSPITAL NO. 81 '
Base Hospital No. 81 was organized in February, 1918, at Fort Riley,
Kans., from officers and enlisted men of the Army at large. On June 14, the
organization was transferred to Camp Travis, Tex., where the officers and
enlisted men were assigned to duty at the base hospital of that camp for in struc-
tion. The unit left Camp Travis on August 17; arrived at Camp Merritt,
N. J., August 20; completed its overseas equipment and embarked on the
Leviathan August 28, and sailed from New York, August 31. It arrived at
Brest, France, September 7; remained there on duty at Pontanezen Barracks
until September 18; proceeded to Le Mans, Sarthe; remained for three days,
receiving instructions in gas defense; left on September 22 for its final destina-
tion, Bazoilles-sur-Meuse, Department of Vosges, in the advance section;
arrived September 25. This was the sixth hospital unit to arrive at that sta-
tion, where it functioned as a part of the hospital center. The unit occupied a
section of type A wooden barracks with a normal bed capacity of 1,000. The
first patients w^ere received October 5, 1918; total number received during the
active service of the hospital unit was 5,991, both surgical and medical cases.
Base Hospital No. 81 ceased to function March 31, 1919; the unit sailed
from St. Nazairc June 3, 1919, on the Amphion; arrived at Newport News, Va.,
June 16, 1919, and was demobilized at Camp Dodge, Iowa, June 24, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. F. E. Bunts, M. C, July 2, 1918, to July 11, 1918.
Lieut. Col. J. E. Daugherty, M. C, July 12, 1918, to July 26, 1918.
Lieut. Col. P. J. H. Farrell, M. C, July 27, 1918, to June 24, 1919.
CHIEF OF SURGICAL SERVICE
Maj. M. A. Hanna, M. C.
Maj. H. M. Hosmer, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Edmund Moss, M. C.
Maj. Howell E. Babcock, M. C.
BASE HOSPITAL NO. 82 -
Base Hospital No. 82 was organized in April, 1918, at Fort Riley, Kans.,
from officers and enlisted men of the Army at large. The unit remained in
training at Fort Riley until July 17, when it was transferred to Camp Crane,
Allentown, Pa., where it arrived July 19. Training was continued at Camp
Crane. On August 28, the organization entrained for the port of embarkation;
reached Hoboken, N. J., the following day; boarded the Leviathan; sailed
August 31; arrived at Brest, France, September 7; remained at Pontanezen
* The statements of fact appearing herein are based on the ''History, Base Hospital Xo. 81, A E F " bv Lieut Cd
i^^u^Cv^^Z^l^l '""^ ''^^ ''^ ^'^^ ^ - the historical
' The statements of fact appearing herein are based on the "History, Base Hospital Xo 82 \ E P " hv thP rnm
manding officer of that hospital. The history is on file in the Historical Division, S. G. C, Washington, D C -Ed
HOSPITALS
701
Barracks, Brest, until September 16; entrained for the hospital center, Allerey,
Department of Saone et Loire, in the intermediate section, where it was to
function as a part of that hospital center; arrived at Allerey September 19, and
was assigned to a section of type A barracks, called 26-A, that was being oper-
ated by a siibimit from Base Hospital No. 26. Two days after its arrival at
Allerey, the unit was ordered to proceed to Toul, Department Meurthe et
Moselle, in the advance section, for duty; left Allerey September 25 and arrived
at its new station September 27.
Base Hospital No. 82 was the fifth base hospital to arrive at Toul, where
it functioned as a part of the hospital center. The organization was assigned
to the Caserne Luxembourg, which had been occupied by the American Red
Cross Hospital No. 114, and consisted of 10 one-story ward buildings and
numerous buildings for administration, storage etc. Each ward building con-
tained 7 wards, and from 3 to 7 small rooms. The normal capacity was 1,500
beds, with emergency expansion to 1,800 beds and cots.
The hospital began to receive patients September 29, two days after its
arrival, and within a week was caring for 1,050 patients.
On January 29, 1919, the hospital plant at Caserne Luxembourg was aban-
doned and the unit took over the plant of Base Hospital No. 45, which had
been ordered to the United States. Base Hospital No. 82 took over all patients
and property of the latter at the Caserne La Marche, and functioned there
until March 31. During its period of activity, the hospital received 7,725
surgical and medical cases.
On March 31, 1919, Base Hospital No. 87 relieved Base Hospital No. 82,
which ceased operating on April 20, and the organization sailed from Brest
May 28, 1919, on the President Grant; arrived in Boston, Mass., June 9, 1919,
and was demobilized at Camp Devens, Mass., June 14, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. A. C. Burnham, M. C, April 29, 1918, to April 13, 1919.
Lieut. Col. C. S. Wilson, M. C, April 14, 1919, to June 14, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Bruce G. PhilHps, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Charles S. Wilson, M. C.
Capt. A. B. Schwartz, M. C.
BASE HOSPITAL NO. 83 «
Base Hospital No. 83 was org anized in April, 1918, at Fort Riley, Kans.,
from officers and enHsted men of the Army at large. In June, 1918, the unit
was transferred to Camp Pike, Ark. On August 25, the unit was ordered
to proceed to Camp Upton, N. Y., where it arrived on August 30; embarked
« The statements of fact appearing herein are based on the "History, Base Hospital No. 83, A. E. F.," by the
commanding ofBcer of that hospital. The history is on file in the Historical Division, S. G. 0., Washington, D. C— Ed.
702
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the following day on the Baltic; left New York Haihor Sopteuibor 1, 1918;
arrived at Liverpool, England, September 13; proceeded by rail to South-
ampton; crossed the English Channel on the night of September 15; readied
Le Havre, France, the following day; remained at Le Havre three days await-
ing orders, and then proceeded hj rail to Revigny, Department of Mciise, in
the advance section, where it united with Evacuation Hospital No. lo,
September 22, 1918.
On October 2 the commanding officer of Base Hospital No. 83 and 5 of
its medical officers, together with 20 enlisted men, were sent on detached service
to Camp Du Raton, Brizeaux, Forrestiere, where a 200-bed influenza and
pneumonia hospital was established as an annex to Evacuation Hospital No.
11. Officers and men w ere also sent on detached service to Evacuation Hospi-
tals No. 6 and No. 7 at Souilly, to Evacuation Hospital No. 10 at Froidos,
and to the American Red Cross Hospital No. 114 at Fleurv
All officers and men on detached service were returned to their proper
station at Revigny on November 10, 1918, and on November 14 Base Hospi-
tal No. 83 assumed charge of the hospital at Revigny. The medical and
surgical work was mostly that of an evacuation hospital in that a majority
of the patients w^ere evacuated as soon as they were in condition to travel.
The hospital functioned independently and was not a part of a hospital
center. The normal capacity w^as 800 beds.
The hospital ceased to function on February 1, 1919, and the personnel
entrained March 8 for port of embarkation at St. Nazaire; sailed April 19,
on the Mercury, for New^port New^s, Va.; arrived in the United States April
30, 1919, and was demobilized at Camp Dix, N. J., May 3, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Arthur A. Small, M. C, April, 1918, to May 3, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Roderick S. Elliott, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Charles G. Beall, M. C.
BASE HOSPITAL NO. 84 "
Base Hospital No. 84 was organized in April, 1918, at Fort Riley, Kans.,
from oflEicers and enlisted men of the Army at large. The unit received pre-
liminary training at Fort Riley, and on June 27, was transferred to Camp
Bowie, Tex., where it was attached to the base hospital of that camp for fur-
ther training. The organization remained at Camp Bowie until August 25,
when it left for the port of embarkation; arrived at Camp Merritt, N. J.,
August 29; embarked on the Talthyhius, August 31; sailed from New York
on September 1; arrived at Liverpool, England, September 13; entrained
' The statements of fact appearing herein are based on the "History, Base Hospital No^T V v -Mfwdie
commanding officer of that hospital. The history is on file In the Historical Division. S. G. 0.,AVash'ington. D.' C.-Ed.
HOSPITALS
703
for Southampton; arrived the same day; crossed the EngHsh Channel the
following night; reached Le Havre, France, September 15. On September 16,
the unit entrained for its final destination, Perigueux, Department Dordogne,
base section No. 2, and arrived there September 18. It was the first hospital
unit to arrive at that station, where it functioned as a part of the hospital
center there. It occupied a type A unit, of 1,000-bed capacity, the buildings
of which had nearly been completed on arrival of the organization.
The first convoy of patients arrived October 18, and up to February 5,
1919, a total of 2,311 patients had been received; of these, 891 were medical
and 1,420 surgical cases, with 250 operations.
On February 5, 1919, Base Hospital No. 84 ceased operating; turned over
its property and records to Base Hospital No. 95; sailed from Bordeaux May
11, 1919, on the Otsego; arrived in New York, May 26, 1919; was trans-
ferred to Camp Bowie, Tex.; and demobilized on July 12, 1919.
PERSONNEL
COMMANDING OFFICER
Capt. A. E. McReynolds, M. C, April 16, 1918, to July 15, 1918.
Lieut. Col. Peter D. MacNaughton, M. C, July 16, 1918, to September
28, 1918.
Maj. Harry A. Peyton, M. C, September 29, 1918, to October 2, 1918.
Lieut. Col. B. H. Olmstead, M. C, October 3, 1918, to February 2, 1919.
Lieut. Col. James A. Harvey, M. C, February 3, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. Harry A. Peyton, M. C.
Capt. Robert D. Gist, M. C.
CHIEF OF MEDICAL SERVICE
Maj. William R. May, M. C.
Capt. Frank D. Gorham, M. C.
BASE HOSPITAL NO. 85 ^
Base Hospital No. 85 w^as organized in April, 1918, at Fort Riley, Kans.,
from officers and enlisted men of the Army at large. The organization was
transferred to Fort Sill, Okla., June 24, and attached, for training, to the base
hospital at that camp. On September 1 the unit left Fort Sill for Camp
Merritt, N. J.; arrived September 5; embarked on the Canada September 7;
left, September 9, for Europe; docked at Glasgow, Scotland, September 22;
proceeded by rail to Southampton, England; crossed the English Channel
the same night; landed in Cherbourg, France, September 23; remained in
the rest camp at Cherbourg for two days; entrained for Paris September 25;
arrived September 26. In Paris the organization was assigned to the Clignan-
court Barracks, where it functioned as a part of the Paris district. The hospital
was located in large military barracks of the French Army. The wall-inclosed
• The statements of fact appearing herein are based on the "History, Base Hospital No. 85, A. E. F.," by Capt.
Roe S. Dorsett, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. O. 0., Washington, D. C.—Ed.
13901—27 45
704
ad:\iinistration, American expeditionary forces
space is situated on the Boulevard Ney and is an integral part of the walls of
the city of Paris. All of the personnel were lodged within the walls of this
institution. The capacity of the hospital was 1,500 beds. The first patients
arrived October 11, 1918; during its service in Paris the hospital cared for
approximately 2,500 medical and surgical cases.
On January 5, 1919, Base Hospital No. 85 was transferred to Angers,
Department of Marne et Loire, base section No. 1, W'here it took over patients
and property of Base Hospital No. 27; the latter organization having been
ordered to return to the United States.
Fig. 142.— Base Hospital No. 85, Paris
Base Hospital No. 85 functioned at Angers until June 12, 1919, and during
that time admitted 7,840 surgical and medical cases.
The organization sailed from St. Nazaire July 9, 1919, on the Panaman,
arriving in New York on July 19, 1919, and was demobilized at Camp Upton,
N. Y., July 25, 1919.
PERSONNEL
COMMANDING OFFICER
Capt. Robert H. Stephenson, M. C, April 16, 1918, to August 8, 1918.
Maj. Stanton A. Friedberg, M. C, August 9, 1918, to August 16, 1918.
Lieut. Col. Charles O. H. Laughinghouse, M. C, August 17, 1918, to
January 29, 1919.
Col. Royal Reynolds, M. C, January 30, 1919, to February 26, 1919.
Col. WilHam R. Eastman, M. C, February 27, 1919, to June 10, 1919.
HOSPITALS
705
CHIEF OF SURGICAL SERVICE
Lieut. Col. Joshua C. Hubbard, M. C.
Maj. Charles C. Sturgeon, M. C.
Maj. John M. Firman, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Appleton H. Pierce, M. C.
BASE HOSPITAL NO. 86
Base Hospital No. 86 was organized in April, 1918, at Fort Riley, Ivans.,
from officers and enlisted men of the Army at large; the enlisted men were
practically all drafted men from the State of Oklahoma. On June 27 the
organization left Fort Riley, en route to Camp Logan, Houston, Tex., where
it arrived the following day. At Camp Logan the unit was trained at the
camp base hospital.
On August 26 the command entrained for Camp Upton, N. Y. ; arrived
August 30; embarked the following day on the Baltic; sailed for Europe,
September 1; arrived at Liverpool, England, September 13; proceeded the
same day by rail to Southampton; crossed the English Channel the following
night; reached Le Havre, France, September 15. On September 17 the unit
entrained for its final station, the hospital center at Mesves, Department of
Xievre, in the intermediate section, and arrived September 19.
Base Hospital No. 86 was the fourth hospital unit to arrive at that station,
where it functioned as part of the hospital center there. The hospital occupied
a section of type A wooden barracks, and began to receive patients on Septem-
ber 27. The normal capacity of the hospital was 1,000 beds in barracks, with
crisis expansion in marquee tents to 2,400. During its activity, September 27,
1918, to March 28, 1919, the hospital cared for 1,823 surgical and 2,252 medical
cases; a total of 4,956. The largest number of patients in hospital was on
Xovember 15, 1918, when 2,340 were undergoing treatment. Base Hospi-
tal No. 86 was also designated to receive all mental and tubercular cases for the
entire hospital center. '^-iwaj^.v
The hospital ceased to function on March 28, 1919; the personnel sailed
from St. Nazaire for New York May 16, 1919, on the Dakotan, arriving in the
United States May 28, and were demobilized at Camp Dix, N. J., May 31, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Herman J. Schlageter, M. C, July 29, 1918, to April 8, 1919.
Lieut. Col. Oliver C. Hargreaves, M. C, April 9, 1919, to May 31, 1919.
CHIEF OF SURGICAL SERVICE
Maj. John H. Blackburn, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Oliver C. Hargreaves, M. C.
^ The statements of fact appearing herein are based on the "History, Base Hospital No. 86, A. E. F.," by Lieut.
Col. H. J. Sehlagoter, M. C, while on duty ivs a member of the stafT of that hospital. The history is on file in the His-
torical Division, S. G. ()., Washington, D. V. — Ed.
706
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 87 '
Base Hospital No. 87 was organized in April, 1918, at Fort Riley, Kans.,
from officers and enlisted men of the Army at large. On June 26, the organi-
zation was transferred to Camp MacArthur, Tex., where it was attached to
the base hospital of that camp for instruction. On September 6, the unit left
Camp MacArthur for Camp Mills, N. Y., and arrived there September 10. Upon
completion of its overseas equipment, the organization sailed from New Yoric
on the Finland on September 15; arrived at Brest, France, September 28;
remained at the rest camp at Pontanezen Barracks for seven days, where the
unit was equipped with gas masks and steel helmets; entrained, October 5, for
its final station, the Justice hospital group, at Toul, Department of Meurthe
et Moselle, in the advance section; arrived at Toul, October 8, and imme-
diately began to function as a part of that hospital center. It was the sixth
hospital unit to arrive at that station. It took over the patients, personnel,
and property of the Justice Gas Hospital and Neurological Hospital No. 2.
The gas hospital was located in the Caserne La Marche annex, which
consisted of a number of large stone and cement buildings, with a bed capacity
of 1,000, and was designated Base Hospital No. 87-A.
Neurological Hospital No. 2, occupied a part of the Caserne Fabvier,
with a bed capacity of 700, and was designated Base Hospital No. 87-B.
After the armistice began, section A was designated to receive all respi-
ratory diseases and section B was used exclusively as a genitourinary hospital.
In March, 1919, section B was abandoned and on April 1, 1919, the Base Hos-
pital No. 87 took over patients and property of Base Hospital No. 82, in the
Caserne La Marche.
During its active service, October 9, 1918, to April 26, 1919, the hospital
admitted 7,431 patients; of these, 5,718 were medical, 630 surgical, and 1,083
gas cases.
Base Hospital No. 87 ceased to function on April 27, 1919, and the per-
sonnel returned to the United States, sailing from Brest, June 10, 1919, on
the Agamemnon; arrived in the United States June 18, 1919, and were demo-
bilized at Camp Funston, Kans., June 23, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. R. D. Harden, M. C, July 27, 1918, to April 8, 1919.
Lieut. Col. O. H. Campbell, M. C, April 9, 1919, to June 23, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. B. F. Alden, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. O. H. Campbell, M. C.
' The statements of fact appearing herein are based on the "History, Base Hospital No 87 \ E F " bv the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Was'hington, T>.C -Ed.
HOSPITALS
707
BASE HOSPITAL NO. 88^
Base Hospital No. 88 was organized in April, 1918, at Fort Riley, Kans.,
from officers and enlisted men of the Army at large. On June 24, the organi-
zation was transferred to Camp Dodge, Iowa, and was assigned to the base
hospital of that camp for duty and instruction. On September 11, the unit
left Camp Dodge, en route to Camp Upton, N. Y.; arrived September 14;
embarked, September 19, on the America; sailed, September 20, for Brest,
France; arrived, September 29; disembarked, October 1, and encamped at
Pontanezen Barracks, where it remained for six days assisting various organi-
zations in caring for sick during the influenza epidemic.
On October 7, the organization entrained for its final destination, Langres,
Department of Haute Marne, advance section, and arrived October 11. This
hospital was the second hospital unit to arrive at that station, where it func-
tioned as a part of the hospital center. It occupied a section of type A wooden
barracks, of 1,000-bed capacity, with an emergency expansion in marquee tents
to 1,500. The first convoy of patients was received October 15; during its
stay at Langres, the hospital cared for 4,691 surgical and medical cases.
On January 11, 1919, the hospital turned over its patients and equipment
to Base Hospital No. 53; proceeded to the hospital center at Savenay, Depart-
ment of Loire Inferieure, for duty; arrived January 16, took over patients and
equipment of Base Hospital No. 69, which was a well organized and equipped
2,500-bed hospital, and immediately began to function as a part of the Savenay
hospital center. This hospital was designated as a special hospital for all
genitourinary cases at that center. Up to March 31, 1919, the hospital cared
for 4,898 patients.
Base Hospital No. 88 ceased to function July 7; the personnel sailed
from St. Nazaire for New York July 13, 1919 on the Sierra; arrived in the
United States July 23, and were demobilized at Camp Dodge, Iowa, July 30,
1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. A. S. Begg, M. C, June 24, 1918, to July 30, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Warren A. Dennis, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Joseph L. Edward, M. C.
BASE HOSPITAL NO. 89 "
Base Hospital No. 89 was organized in April, 1918, at Fort Riley, Kans.,
from officers and enlisted men of the Army at large. On June 21, the unit left
Fort Riley for Camp Sheridan, Ala., where it arrived June 23. At Camp
/ The statements of fact appearing herein are based on the "History, Base Hospital No. 88, A. E. F.," by the com-
manding officer of the hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
» The statements of fact appearing herein arc based on the "History, Base Hospital No. 89, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
708
ADMINISTRATION', AMERICAN EXPEDITIONARY FORCES
Sheridan the organization was attached to the base hospital of that camp for
instructions. On September 1, the command entrained for Camp Mcri-itt, X. ,1.,
arrived September 3 and remained for five days, completing its equipment.
The unit embarked on the Nelens; sailed from New York on September 9 ; landed
at Glasgow, Scotland, September 22; entrained the same day for Southampton,
England; arrived the following day; crossed the English Channel the same
night; reached Le Havre, France, September 23; proceeded by rail to its final
destination, Mesves, Department of Nievre, in the intermediate section; arrived
September 26. It was the sixth hospital unit to arrive at that station, where it
functioned as a part of the hospital center.
The unit occupied a section of type A wooden barracks, the construction of
which had not yet been completed. The bed capacity of hospital was 1,000
in barracks, with crisis emergency expansion to 2,190 beds. This included
tents and all available space in the recreation hall and personnel quarters.
The first patients were received on October 7, when 630 ambulatory patient?
were received, and on the following day an additional 800 cases were admitted;
the largest number of patients treated at one time was 2,186, on November i:^.
Base Hospital No. 89 received both surgical and medical cases; up to January
25, 1919, a total of 3,843 had been admitted.
Base Hospital No. 89 ceased to function as a hospital on April 19, 1919; the
personnel sailed from Brest for New York May 22, 1919, on the Louisville;
arrived in United States May 31, 1919, and were demobilized at Camp Dix,
N. J., July 12, 1919.
PERSONNEL
COMMANDING OFFICER
Capt. Fred F. Schwartz, M. C, June 12, 1918, to July 28, 1918.
Lieut. Col. Ross H. Skillern, M. C, July 29, 1918, to December 13, 1918.
Maj. Thomas G. Nelan, M. C, December 14, 1918, to February, 1919.
Maj. J. S. Fielden, M. C, February, 1919, to July 12, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Thomas P. Lloyd, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Walter S. Lucas, M. C.
BASE HOSPITAL NO. 90
Base Hospital No. 90 was organized in June, 1918, at Fort Riley, Kans.,
from officers and enhsted men of the Army at large, and trained at that station
until October 27. From Fort Riley the organization proceeded to Camp Mer-
ritt, N. J.; arrived October 30; remained completing its equipment until
November 10, when it embarked and sailed on the Mauretania; reached Liver-
pool, England, November 17; entrained the same day for the rest camp at
Winchester; arrived the following day ; crossed the English Channel and landed
» The statements of fact appearing herein are based on the "History, Base Hospital No. 90, A E F " bv the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.-Ed.
HOSPITALS
709
at Le Havre, France, November 19; remained awaiting orders for 10 days;
proceeded by rail to its station, Commercy, Department Meuse, advance section,
on November 29; arrived there December 1. It was the second hospital unit
to reach that station, where it formed a part of a two-unit hospital center.
The organization took over the Caserne Lerouville, and proceeded to convert its
buildings into a hospital. During its stay at Commercy it did not function as a
hospital, but a number of its officers and men assisted Base Hospital No. 91,
which was operating a hospital at that station, in caring for its patients. On
January 7, 1919, the unit was transferred to Chaumont, Department of Haute
M arne, in the advance section, where it took over the patients and equipment of
Base Hospital No. 15. Base Hospital No. 90 ceased to function on June 8, 1919,
and the personnel returned to the United States; sailed June 26, 1919 on the
Mongolia; arrived in New York July 6, 1919, and were demobilized at Camp
Custer, Mich., July 12, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. W. P. Morrill, M. C, August 9, 1918, to January 5, 1919.
Lieut. Col. Harry T. Summergill, M. C, January 6, 1919, to Februarv 28,
1919.
Lieut. Col. Harry G. Ford, M. C, March 1, 1919, to June 10, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. H. F. Connally, M. C.
CHIEF OF MEDICAL SERVICE
Maj. James D. Pilcher, M. C.
BASE HOSPITAL NO. 91 '
Base Hospital No. 91 was organized June 16, 1918, at Camp Greenleaf, Ga.,
from officers and enlisted men of the Army at large. The command received
preliminary training at Camp Greenleaf, and on August 15 was transferred to
Camp Gordon, Ga., where it was attached to the camp base hospital for further
instructions.
The organization remained in training at Camp Gordon until October 31,
when it entrained for Camp L^pton, Long Island, N. Y.; arrived November 2;
remained and completed its equipment, until November 9. On November 10
the unit boarded the Mauretania; left New York Harbor the same day; arrived
at Liverpool, England, November 17; proceeded by rail to the rest camp at
Winchester; left on November 19 for Southampton; crossed the English Chan-
nel the same day; disembarked at Le Havre, France, November 20; remained
encamped at Le Havre until November 27; proceeded by rail to its final station,
Commercy, Department of Meuse, in the advance section; arrived November
30. This was the first hospital unit to be permanently assigned to that station,
which was to become a small hospital center. Upon arrival at Commercy the
• The statements of fact appearing herein are based on the "History, Base Hospital No. 91, A. E. F.," by Capt.
F. L. Burch, M. C, while on duty as a member of the stnff of that hospital. The history is on file in the Historical Divi-
sion, S. a. O., Washington, D. C.—Ed.
710
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
unit took over the hospital in the Caserne Oudinot, which was being operated
by Evacuation Hospital No. 13. The hospital plant consisted of several stone
buildings, which were found in a good condition and contained 450 patients.
The normal bed capacity of the hospital was 1,000 with an emergency expan-
sion to 1,500; the largest number of patients in hospital was on January 24,
1919, when 1,458 were under treatment.
Base Hospital No. 91 ceased to function July 1, 1919, and the personnel
sailed July 22, 1919, for the United States from Brest on the Pocahontas; arrived
August 1, 1919, and were demobilized at Camp Upton, N. Y., August 5, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Harry T. Summergill, M. C, July 8, 1918, to January 6, 1919.
Lieut. Col. Warren P. Morrill, M. C, January 7, 1919, to February 13,
1919.
Lieut. Col. Thomas J. Leary, M. C, February 14, 1919, to June 15, 1919.
Lieut. Col. George C. Dunham, M. C, June 16, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. James G. Flynn, M. C.
Maj. Harry Gross, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Harry Gross, M. C.
Capt. Hugh P. Boswell, M. C.
Maj. S. B. Newton, M. C.
BASE HOSPITAL NO. 92'
Base Hospital No. 92 was organized June 17, 1918, at Camp Greenleaf, Ga.,
from officers and enlisted men of the Army at large. The command received
its preliminary training at that camp, and on August 18 was transferred to
Camp Greene, N. C, for further instruction. The unit remained at Camp
Greene until October 27; entrained for Camp Merritt, N. J.; arrived there the
following day; proceeded to New York on November 10; boarded the Mau-
retania and left New York for Europe the same day; disembarked at Liverpool,
England, November 17; entrained for the rest camp at Winchester; arrived
the following day; proceeded to Southampton November 19; crossed the Eng-
lish Channel and landed at Le Havre, France, November 20.
After a rest of three days the organization proceeded to Pontanezen
Barracks, near Brest, where it remained in the rest camp for one week. Base
Hospital No. 92, while with the American Expeditionary Forces, did not work
as a unit, but as groups between Pontanezen and Kerhuon, at Camp Hospital
No. 33, and with Base Hospitals Nos. 65 and 105.
T • . 'ATK\'*f appearing herein are based on the "History, Base Hospital No. 92, \. E F " by First
Lieut. Albert A Shap.ro, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C -Ed "ifiory is on nie m lae
HOSPITALS
711
The unit was skeletonized February 10, 1919; a small detachment sailed
from Brest March 23, 1919, on the Aquitania; arrived in the United States
March 30, and was demobilized at Camp Upton, N. Y., shortly afterward.
PERSONNEL
COMMANDING OFFICER
Maj. J. C. Friedman, M. C, August 30, 1918, to September 30, 1918.
Maj. J. A. Livingston, M. C, October 1, 1918, to December 17, 1918.
Maj. J. C. Friedman, M. C, December 18, 1918, to February 10, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Josiah M. Slemane, M. C.
CHIEF OF MEDICAL SERVICE
Maj. J. C. Friedman, M. C.
BASE HOSPITAL NO. 93 «^
Base Hospital No. 93 was organized July 15, 1918, at Camp Lewis, Wash.,
from officers and enlisted men of the Army at large, and remained in training
until the last week of September, 1918, when the organization was ordered
to proceed to San Francisco, Calif., where it arrived October 10. Orders
for its embarkation at San Francisco were changed to embarkation at an
eastern port, and the unit proceeded by rail to Camp Mills, N. Y., where it
arrived October 16. At Camp Mills the organization was broken up into
several groups and assigned to various transports for transportation overseas.
The organization left New York Harbor in the convoy, October 19, and arrived
at Liverpool, England, October 31. Here the command was reassembled
and then proceeded by rail to Southampton; arrived the following morning;
crossed the English Channel the night of November 3; landed at Le Havre,
France, November 4; entrained the following day for its station at Le Mont
Dore, Department Puy de Dome, intermediate section; arrived November 6.
Base Hospital No. 93 was the only hospital at that station, but functioned
as a part of the Clermont-Ferrand hospital center. The unit occupied the
hotel Sarciron, which was the largest and most modern hotel in the city, and
reported ready for patients two days after its arrival; the first patients were
received November 11, 1918. The bed capacity of the hospital was 717;
total number of patients admitted was 970. The unit functioned at Le Mont
Dore for Httle over a month; was transferred, December 18, to Cannes,
Alpes Maritimes, base section No. 6, for duty; arrived at its new station
December 22, and immediately began to function as a part of the Riviera
hospital center.
At Cannes the unit took over four large hotels and converted them into
hospitals; these hotels were admirably suited to hospital purposes, and had
a bed capacity of 1,450. Each hotel was in charge of an officer, who was
* The statements of fast appearing herein are based on the "History, Base Hospital No. 93, A. E. F.," by Capt.
Arthur C. Johnson, M. C, while on duty as a member of the stall of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C.—Ed.
712
AD:MIXISTRATrOX, AMERICAN EXPEDITIONARY FORCES
responsible to the commanding officer for its proper administration. The
first convoy of patients arrived January 19, 1919, and up to April 1, 1919,
3,669 surgical and medical cases were admitted.
Base Hospital No. 93 ceased to function on May 10, 1919; the personnel
returned to the United States on the Patria; sailed from Marseille June 7,
1919; arrived at Camp Merritt, N. J., June 22, and were demobilized sliortly
afterward.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. J. D. Whitham, M. C, August 26, 1918, to May 3, 1919.
Maj. James Hamilton, jr., M. C, May 4, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Maj. Joseph K. Swindt, M. C.
CHIEF OF MEDICAL SERVICE
Maj. William G. Cassels, M. C.
BASE HOSPITAL NO. 94 '
Base Hospital No. 94 was organized July 23, 1918, at Camp Cody, N. Mex.,
from officers and enlisted men of the Army at large, and was equipped and
received training at that camp until October 8, when the command entrained
for Camp Upton, Long Island, N. Y., where it arrived October 13. During
this trip, a large part of the personnel was taken sick with influenza, necessi-
tating leaving 35 men behind when the unit left for overseas. On October 19,
the organization embarked on the Walmer Castle sailed from New York Har-
bor the same day; arrived at Liverpool, England, October 31; entrained for
Southampton the same day; arrived November 1; crossed the English
Channel the following night; landed at Le Havre, France, November 3; re-
mained in the Le Havre rest camp until November 5; proceeded by rail to its
final destination, Pruniers, Department Loire et Cher, in the intermediate
section; arrived at Pruniers, November 7.
Base Hospital No. 94 occupied a section of wooden barracks, of 1,000-bed
capacity. The hospital was not a part of any hospital center, but functioned
independently. The first patients were admitted November 14, one week
after its arrival. During November, 539 medical and surgical cases were
received.
In February, 1919, a majority of the personnel was transferred to various
organizations for duty, and on February 10, 1919, Camp Hospital No. 43
took over the patients and equipment of Base Hospital No. 94. The skeleton-
ized unit, 1 officer and 5 enlisted men, proceeded to St. Nazaire; sailed from
that port March 25, on the Orizaba; arrived at Camp Merritt, N. J., April 2,
1919, and was demobilized at Bowie, Tex., April 28, 1919.
'• The statements of fact appearing herein are based on the "History, Base Hospital No. 94, A. E. F.," by Lieut. Col.
Henry R. Brown. M. C, while on duty as a member of the staff of that hospital. The history is on file' in the Historical
Division, S. G. O., Washington, D. C.~Ed.
HOSPITALS 713
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Henry R. Brown, M. C, July 23, 1918, to February 10, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Leonard S. Willour, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Brewster C. Doust, M. C.
Fig. 143.— Part of Ba.se Hospital No. 94, Piuniers
BASE HOSPITAL NO. 95
Base Hospital No. 95 was organized August 17, 1918, at Camp Fremont,
Calif., from officers and enlisted men of the Army at large. The organization
was attached to the base hospital at that camp for temporary duty and there
received its training. The command left Camp Fremont for Camp Upton
November 4; arrived November 10; remained for four days completing its
overseas equipment; proceeded to New York on November 15; boarded the
La France and sailed the same day for Brest, France; arrived November 22.
The statements of fact appearing herein are based on the "History, Base Hospital No. 95, A. E. F.," by the
commanding ofTicer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
714
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
After several days of rest at the Pontanezen Barracks, the organization pro-
ceeded by rail to its final destination, Perigueux, Department of Dordogne,
base section No. 2, and arrived December 3. This was the second hospital
unit to reach that station, where it functioned as a part of the hospital center.
It occupied a section of type A barracks, with a bed capacity of 1,000. The
first convoy of patients arrived on December 15, 1918. During January,
1919, this hospital was designated as one of the orthopedic hospitals of the
American Expeditionary Forces, and a great many orthopedic cases were
received from the medical formations in the advance section.
Base Hospital No. 95 ceased to function May 16, 1919, and the personnel
left for Bordeaux on May 31, for embarkation to the United States. Embarked
on the Ohioan; sailed for New York June 9, 1919; arrived in the United
States on June 21, 1919; were demobilized at Fort D. A. Russell, Wyo., July 1,
1919.
PERSONNEL
COMMANDING OFFICER
Maj. Edward A. Coates, M. C, August 19, 1918, to February 2, 1919.
Lieut. Col. B. H. Olmstead, M. C, February 3, 1919, to July 1, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Benjamin F. Cunningham, M. C.
Maj. Harry J. Craycroft, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Roy A. Brown, M. C.
BASE HOSPITAL NO. 96 «
Base Hospital No. 96 was organized in September, 1918, at Camp Kearny,
Calif., and received its training at that camp. The unit left Camp Kearny
on October 15 en route to Camp Upton, N. Y.; arrived October 20; remained
there completing its overseas equipment until October 27. During this time,
influenza broke out among its members, and when the unit sailed it left 65 of
its men behind. On October 27, the organization left New York harbor on
the Orca; arrived at Liverpool, England, November 8; proceeded by rail to
Southampton, and crossed the English Channel on the following day; landed
at Le Havre, France, November 11; remained at the Le Havre rest camp
until November 28; entrained for its final destination, the hospital center at
Beaune, Depart-Cote d'Or, in the advance section; arrived November 30. It
was the fifth hospital unit to arrive at that center. It was assigned a section
of type A wooden barracks, of 1,000-bed capacity. The unit never functioned
as a hospital in the American Expeditionary Forces, and the majority of its
personnel was transferred to other hospitals for duty.
The skeletonized unit sailed from St. Nazaire for Newport News, Ya.,
April 20, 1919, on the Finland; arrived in United States May 1, 1919, and
was demobilized at the Presidio of San Francisco, Calif., May 26, 1919.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 96, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. Q O., Washington, D. C.—Ed.
HOSPITALS
715
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Robert Smart, M. C, September, 1918, to February 19, 1919.
Capt. Leon Jacobs, M. C, February 20, 1919, to May 26, 1919.
CHIEF OF SURGICAL SERVICE
Capt. Ralph Hagan, M. C.
CHIEF OF THE MEDICAL SERVICE
Capt. Leon Jacobs, M. C.
BASE HOSPITAL NO. 97 «
Base Hospital No. 97 was organized June 25, 1918, at Camp Newton D.
Baker, El Paso, Tex., from officers and enlisted men of the Army at large.
August 14, the unit was moved to Camp Fort Bliss, El Paso, Tex., where it
received its training. A majority of the personnel was assigned to the base
hospital at Fort Bliss for temporary duty. On October 20, the command left
Fort Bliss, en route to Camp Mills, Long Island, N. Y.; arrived October 25;
boarded the Balmoral Castle at New York; sailed October 27 for Liverpool,
England; landed November 8; entrained the following day for Southampton;
crossed the English Channel from that port on November 10; reached Le
Havre, France, November 11; remained at the Le Havre rest camp until
November 28; entrained for Allerey, Department of Saone et Loire, inter-
mediate section; arrived November 30. It was the seventh hospital unit to
reach Allerey, where for a short time it functioned as a part of that hospital
center. The organization was assigned to a section of type A barracks, which
had been operated by a subunit from Base Hospital No. 70, and contained 748
convalescent patients on December 10, when the transfer was made.
Base Hospital No. 97 functioned as a hospital from December 10 to 28, on
which date the commanding officer of the hospital center ordered it to be con-
verted into an evacuation unit, and from that time on the unit handled only
class A men. On February 28, 1919, the unit ceased to function and the major-
ity of the personnel was assigned to various organizations for duty.
The skeletonized Base Hospital No. 97 returned to the United States on
the Grai Waldersee, sailing from Brest on April 7, 1919; arrived at Hoboken^
N. J., April 20, and was demobilized at Camp Dix, N. J., April 22, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. J. E. Dougherty, M. C, June 25, 1918, to April 22, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Charles D. Bodine, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Thad Shaw, M. C.
•The statements of fact appearing herein are based on the "History, Base Hospital No. 97, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C.—Ed.
716
ADMINISTRATION, A:\rERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 98 "
Base Hospital No. 98 was organized in July, 1918, at Camp Greenleaf, (Ja.,
from officers and enlisted men of the Army at large. On August G, the com-
mand was transferred to Camp Hancock, Ga., where it received its training
and was attached to the base hospital of that camp for instruction. The
organization left Camp Hancock for Camp Merritt, N. J., October 3, and
remained there on temporary duty, assisting at the base hospital during
the influenza epidemic. On November 10, it left Camp Merritt, N. J., for
New York; boarded the Empress of Russia; sailed on November 12 for Brest,
France; arrived November 22; proceeded to the rest camp at Pontanezen
Barracks, where it remained until November 29; entrained for Paris; arrived
the following day. In Paris, the unit was assigned to duty at the convalescent
camp, which had been established on the race track at Tremblay, Nogent sur
Marne. On December 20, the hospital was ordered to proceed to Lourdes,
Department of Haute Pyrenees, in base section No. 2; arrived December 22,
and was assigned a number of hotels in which the unit was to operate a hospital.
On January 1, 1919, the project of establishing a hospital at Lourdes was aban-
doned and Base Hospital No. 98 was ordered to Limoges for duty; entrained
on January 22; arrived at Limoges, Department Haute Vienne, base section
No. 2, January 23. At Limoges it relieved Base Hospital No. 28 and took
over its patients and equipment and assumed full charge on February 1, 1919.
In March, 1919, the entire hospital plant was abandoned and all patients and
personnel were moved to the Bellaire Seminary, which prior to that had been
used as an annex to the hospital. The capacity of the hospital was reduced to
200 beds, and the hospital served only the troops stationed in Limoges.
Base Hospital No. 98 ceased to function on May 23, 1919; the personnel
sailed from Bordeaux for New York, June 9, 1919, on the Ohioan; arrived in
the United States June 21, and were demobilized at Camp Dix, N. J., June 23,
1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Walter Bensel, August 24, 1918, to December 27, 1918.
Maj. Charles H. Weber, December 28, 1918, to June 23, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Henry M. Chapman.
CHIEF OF MEDICAL SERVICE
Maj. James W. Barrow.
BASE HOSPITAL NO. 99 "
Base Hospital No. 99 was organized August 22, 1918, at Camp Custer,
Mich., from officers and enlisted men of the Army at large, and received its
training at the camp base hospital. After two months of training, the command
"The statements of fact appearing herein are based on the "History, Base Hospital No. 98, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
0 The statements of fact appearing herein are based on the "History, Base Hospital No. 99, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
717
proceeded by rail to Camp Merritt, N. J.; arrived October 22; sailed from
New York harbor October 27, on the MinnekaMa; arrived at Liverpool, Eng-
land, November 8; entrained the same day for Southampton; arrived the
following day; crossed the English Channel during the night of November 10;
landed at Le Havre, November 11; remained at the Le Havre rest camp until
November 22; left for its station at Hyeres, Department of Var, base section
No. 6; arrived November 26. It was the first hospital unit to arrive at that
station, w^here it took over United States Convalescent Hospital No. 1, and
became a part of the Riviera hospital center. The hospital functioned as a
convalescent hospital. The plant consisted of 10 buildings, situated from one-
half mile to 5 miles apart; prior to their being taken over by the United States
Army the various buildings had been hotels. Hyeres is one of the popular
resorts on the Riviera and is an ideal place for a convalescent hospital. The
hospital had a bed capacity of 3,638; during its period of activity, November
26, 1918, to May 1, 1919, it handled over 8,000 medical and 2,147 surgical
cases.
Base Hospital No. 99 ceased to function May 10, 1919, and the unit left
Hyeres for Marseille, May 20, 1919; sailed May 31, 1919, on the Duca
D'Ahruzzi for New York; arrived, June 18, 1919, and was demobilized at Camp
Custer, Mich., June 27, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Maynard L. Simmons, M. C, August 22, 1918, to March 26, 1919.
Lieut. Col. Leopold Mitchell, M. C, March 27, 1919, to May 1, 1919.
Lieut. Col. George C. Dunham, M. C, May 2, 1919, to May 15, 1919.
Maj. Frederick C. Warnshuis, M. C, May 16, 1919, to June 27, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Frederick C. Warnshuis, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Nelson W. Janney, M. C.
Maj. Joseph Catton, M. C.
BASE HOSPITAL NO. 100 '
Base Hospital No. 100 was organized, July 12, 1918, at Camp Greenleaf,
Oa., from officers and enlisted men of the Army at large. On August 21,
the command was transferred to Camp Custer, Mich., where it was assigned
to the camp base hospital for training. On October 30, 1918, the organiza-
tion entrained at Camp Custer for Camp Upton, N. Y.; arrived November 1;
remained until November 10; proceeded to the port of embarkation; sailed
on the Mauretania on the same day ; arrived at Liverpool, England, November
17; entrained for Winchester; arrived the following day; left the Winchester
rest camp for Southampton November 19; crossed the English Channel;
' The statements of fact appearing herein are based on the "History, Base -Hospital No. 100, A. E. F.," by the
commanding ofRcer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
718
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
landed at Le Havre, France, November 20; entrained on November 21 for
its final station at Savenay, Department Loire Inferieure, base section No. 1;
arrived on November 23.
Base Hospital No. 100 was the fifth hospital unit to reach Savenay,
where it functioned as a part of the hospital center. It was assigned to a type
A, 1,000-bed hospital, already under operation as an auxiliary to Base Hospital
No. 8, but not fully completed. This hospital consisted of 19 buildings of
frame construction and 5 of cement. After its arrival, six frame barracks
were erected, to be used for the hospital personnel. It was used largely as a
receiving and evacuating hospital for walking cases. On the date of its arrival,
the hospital was filled with 1,109 patients. During its period of activity,
November 23, 1918, to June 21, 1919, the hospital handled 11,081 patients.
The hospital ceased to function, June 21, 1919, and the personnel sailed
from St. Nazaire July 5, 1919 on the South Bend; arrived in the United States
July 15, and were demobilized at Camp Sherman, Ohio, July 20, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Frederick H. Newberry, M. C, August 16, 1918, to April 10,
1919.
Maj. Mortimer Warren, M. C, April 11, 1919, to July 20, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Hammer C. Irwin, M. C.
Maj. Lawrence H. Hoffman, M. C.
Maj. Josiah R. McKirahan, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Mortimer Warren, M. C.
Maj. John A. Dodd, M. C.
BASE HOSPITAL NO. 101 »
Base Hospital No. 101 came into existence about July 5, 1917, at St.
Nazaire, Department Loire Inferieure, base section No. 1, the personnel being
taken from the Medical Department of the 1st Division, and Base Hospital
No. 18. All members of Base Hospital No. 18 were replaced in August, 1917,
by officers and men from Base Hospital No. 8, who in turn were relieved in
October, 1917, by a casual medical detachment of the Regular Army.
Base Hospital No. 101 was the first base hospital to operate with the Amer-
ican Expeditionary Forces, and when organized was United States Army Hos-
pital No. 1, which subsequently was changed to Base Hospital No. 101. The
hospital was located in the Municipal College of St. Nazaire, and had been
used as a military hospital by the French Army during the three years preced-
ing. When taken over by us the hospital contained about 290 sick American
soldiers and civilian employees.
• The statements of fact appearing herein are based on the "History, Base Hospital No. 101, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C.—Ed.
HOSPITALS
719
During its first year of service practically all the patients admitted were
from incoming transports; on October 6 and 7, 1918, over 900 cases of influ-
enza and severe cases of pneumonia were received from the Princess Matoika,
the Mongolia, and the President Grant. The number of deaths was quite
appalling and occurred directly after admission to the hospital. At this
time the capacity of the hospital was very much overtaxed and cots and bed
sacks were placed in every available shelter to accommodate incoming patients.
The normal capacity of the hospital was 1,020 beds, with an emergency
expansion to 1,500. During its period of activity it cared for about 20,000
surgical and medical cases.
Besides being the first base hospital to function with United States troops
in P'rance, Base Hospital No. 101 was one of the last hospitals to cease oper-
ations. It closed its doors on June 20, 1919, and the personnel sailed from
Marseille June 28, 1919, on the Marica. Upon arrival in New York, July 9,
1919, the organization w^as split up and sent to various camps for demobiliza-
tion.
PERSONNEL
COMMANDING OFFICER
Col. George P. Peed, M. C, July 5, 1917, to July 14, 1917.
Maj. Wayne H. Crum, M. C, July 15, 1917, to January 14, 1918.
Col. Albert S. Bowen, M. C, January 15, 1918, to September 22, 1918.
Lieut. Col. William B. Meister, M. C, September 23, 1918, to June 5, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Harvey Stone, M. C.
Maj. James A. Duff, M. C.
Maj. E. L. Gilchrist, M. C.
Maj. Thomas Mullen, M. C.
Maj. P. Nesbitt, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Henry C. Thacher, M. C.
Maj. Milton B. Katzenstin, M. C.
BASE HOSPITAL NO. 102 '
Base Hospital No. 102 w^as organized in February, 1918, at San Juan,
P. R., from officers and enlisted men of the Army at large. The unit was
transferred to Camp Beauregard, La., where it completed its training. In
July, 1918, the organization proceeded to Fort McHenry, Md., where it arrived
on July 24, and was attached to General Hospital No. 2 for temporary duty.
On August 4, the unit proceeded to Baltimore, Md.; embarked the same
day on the TJmhria; sailed for Genoa, Italy; arrived at Genoa, August 27;
remained, awaiting orders, until September 6; proceeded to its station at
Vicenza, Italy; arrived there the following day.
' The statements of fact appearing herein'are based on the "History, Base Hospital No. 102, A. E. F.," by the com-
manding oflicer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
13901—27 46
720
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
This unit was sent to Italy for service with the Italian Army. Previous
to the signing of the armistice this hospital was not open to medical cases,
particularly cases of chronic nature, such as venereal diseases. The entire
hospital and personnel were held in reserve for casualties evacuated from
the front. However, in September, arrangements were made whereby medical
and other cases of the American Forces were accepted regardless of their
nature. Later the hospital acquired an additional building accommodating
about 400 beds, and converted it into a hospital for medical cases; the original
hospital now was used entirely for surgical cases.
During the period this hospital was in operation 397 Americans were
admitted and treated. This small number represented only a very small
per cent of the total cases admitted, the great majority coming from the Italian
forces at the front and elsewhere. This was the only base hospital on duty
with the Italian forces and was in active operation from September 29, 1918,
to March 31, 1919.
On March 31, Base Hospital No. 102 ceased to function and proceeded
to Genoa for embarkation to the United States and sailed from that port
April 7, 1919, on the Duca D'Ahruzzi. Upon arrival in the United States,
April 23, 1919, the organization was sent to Camp Shelby, Miss., where it
was demobilized shortly afterwards.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Edgar E. Hume, M. C, July 6, 1918, to February 21, 1919.
Lieut. Col. Joseph A. Danna, February 22, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Joseph A. Danna, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. William L. Dunn, M. C.
BASE HOSPITAL NO. 103 "
Base Hospital No. 103 was organized in May, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. On August 21
the command was transferred to Fort Sheridan, 111., where it arrived August
22, and completed its training. It entrained October 15 for Camp Upton,
N. y.; arrived October 17; remained until October 25; embarked from New
York on the Lemathan October 25; sailed October 27. The Leviathan &mxed
in Liverpool November 3; from there the unit proceeded by rail to Winchester;
arrived at Winchester November 4; remained in the rest camp until the
following day; proceeded by rail to Southampton; crossed the English Chan-
nel the same night and landed at Le Havre, France, November 6; entrained
the following day for its final destmation, the hospital center at Clermont-
" The statements of fact appearing herein are based on the "History, Base Hospital No. 10.3, A. E. F.," by Capt.
Henry E. Melany, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. G. 0., Washington, D. C.—Ed.
HOSPITAJ.S
721
Ferrand, Department Piiy de Dome, in base section No. 2; arrived Novem-
ber 9. Base Hospital No. 103 was the fourth hospital unit to arrive at that
station and became a part of the hospital center. The unit was assigned a
convent school and French artillery barracks, with a total bed capacity" of
2,600. Shortly after the arrival of the organization the hospitalization proj-
ect at Clermont-Ferrand was abandoned and the unit, without having func-
tioned as a hospital, was ordered to Dijon for duty.
Base Hospital No. 103 left its station on January 1, 1919, and arrived at
Dijon, Department Cote d' Or, in the advance section, January 2. At Dijon
the organization relieved Base Hospital No. 17, and transfer of patients and
e(|uipment was completed on January 9. The hospital contained 1,139 pa-
P"ii;, 144.— Main building, Base llospital No. 103, Di.ioii.
tients when taken over; and as Base Hospital No. 103 was short of personnel
some of the members of Base Hospital No. 17 remained on duty with the new
command.
On February 5 four cases of smallpox broke out in the command and the
entire hospital was placed in quarantine. During this time no patients were
being evacuated, and at the end of the quarantine, February 20, the hospital
contained 1,786 patients, the largest number ever treated at one time. Dur-
ing its period of activity the hospital cared for 7,563 surgical and medical
cases, with 306 operations.
Base Hospital No. 103 ceased to function June 12, 1919; the personnel
sailed from Brest July 1, 1919, on the Great Northern; arrived at New York
July 6, 1919, and were demobilized at Camp Funston, Kans., July 15, 1919.
722
ADMINISTRATION, AMERICAN EXPEDITIOXARV FORCES
PERSONNEL
COMMANDING OFFICER
Maj. John N. Teeter, M. C, August 23, 1918, to October 24, 1918.
Lieut. Col. John C. Morfit, M. C, October 25, 1918, to January 20, 1919.
Lieut. Col. H. H. Van Kirk, M. C, January 21, 1919, to July 15, 1919.
CHIEF OF SURGICAL SERVICE
Capt. John R. Vaughan, M. C.
CHIEF OF MEDICAL SERVICE
Maj. John N. Teeter, M. C.
BASE HOSPITAL NO. 104 "
Base Hospital No. 104 was organized July 12, 1918, at Camp Greenleaf,
Ga., from officers and enUsted men of the Army at large. On August 12
the unit was transferred to Camp Dodge, Iowa, for training.
On October 31 the command entrained for Camp Upton, Long Island,
N. Y., where it arrived November 2. It remained, completing overseas equip-
ment, until November 10; embarked on the Mauretania; sailed the same day
for Europe; arrived at Liverpool, England, November 17; proceeded by rail
to the rest camp at Winchester; remained until November 19; proceeded to
Southampton; crossed the English Channel November 20; landed at Le Havre,
France, November 21; entrained the same day for its final destination, the
hospital center at Beau Desert, Department Gironde, base section No. 2,
where it arrived November 24.
Base Hospital No. 104 was the fourth hospital unit to arrive at Beau Des-
ert, where it functioned as a part of the hospital center. The unit was assigned
for temporary duty with Base Hospital No. 22, until December 18, when it
took charge of a section of type A wooden barracks, and began to function
as a hospital. The normal capacity was 1,000 beds, with emergency expan-
sion to 1,660. During its period of activity, December 18, 1918, to May 31,
1919, the unit cared for 7,127 surgical and medical cases.
Base Hospital No. 104 operated as a receiving hospital for the center,
the class of patients handled being noncontagious and nonvenereal, the majority
being convalescents. Practically all officer patients admitted to the center
were handled through this hospital.
Base Hospital No. 104 ceased to function May 31, 1919, and the personnel
sailed for the LTnited States from Bordeaux June 10 on the lowan; arrived
in New York June 22; were demobilized at Camp Dix, N. J., on June 25,
1919.
• The statements of fact appearing herein are based on the "History, Base Hospital No. 104, A. E. F.," by Lieut.
Col. James S. Hammers, M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
723
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Charles A. E. Codman, M. C, August 23, 1918, to November
2, 1918.
Lieut. Col. James S. Hammers, M. C, November 3, 1918, to May 31, 1919.
Capt. eJohn A. Green, M. C, June 1, 1919, to June 25, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Frank R. Sheppard, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Charles A. E. Codman, M. C.
Capt. John A. Green, M. C.
BASE HOSPITAL NO. 105 ^
Base Hospital No. 105 was organized July 22, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. On August 29 the
unit was transferred to Fort Benjamin Harrison, Ind., where it arrived August
31, and completed its training and equipment. The command left Fort
Benjamin Harrison, October 23, en route to Camp Merritt, N. J., and arrived
two days later. On October 27 it proceeded to Hoboken, N. J., where it was
split up and placed on board four ships for transportation to Europe. All
four groups left New York Harbor at the same time, October 28.
The convoy reached Brest, France, November 9; the unit was reassembled
and sent to the rest camp at Pontanezen Barracks, where it remained until
November 12, w^hcn it was transferred to the Hospital Center, Kerhuon, in
base section No. 5. There the unit took charge of a section of type A barracks
of 1,240-bed capacity, and began to function as an annex to Base Hospital
No. 65. The nature of the work at this hospital was that of an embarkation
hospital.
On February 6, 1919, the unit was skeletonized, the personnel being trans-
ferred to various organizations for duty. The skeletonized unit, consisting
of 1 officer and 5 enlisted men, sailed from Brest for New York, March 16,
1919, on the Felix Taussig; arrived in the United States April 1, 1919, and
was demobilized at Camp Dix, N. J., April 1, 1919.
PERSONNEL
, COMMANDING OFFICER
Col. Edward W. Pinkham, M. C, August 31, 1918, to February 9, 1919.
Fu-st Lieut. Vernard R. Hodges, M. C, February 10, 1919, to April 1, 1919.
"The statements of fact appearing herein are based on the "History, Base Hospital No. 105, A. E. F.," by Lieut.
Col. Edward W. Pinkham, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C. — Ed.
724
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CHIEF OF SURGICAL SERVICE
Lieut. Col. Harry M. Lee, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Charles W. Knapp, M. C.
BASE HOSPITAL NO. 106 -
Base Hospital No. 106 was organized in August, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. The command
was transferred, on August 31, to Camp Jackson, S. C, where it was attached
to the camp base hospital for temporary duty. On October 15, the organi-
FiG. 145. — Main kitchen, ]iaso Hospital No. lU»i, Beau Desert hospital center
zation left Camp Jackson, S. C, for Camp Merritt, N. J., where it arrived
October 17, and remained there for 10 days, completing its overseas equip-
ment. On October 25, the unit embarked on the Leviathan at Hoboken,
N. J.; sailed for Europe October 27; arrived at Liverpool, England, November
3; proceeded by rail to Southampton by way of Winchester; crossed the
English Channel to Le Havre, France; arrived November 6.
From Le Havre the unit proceeded by rail to its final station, the hospital
center at Beau Desert, Department Gironde, in base section No. 2; arrived
November 10. Base Hospital No. 106 was the third hospital unit to arrive
at that station, where it functioned as a part of the hospital center. It was
assigned to a section of type A wooden barracks which were about 90 per cent
complete, and had a capacity of 1,000 beds.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 106, A. E. F.," by Lieut.
Col. Louis I. Mason, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division. S. G. O., Washington, D. C. — Ed.
HOSPITALS
725
This hospital was designated as a receiving hospital for all venereal,
contagious, and infectious diseases, tuberculosis and surgical chest cases
for the entire center. The first patients were admitted December 4, 1918;
during its period of activity, the organization cared for 4,297 medical and
surgical cases; of these 735 were venereal and 865 were tuberculous patients.
Base Hospital No. 106 ceased to function May 31, 1919, and its personnel
returned to the United States on the lowan; sailed from Bordeaux June 10,
1919; arrived in New York June 22, 1919, and were demobilized at Camp
Dix, N. J., July 12, 1919,.
Fig. 146. — Interior, detachment mess, Base Hospital No. 106
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Louis L Mason, M. C, September 17, 1918, to July 12, 1919.
CHIEF OF SURGICAL SERVICE
Maj. George W. Newell, M. C.
Maj. Walter A. Kennedy, M. C.
Capt. Daniel W. Prentiss, M. C.
Maj. Ralph Balch, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Robert B. Scales, M. C.
726
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 107 "
Base Hospital No. 107 was organized in July, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. On August 27, the
command was transferred to Fort Snelling, Minn., where it received further
training at General Hospital No. 29. On October 25 the unit entrained at
Fort Snelling for Camp Upton, Long Island, N. Y., where it arrived
October 28. Two days later the unit proceeded to Hoboken, N. J.; embarked
on the Great Northern; sailed the following day, October 31, for Europe; arrived
at Brest, France, November 9; disembarked on the .following day; remained
at the Pontanezen rest camp until November 14; proceeded by rail to its final
destination, the hospital center at Mars-sur-Alliers, Department Nievre, in
the intermediate section.
Base Hospital No. 107 arrived at Mars November 17, and was the seventh
hospital unit to reach that station, where it immediately began to function
as a part of the hospital center. On November 18 the unit took over a section
of type A barracks that had been operated as an annex to Base Hospital Xo.
35, and contained 1,139 patients. The normal bed capacity of the hospital
was 1,170. During its activity, November 18, 1918, to April 20, 1919, it cared
for 1,267 surgical and 1,722 medical cases; the majority of whom were con-
valescent. This unit never had any Army nurses regularly assigned to it;
but whenever needed, casual nurses were sent there for temporary duty.
Base Hospital No. 107 ceased to function April 20, 1919; the personnel
sailed for New York from St. Nazaire June 23, 1919, on the Arizonan; arrived
in the United States July 6, and were demobilized at Camp Pike, Ark., July 15,
1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. J. M. W. Scott, M. C, August 24, 1918, to November 21, 1918.
Maj. Scurry L. Terrell, M. C, November 22, 1918, to December 4, 1918.
Lieut. Col. J. M. W. Scott, M. C, December 5, 1918, to March 1, 1919.
Maj. N. M. Jones, M. C, March 2, 1919, to May 7, 1919.
Capt. Llewelyn R. Johnson, M. C, May 8, 1919, to July 15, 1919.
CHIEF OF SURGICAL SERVICE
Maj. N. M. Jones, M. C.
Capt. Foster K. Collms, M. C.
CHIEF OF MEDICAL SERVICE
Capt. H. Caro, M. C.
Capt. J. F. Lynn, M. C.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 107, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. Q.—Ed.
HOSPITALS
727
BASE HOSPITAL NO. 108 ^
Base Hospital No. 108 was organized August 15, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. On September 12
the command was transferred to Fort Snelling, Minn., where it was attached
to General Hospital No. 29, for further instruction. The unit remained at
Fort Snelling until October 25; entrained for Camp Upton, Long Island, N. Y.;
arrived October 28; completed overseas eciuipment; October 30 proceeded to
Hoboken, N. J.; embarked on the George Washington; sailed the following day,
October 31, for Europe.
The unit arrived at Brest, France, November 9; disembarked and marched
to Pontanezen Barracks; encamped and remained until November 17; pro-
ceeded by rail to its permanent station, the hospital center at Mesves, Depart-
ment of Nievre, in the intermediate section. Base Hospital No. 108 arrived
at Mesves November 20 and began to function as a part of the hospital center.
It occupied a section of type A barracks, the construction of which was very
much incomplete when taken over. The first patients were received on Novem-
ber 29, 500 being admitted on that date, largely convalescent surgical and
medical cases. The normal bed capacity of the hospital was 1,000; during
its period of active service, November 29, 1918, to May 16, 1919, 1,290 surgical
and 920 medical cases were admitted.
Base Hospital No. 108 ceased to function May 16, 1919, and its personnel
sailed from St. Nazaire for New York June 23, 1919, on the Arizonan; arrived
in the United States July 6, and were demobilized at Camp Dodge, Iowa,
July 10, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Albert Vander Veer, M. C, September 14, 1918, to November 21,1918.
Maj. Charles T. Sturgeon, M. C, November 22, 1918, to November 25,
1918.
Col. E. H. Bruns, M. C, November 26, 1918, to December 20, 1918.
Lieut. Col. William A. Jolley, M. C, December 21, 1918, to July 10, 1919.
I CHIEF OF SURGICAL SERVICE
Maj. Charles T. Sturgeon, M. C.
Maj. Harold A. Fiske, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Joseph H. Saunders, M. C.
Maj. Albert Vander Veer, M. C.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 108, A. E. F.," by the
commanding ofTicer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C. — Ed.
728
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 109"
Base Hospital No. 109 was organized August 24, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. The command was
transferred on September 15, 1918, to Fort Benjamin Harrison, Ind., where it
received further training. On October 18, the organization left for Camp Mer-
ritt, N. J.; arrived October 20; remained for five days, completing its overseas
equipment; embarked, October 25, an the Cretic; left New York, October 26,
for Europe; arrived at Liverpool, England, November 8; entrained the follow-
ing day for Southampton; arrived November 9; crossed the English Channel
on the night of November 10; landed at Le Havre, France, November 11.
From Le Havre, the unit proceeded to its final station, the hospital center at
Vichy, Department Alliers, intermediate section; arrived November 24, 1918.
On December 3, 1918, Base Hospital No. 109 took over four hotels, with
470 patients, from other hospitals in the center, and later, it was assigned
additional buildings, so that before it ceased to function it operated in 22
separate buildings. During its period of active service, December 3, 1918, to
March 12, 1919, the hospital cared for 4,700 surgical and medical cases.
The unit ceased to function as a hospital on March 12, 1919, and left
Vichy, April 7, en route to Brest, where it arrived, April 10. On April 25, the
organization embarked on the Cap Finistere, sailing the same day for Hoboken,
N. J., arriving there May 5, 1919, and was demobilized at Camp Dodge, Iowa,
Mav 16, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Francis Vinsonhaler, M. C, September 15, 1918, to May 16,
1919.
CHIEF OF SURGICAL SERVICE
Maj. Prince E. Saw^w, M. C.
CHIEF OF MEDICAL SERVICE
Capt. William E. Howell, M. C.
BASE HOSPITAL NO. 110 *
Base Hospital No. 110 was organized in August, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. On September 11,
1918, the command was transferred to Camp Sevier, S. C, for further training.
On November 1, 1918, the organization entrained for Camp Upton, Long Island,
N. y., arrived November 3; remained, completing its overseas equipment, until
November 10; embarked on the Empress of Asia, and two days later, November
12, sailed for Europe; arrived at Brest, France, November 22, 1918; encamped at
Pontanezen Barracks, and remained there until December 2; proceeded to its
final station, the hospital center at Mars-sur-Alliers, Department of Nievre, in
the intermediate section; arrived December 4.
° The statements of fact appearing herein are based on the "History, Base Hospital No. 109, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, d'. C.—Ei.
'The statements of fact appearing herein are based on the "History, Base Hospital No. 110, A. E. F.," by Capt.
Isaac Reitzfeld, M. C, whUe on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
729
Base Hospital No. 110 was the eighth hospital unit to reach Mars, where
it functioned as a part of the hospital center. The unit took over a section of
type A wooden barracks and began to receive patients two days after its arrival.
This hospital received both medical and surgical cases, but in January, 1919,
it was designated as a special hospital for neuropsychiatric cases. The normal
capacity of the hospital was 1,000 beds; during its service as a hospital, De-
cember 6, 1918, to May 10, 1919, it cared for 2,885 patients, including several
hundred neuropsychiatric cases.
Base Hospital No. 110 ceased to function May 10, 1919, and its personnel
returned to the United States; sailed from St. Nazaire June 23, 1919, on the
Arizonan; arrived in the United States July 6, and was demobilized at Camp
Dix, N. J., July 10, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. WiUiam C. Le Compts, M. C, August 23, 1918, to April 30, 1919.
Lieut. Col. Thew Wright, M. C, May 1, 1919, to July 10, 1919.
Lieut. Col. Thew Wright was chief of both the surgical and medical services.
BASE HOSPITAL NO. Ill
Base Hospital No. Ill was organized August 10, 1918, at Camp Greenleaf,
(la., from officers and enlisted men of the Army at large; the enlisted person-
nel were composed of drafted men from Oklahoma, Mississippi, and New York.
The unit remained in training at Camp Greenleaf until September 10, 1918,
when it was transferred to Camp Beauregard, La., where training was con-
tinued until October 29, 1918. The unit proceeded to Camp Upton, Long
Island, N. Y.; arrived November 2, 1918; embarked November 10, 1918, on
the Empress of Asia, left New York, November 12; arrived at Brest, France,
November 22, 1918; proceeded to the rest camp at Pontanezen Barracks;
remained there until November 25; entrained for its permanent station, the
hospital center at Beau Desert, Department Gironde, base section No. 2.
Upon arrival at Beau Desert, the organization took over a type A 1,000-
l)ed hospital and began to receive patients on December 8, 1918. On May 1,
1919, Evacuation Hospital No. 20 was relieved from duty at Beau Desert,
and Base Hospital No. Ill took over its plant and equipment and functioned
as an evacuation hospital for all cases en route to the United States. The
medical service, in addition to its other duties, held daily sick call for 1,300
prisoners of war and three escort companies, stationed at Beau Desert. In
addition to the patients handled while functioning as an evacuation hospital,
the organization cared for approximately 7,000 surgical and medical cases.
Base Hospital No. Ill ceased operating on May 31, 1919, and the per-
sonnel returned to the United States; sailed from Bordeaux June 10, 1919,
on the lowan; arrived at Philadelphia, June 22, 1919; proceeded by rail to
Camp Dix, N. J., where they were demobilized shortly afterward.
' The statements of fact appearing herein are based on the "History, Base Hospital No. Ill, A. E. F.," by Lieut.
Col. James B. Woodman, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Ilistorieal Division, S. O. O., Washington, D. C.—Ed.
730
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL
COMMANDING OFFICER
Maj. George F. Glass, M. C, September 12, 1918, to September 'M), 1919.
Lieut. Col. James B. Woodman, M. C, October 1, 1918, to demobilization.
CHIEF OF SURGICAL SERVICE
Capt. B. A. Bopp, M. C.
CHIEF OF MEDICAL SERVICE
Maj. George F. Glass, M. C.
BASE HOSPITAL NO. 112
Base Hospital No. 112 was organized in August, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. The command was
transferred on September 14 to Camp Sherman, Ohio,- for further training.
During the epidemic of influenza in October, 1918, the unit was assigned to
the Camp Sherman base hospital for temporary duty. On October 28, the
organization entrained for Camp Upton, N. Y.; arrived October 30; embarked
on the Empress of Russia, November 10; left November 12, for Brest, France;
arrived November 22, 1918. Upon arrival the unit was assigned to the Ker-
huon hospital center for duty, but later the order was revoked and the unit
placed under the camp surgeon, Camp Pontanezen, who assigned the officers
and men to the various organizations of that camp for duty. A majority of
the personnel was assigned to Camp Hospital No. 33 and the quarantine camp;
others to the delousing plant, transport service and venereal camp. The
organization never functioned as a hospital.
On February 7, 1919, Base Hospital No. 112 was ordered skeletonized to
1 officer and 5 enlisted men. The remainder of the unit continued their duties
under the direction of the camp surgeon, Pontanezen Barracks. The skele-
tonized hospital sailed from Brest on the Ulua on March 23, 1919; arrived
in the United States April 2, 1919, and was demobilized at Camp Dix, N. J.,
April 31, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Lewis H. McKinnie, M. C, September 30, 1918, to January 29, 1919.
Maj. Robert S. McCaughey, M. C, January 30, 1919, to February 7, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Lewis H. McKinnie, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Robert S. McCaughey, M. C.
^ The statements of fact appearing herein are based on the "History, Base Hospital No. 112, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
731
BASE HOSPITAL NO. 113 '
Base Hospital No. 113 was organized in August, 1918, at Camp Greenleaf,
Ga., from officers and enlisted men of the Army at large. On August 20, the
command was transferred to Camp Sherman, Ohio, for training at the camp base
hospital. On November 1, the organization entrained for Camp Upton, N. Y.,
where it completed its overseas equipment, and sailed for Europe, November
12 on the Empress of Russia. It had arrived at Brest, France, November
22; proceeded to Savenay, Department Loire Inferieure, base section No. 1;
arrived November 25.
This organization was the fifth hospital unit to arrive at Savenay, where it
immediately began to function as a part of the hospital center. It was assigned
to a type A, 1,000-bed hospital, which already had been in operation under Base
Hospital No. 69. The hospital plant was in various stages of construction, but
was completed shortly after its occupancy by Base Hospital No. 113.
The professional activities of the unit began with its arrival, November 25,
but the records of the unit continued to be operated by Base Hospital No. 69
until December 19, when all were taken up by Base Hospital No. 113. At
Savenay, the unit performed the usual functions of a base hospital, and up to
March 31, 1919, admitted 6,338 medical and surgical cases. This unit was
designated as a hospital from which all disabled nurses were to be evacuated to
the United States.
Base Hospital No. 113 ceased to function as a hospital on June 30, 1919.
The personnel returned on the Santa Teresa; sailed from St. Nazaire on July 15,
1919; arrived in New York, July 27, 1919, and were demobilized at Camp Dix,
N. J., August 1, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Edwin C. Henry, M. C, August 20, 1918, to January 26, 1919.
Maj. G. Milton Linthicum, M. C, January 27, 1919, to August 1, 1919.
CHIEF OF SURGICAL SERVICE
Maj. G. Milton Linthicum, M. C.
Maj. Charles L. Patton, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Edward T. Gallagher, M. C.
BASE HOSPITAL NO. 114^
Base Hospital No. 114 was organized Alarch 8, 1918, at Camp Crane, Pa.,
from officers and enlisted men of the Army at large, and was given intensive
training at Camp Crane. On June 5, the unit proceeded by rail to Hoboken,
N. J.; embarked the same day on the Manchuria; sailed for France June 7;
• The statements of fact appearing herein are based on the "History, Base Hospital No. 113, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
I The statements of fact appearing herein are based on the "History, Base Hospital No. 114, A. E. F.," by Lieut.
Col. J. A. Talbott, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. Q. O., Washington, D. C.—Ed.
732
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
disembarked at St. Nazaire, France, June 19; remained in the rest camp there
until June 21; entrained for Beau Desert, Department Gironde, base section
No. 2; arrived, June 22, 1918.
Base Hospital No. 114 was the second hospital unit to arrive at Beau Desert,
where it functioned as part of the hospital center. The organization occupied
a type A, 1,000-bed unit, with an emergencey expansion of 500 beds; later it
expanded into two additional 1,500-bed units, and on November 7, 1918, the
total bed capacity was 5,400. On the same date the number of patients in
hospital was 4,596, the majority of whom required dressing and constant
attention. They were cared for by a personnel consisting of 18 offieers, 202
enlisted men, and 67 nurses. This state of affairs existed until the latter part of
November, 1918, when another hospital unit reported in the center and took over
one of the units operated by Base Hospital No. 114.
After the signing of the armistice, the hospital functioned as an evacuation
hospital for orthopedic cases, and continued as such until February, 1919, when
it was changed to a receiving hospital. The largest number of patients admitted
was in October, 1918, when 5,130 were received. During its period of activity,
the organization cared for more than 17,000 medical and surgical cases.
Base Hospital No. 114 ceased to function as a hospital April 16, 1919, and
the personnel sailed from Bordeaux for New York, May 12, 1919, on thePanaman;
arrived in the United States on May 23, and were demobilized at Camp Meade,
Md., Mav 30, 1919.
PERSONNEL
COMMANDING OFFICER
Col. Harold W. Jones, M. C, March 13, 1918, to July 5, 1918.
Lieut. Col. George A. Craigin, M. C, July 6, 1918, to August 16, 1918.
Lieut. Col. J. A. Talbott, M. C, August 17, 1918, to May 30, 1919.
CHIEF OF SURGICAL SERVICE
Capt. Bert G. Cholett, M. C.
Capt. Robert D. Schreck, M. C.
Maj. Wallace Cole, M. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. George A. Craigin, M. C.
BASE HOSPITAL NO. 115 "
Base Hospital No. 115 was organized in June, 1918, at Camp May, N. J.,
from officers and enhsted men of the Army at large. When organized, this
hospital was designated as a special head hospital, and its staff and equipment
were selected with that point in view. The mobiUzation of the unit was com-
pleted during July, 1918, at the General Hospital No. 11, at Camp May, N. J.
On August 5 the command proceeded to Camp Upton, Long Island, N. Y.;
completed its overseas equipment; embarked August 15 on the Missenahie;
left New York Harbor August 15; arrived at Liverpool, England, August 28;
» The statements of fact appearing herein are based on the "History. Base Hospital No 115 A E F "bv the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D c'-Ed.
HOSPITALS
733
entrained the same day for Brookwood, England; arrived the follo^dng day
remained encamped for four days; proceeded by rail to Southampton on
September 1 ; crossed the English Channel the same night; landed at Cherbourg,
France, September 2. On the following morning the organization left Cher-
l)ourg for Vichy, Department of Allier, intermediate section, and arrived on
September 6. This was the third hospital unit to reach Vichy, where it func-
tioned as a part of the hospital center. It was assigned to the Hotel Ruhl, a
hirge concrete building nine stories high, with a capacity of 1,657 beds. This
building had been operated by Base Hospital No. 1, and when taken over, on
September 11, contained 822 patients. Later the capacity of the hospital was
increased to 2,963 beds.
This hospital did not function as a special head hospital for which it was
intended but received a large majority of the head cases coming to the center.
During its period of activity, September 11, 1918, to February 12, 1919, 6,962
medical and surgical cases were admitted. The largest number of patients in
hospital at one time was 2,778, on November 17, 1918; the greatest number
of officer patients at one time was 240.
Base Hospital No. 115 ceased to function February 12, 1919, and sailed
from St. Nazaire on the Mercury April 19, 1919; arrived at New York April
30; and the entire organization was demobilized at Camp Dix, N. J., by Alay 10
1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Edward C. EUett, M. C, June 28, 1918, to May 10, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Norval H. Pierce, \l. C.
CHIEF OF MEDICAL SERVICE
Lieut. Col. Daniel J. McCarthy, M. C.
Maj. Henry B. Doust, M. C.
BASE HOSPITAL NO. 116''
Base Hospital No. 116 was organized. December 20, 1917, at the Seventy-
Hrst Regiment Armory, New York City, from officers and enlisted men of the
Army at large. The unit was under training at the armory until March 25,
1918, when it sailed from New York on the Mauretania; arrived at Liverpool,
England, April 3; immediately proceeded by rail to Southampton; crossed the
English Channel on the night of April 5; landed at Le Havre, Fr ance, April 6 ;
entrained at Le Havre April 7 for Bazoilles-sur-Meuse, Department Vosges,
in the advance section; arrived April 9. It was the thii'd hospital unit to
an-ive at Bazoilles, where it functioned as an independent hospital until July 1 ;
alter July 1, 1918, it formed a part of the hospital center. It was assigned to
a set of type A barracks, which were only partially complete, and had a crisis
expansion in marquee tents, making a total capacity of 2,000 beds.
''The statements of fact appearing herein are based on the "History, Base Hospital No. 116, A. E. F.," by the com-
manding oflicer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.~Ed.
734
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The first patient was received June 2, 1918; during its period of active
service the hospital cared for 5,837 medical and 6,603 surgical cases, with 1,259
operations. This hospital was designated as a special hospital for ear, nose,
and throat and fracture cases in the hospital center. On July 20, 1918, Base
Hospital No. 116 began to operate a neuropsychiatric department. This
department functioned in a plant consisting of six wooden barracks, operated
its own mess, and had its own specially trained personnel. During its service
with Base Hospital No. 116 it admitted 1,048 cases, the majority of which
were evacuated to the United States through Base Hospital No. 8 at Savenay.
On January 29, 1919, Base Hospital No. 116 ceased operating and turned
over its patients and plant to Base Hospital No. 79. The personnel left the
Bazoilles hospital center on March 19, 1919, and sailed from St. Nazaire March
28, 1919, on the Turrialha; arrived at Hoboken, N. J., April 13, 1919, and were
demobilized shortly afterward.
PERSONNEL
COMMANDING OFFICER
Col. John W. Hanner, M. C, December 19, 1917, to June 27, 1918.
Lieut. Col. John B. Walker, M. C, June 28, 1918, to January 16, 1919.
Lieut. Col. Michael J. Thornton, M. C, January 17, 1919, to February
20, 1919.
Maj. Carlton W. Russell, M. C, February 21, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Lieut. Col. John B. Walker, M. C.
Maj. Torr W. Harmer, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Theodore J. Abbott, M. C.
Capt. Frederic A. Ailing, M. C.
BASE HOSPITAL NO. 117 '
Base Hospital No. 117 was organized in March, 1918, at Camp Crane,
Pa., from officers and enlisted men of the Army at large. This unit was intended
to serve as a neuropsychiatric hospital and was composed of officers, enlisted
men, and nurses who had had previous experience with mental and nervous
diseases. The unit was trained at Camp Crane until May 17, 1918, when it
proceeded by rail to the port of embarkation; arrived at Hoboken, N. J.,
on the following day; embarked on the Saxon and left port May 19, 1918,
for Liverpool, England; arrived May 31; entrained the same day for the rest
camp at Romsey, England; arrived June 1 and remained until June 7; marched
to Southampton; crossed the English Channel the same night; landed in Le
Havre, France, June 8. On June 9, the command left Le Havre for Savenay,
Department Loire Inferieure; arrived June 11; proceeded to its permanent
station at La Fauche, Department of Haute Marne, advance section, June 15;
arrived, June 16.
• The statements of fact appearing herein are based on the " History, Base Hospital No. 117, A. E. F.," by the
commanding oiBcer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
735
At La Fauche the hospital occupied 22 100-foot barracks, with a total
bed capacity of 350. This plant was being operated by a detachment of 4
officers and 10 enlisted men who were amalgamated with the personnel of
Base Hospital No. 117. Later, the capacity of the hospital was increased by
the erection of additional barracks, so that at the conclusion of the war, the
hospital had a capacity of 1,000 beds. It also had a convalescent camp, located
about half a mile from the hospital, consisting of four buildings, three of which
were used as dormitories and one as a mess hall and kitchen. A small and very
attractive farm was leased for the accommodation of sick officers.
Base Hospital No. 117 was not a part of any hospital center; it functioned
independently and admitted neuropsychiatric cases only. Dm-ing its exist-
ence, 3,268 patients were admitted; of these 295 were nonpsychoneurotic
cases, having been received through error; of the remaining number, about
91 per cent were returned to duty (classes A, B, and C).
Base Hospital No. 117 ceased to function January 12, 1919; its per-
sonnel were reassigned to various hospitals for duty and the hospital plant
at La Fauche was abandoned, January 31, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Clarence R. Bell, M. C, March 4, 1918, to September 4, 1918.
Lieut. Col. Frederick W. Parson, M. C, September 5, 1918, to January 26,
1919.
Maj. Walter J. Otis, M. C, January 27, 1919, to January 31, 1919.
CHIEF OF SERVICE
Maj. Sidney I. Schwab, M. C.
Capt. Douglas A. Thom, M. C.
BASE HOSPITAL NO. 118 '
Base Hospital No. 118 was organized in September, 1918, at Camp
Zachary Taylor, Ky., from officers and enlisted men of the Army at large.
The unit was in training at Camp Taylor until November 3, when it entrained
for Camp Mills, Long Island, N. Y.; sailed from New York November 13, 1918,
on the Cedric for Liverpool, England; arrived November 24. On November
30, 1918, the organization arrived at Savenay, Department Loire Inferieure,
base section No. 1, France. It was the seventh hospital unit to arrive at
Savenay, where it functioned as part of the hospital center.
The personnel of this hospital assisted other units in the center from the
date of arrival until January 21, 1919, when it was reassembled and began
to function as a hospital for contagious diseases. It took over the buildings
formerly occupied by Base Hospital No. 214, consisting of 11 frame and 4
cement buildings and 6 large tents. On January 27, it assumed charge of the
tuberculosis camp, formerly operated by Base Hospital No. 8. This camp
1 The statements of fact appearing herein are based on the "History, Base Hospital No. 118, A. E. F.," by the
commanding ofricer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
13901—27 47
736
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
consisted of 13 hollow- tile buildings. The distance between these two hos-
pitals was about 1 km., which necessitated the operation of separate messes
and receiving wards.
During its active service the contagious disease section admitted 1,111,
and the tuberculosis section 1,940 patients.
Base Hospital No. 118 ceased to function June 23, 1919, and the personnel
returned to the United States; sailed from St. Nazaire, July 6, 1919, on the
Matsonia; arrived in the United States, July 16, and were demobilized at
Camp Zachary Taylor, Ky., shortly afterward.
PERSONNEL
COMMANDING OFFICER
Capt. Thomas R. Payne, M. C, September 13, 1918, to March 23, 1919.
Lieut. Col. Thomas W. Burnett, M. C, March 24, 1919, to demobilization.
CHIEF OF SURGICAL SERVICE
Capt. WiUiam H. Carter, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Erie O. Daniels, M. C.
BASE HOSPITAL NO. 119*
Base Hospital No. 119 was organized in September, 1918, at Camp Zachary
Taylor, Ky., from officers and enlisted men of the Army at large. The unit was
attached to the base hospital of that camp for instructions and temporary duty.
The organization left Camp Taylor October 26, for Camp Upton, N. Y. ; arrived
October 28; remained until October 30; proceeded to Hoboken, N. J. ; embarked
the same day on the Great Northern; sailed October 31 for Europe; arrived at
Brest, France, November 9; marched to the rest camp at Pontanezen Barracks;
remained until November 13; entrained at Brest for its permanent station at
Savenay, Department Loire Inferieure, base section No. 1; arrived, November
14. This was the fourth hospital unit to arrive at that station, where it func-
tioned as a part of the hospital center. The organization was assigned to unit
No. 5, a type A, 1,000-bed hospital, already in operation as an auxiliary to Base
Hospital No. 8.
For a short period the administration continued to be under Base Hospital
No. 8, but professional duties were at once taken over by the personnel of Base
Hospital No. 119, and in December, 1918, it also took over the records and
administration.
Since its facilities were not such as would permit giving proper care to
patients critically ill, this hospital functioned chiefly as a receiving and evacu-
ating hospital for patients sufficiently convalescent to be classed as walking
cases.
During its active service as a hospital it cared for 10,467 medical and sur-
gical cases.
* The statements of fact appearing herein are based on the "History, Base Hosoital No. 119, A. E. F.," by Lieut.
Col. Leeson O. Tarieton, M C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
737
Base Hospital No. 119 ceased to function June 22, 1919; its personnel
sailed from St. Nazaire on the Matsonia July 6, 1919; arrived in the United
States July 16, and were demobilized at Camp Zachary Taylor, Ky., on July
21, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. WilHam M. Chowning, M. C, September 1, 1918, to December 6,
1918.
Lieut. Col. Leeson O. Tarleton, M. C, December 7, 1918, to July 21, 1919.
CHIEF OF SURGICAL SERVICE
Capt. Francis M. Gorman, M. C.
Maj. William S. Titus, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Charles McC. Iseman, M. C.
Capt. Richard I. Dorge, M. C.
BASE HOSPITAL NO. 120 '
Base Hospital No. 120 was organized at Camp Greenleaf, Ga., on August
28, 1918, from officers and enlisted men of the /Vrmy at large. On September
10, 1918, the unit received orders to proceed to Camp Beauregard, La., and
arrived at that station on September 12, 1918. On November 1, 1918, the
unit left Camp Beauregard for Camp Upton, N. Y.; arrived November 5, 1918;
remained until November 10; embarked on the Empress of Russia; sailed for
Brest, France, November 12; arrived November 22; remained at the rest camp
Pontanezen Barracks until December 10, 1918; proceeded to hospital center,
Kerhuon, where it functioned under Base Hospital No. 65 until January 10,
1919.
On January 10, 1919, orders were received transferring the unit to Tours,
at which station it arrived on January 15, 1919, and relieved Base Hospital No.
7, that organization being scheduled for return to the United States.
Base Hospital No. 120 continued to function at the hospital center, Joue-
les-Tours, until June 10, 1919, when it ceased operating. On June 28, it sailed
from St. Nazaire on the Marica; arrived in the United States on July 9, 1919.
The unit remained at Camp Merritt, N. J., until July 13, 1919, on which date
it was transferred to Camp Dodge, Iowa, where it was demobilized July 16,
1919.
PERSONNEL
COMMANDING OFFICERS
Maj. William J. McManus, M. C, August 28, 1918, to February 12, 1919.
Col. Edward W. Pinkham, M. C, February 13, 1919, to July 16, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Dalbert E. Hoover, M. C.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 120, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C—Ed.
738
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CHIEF OF MEDICAL SERVICE
Lieut. Col. Harry M. Lee, M. C.
Maj. Charles W. Knapp, M. C.
Lieut. Col. Rogers S. Morris, M. C.
BASE HOSPITAL NO. 121 -
Base Hospital No. 121 was organized in August, 1918, at Camp Beaure-
gard, La., from officers and enlisted men of the Armj^ at large. The organi-
zation trained at Camp Beauregard until October 29, when it proceeded by
rail to Camp Upton, N. Y., and arrived November 2, 1918. At Camp Upton,
the unit remained for 10 days, completing its overseas equipment, and on
November 12 it embarked on the Adriatic, leaving the following day, Novem-
ber 13, for Europe. It arrived at Liverpool, England, November 24; imme-
diately proceeded b}'^ rail to Winchester and thence to Southampton; arrived
November 25; crossed the English Channel the same night and landed at Le
Havre, France, November 26. On November 27, the unit entrained for its
permanent station, the hospital center at Beau Desert, Department of Gironde,
base section No. 2, where it arrived November 29. Base Hospital No. 121
was the sixth hospital unit to arrive at the Beau Desert hospital center, where
it took over a type A, 1,000-bed hospital. The hospital did not receive patients
until January 24, 1919, and up to March 31, 1919, a total of 2,629 medical
and surgical cases had been admitted.
Base Hospital No. 121 ceased to function as a hospital June 21, 1919,
and its personnel proceeded on June 24, 1919, to Bordeaux for transportation
to the United States; sailed from Bordeaux June 29, 1919, on the Huron;
arrived in the United States July 11, and were demobilized at Camp Dodge,
Iowa, July 17, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Orville T. Rogers, M. C, August 22, 1918, to December 7, 1918.
Maj. Jule B. Frankenheimer, M. C, December 8, 1918, to February 6,
1919.
Lieut. Col. Otho A. Fiedler, M. C, February 7, 1919, to April 21, 1919.
Lieut. Col. Maj. Charles A. E. Codman, M. C, April 22, 1919, to July 17,
1919.
CHIEF OF SURGICAL SERVICE
Capt. Irwin W. Ditton, M. C.
CHIEF OF MEDICAL SERVICE
Maj. George W. Scupham, M. C.
BASE HOSPITAL NO. 123 "
Base Hospital No. 123 was organized September 5, 1918, at Camp Green-
leaf, Ga., from officers and enlisted men of the Army at large, and was trans-
ferred September 9, 1918, to Camp Greene, N. C. The organization remained
The statements of fact appearing herein are based on the "History, Base Hospital No. 121, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 123, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
739
in training at Camp Greene until October 28, on which date it left for
Camp Mills, N. Y., arriving October 30. At Camp Mills the unit completed
its overseas equipment; sailed from New York on the Adriatic for Europe,
November 13; arrived at Liverpool, England, November 24; immediately
entrained for Southampton; arrived on the following day; crossed the English
Channel the same night; landed at Le Havre, France, November 26. After
three days' rest at the Le Havre rest camp, the command proceeded by rail to
its final destination, Mars-sur-Allier, Department of Nievre, in the interme-
diate section; arrived, December 2. This was the eighth hospital unit to
reach Mars, where it functioned as a part of that hospital center. On Decem-
ber 5, the organization took over a type A, 1,000-bed hospital, which had
been operated as an annex to Base Hospital No. 68, and which contained
about 1,200 patients; these patients consisted mostly of classified (A and B)
casuals from Base Hospital No. 68.
The hospital, taken over from Base Hospital No. 68, was not very well
equipped, and on February 5, 1919, Base Hospital No. 123 took over the patients
and the plant of Evacuation Hospital No. 30, which was a well-appointed
hospital, having a thoroughly equipped operating room and X-ray apparatus.
Base Hospital No. 123 ceased to function April 20, 1919, and its personnel
sailed from St. Nazaire June 23, 1919, on the Arizonan; arrived in the United
States July 6, and were demobilized at Camp Pike, Ark., July 15, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Carlyle E. Sutphen, M. C, September, 1918, to July 15, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Thomas B. Carroll, M. C.
CHIEF OF MEDICAL SERVICE
Maj. August G. Wichman, M. C.
BASE HOSPITAL NO. 131 "
Base Hospital No. 131 was organized July 23, 1918, at Jeiferson Barracks
AIo., from officers and enlisted men of the Army at large. The organiza-
tion trained at that station until September 25, when it entrained for Camp
Upton, N. Y., where it arrived September 28. On account of the influenza
epidemic, the unit was detained at Camp Upton for two weeks; sailed on the
Ortega, October 13; arrived at Liverpool, England, October 24; entrained
immediately for Winchester, England; arrived the following day. On October
26, the command proceeded by rail to Southampton; crossed the English
Channel the same night, landed at Cherbourg, France, October 27; remained
at the Cherbourg rest camp for five days; entrained for its permanent station,
the hospital center at Mars-sur-Allier, Department of Nievre, in the inter-
• The statements offset appearing herein are based on the "History, Base Hospital No. 131, A. E. F.," by Lieut.
Col. H. H. Smith, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Historical
Division, S. O. 0., Washington, D. C. — Ed.
740
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
mediate section, October 31; arrived November 3, 1918. It was the sixth
hospital unit to reach Mars, where it functioned as a part of the hospital
center. It was assigned to a type A, 1,000-bed hospital, and began to receive
patients on November 18.
On January 15, 1919, the unit took over the patients and the plant of
Base Hospital No. 14, of the same center, moving its own patients and offices
to the new location. On January 20, the patients and equipment of Base
Hospital No. 68 were taken over. At this time the hospital contained the
largest number of patients, 1,034. During its period of activity, November 18,
1918, to April 10, 1919, 3,048 surgical and medical cases were admitted.
Base Hospital No. 131 ceased to function as a hospital on April 10, 1919,
and its personnel sailed from Brest for New York, May 23, 1919, on the Fred-
erick; arrived in the United States, June 2, and were demobilized at Camp
Taylor, Ky., shortly afterwards.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Hubert H. Smith, M. C, July 23, 1918, to April 10, 1919.
CHIEF OF SURGICAL SERVICE
Lieut. Col. Daniel F. Jones, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Duncan B. McEachern, M. C.
BASE HOSPITAL NO. 136 "
Base Hospital No. 136 was organized in September, 1918, at Camp
Greenleaf, Ga., from officers and enlisted men of the Army at large. On
September 10, 1918, the unit was transferred to Camp Wheeler, Ga., where it
trained until October 18, when it left for Camp Merritt, N. J., arriving there
October 20. On October 25, it moved to Camp Upton, N. Y.; remained there
until November 15, 1918; sailed on that date from New York on the La France;
arrived at Brest, France, November 22; marched to the rest camp at Ponta-
nezen Barracks; remained for one week and then proceeded by rail to its
final destination, the hospital center at Vannes, Department Morbihan,
base section No. 5; arrived December 1, 1918. It was the second hospital
unit to arrive at that station, where it functioned as a part of a small two-
unit hospital center. At Vannes, the unit was assigned to the Caserne Quartier
Senarmont, formerly occupied by the French Thirty-fifth Field Artillery.
These barracks consisted of three large four-story buildings, kitchens, guard-
house, stables, and several other buildings surrounded bv a wall, forming an
inclosure 760 by 860 feet.
The hospital received its first patients on December 16, 1918; during
its active service it cared for approximately 3,000 surgical and medical cases!
J The statements of fact appearing herein are based on the'' mstory, Base Hospital No. 136 \ E F " bv Lieut
HOSPITALS
741
The bed capacity of the hospital was 2,300; the largest number of patients
in hospital at one time was 1,558, on February 8, 1919; this included patients
in an annex at Carnac.
On January 18, 1919, Base Hospital No. 136 took over patients and the
plant of Base Hospital No. 236, which was located at Carnac, and whose
personnel were amalgamated with Base Hospital No. 136.
Base Hospital No. 136 ceased to function as a hospital on June 9, 1919,
and its personnel sailed from St. Nazaire for New York July 8, 1919, on the
Manchuria; arrived in the United States, July 18, and were demobilized at
Camp Upton, N. Y., July 24, 1919.
PERSONNEL
COMMANDING OFFICER
Capt. Francis L. Quigley, M. C, September 10, 1918, to November 8,
1918.
Lieut. Col. Howard Fox, M. C, November 9, 1918, to July 24, 1919.
CHIEF OF SURGICAL SERVICE
Capt. Francis R. Haussling, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Mark Millikin, M. C.
Capt. Francis L. Quigley, M. C.
BASE HOSPITAL NO. 202 «
Base Hospital No. 202 was organized in France, in June, 1918, from officers
and enlisted men of the American Expeditionary Forces at large. At this time
it was known as Hospital A; later, in July, 1918, it was officially designated as
Base Hospital No. 202. The nucleus of the personnel was taken from replace-
ment unit A, which arrived at Blois, France, June 12, 1918. Base Hospital
No. 202 was situated at Orleans, France, Department Loriet, in the intermediate
section. This hospital operated in an excellent plant, consisting of several
schools and barracks, all of which were well adapted for hospital purposes. All
of the buildings were electrically lighted, some were steam heated; water was
supplied in abundance.
The normal bed capacity on November 11, 1918, was 2,800, with provisions
for expansion to 6,000 beds. During its period of activity, July 17, 1918, to
February 17, 1919, the hospital cared for 3,127 medical cases and 2,717 surgical
cases, with 887 operations. It was our only hospital unit at Orleans and func-
tioned independently.
Base Hospital No. 202 ceased to function on February 17, 1919, when it was
officiall}' closed, all remaining patients having been transferred to other hospitals
on February 16, 1918. On March 16, 1919, the organization proceeded to
Brest; sailed April 7, on the Graf Waldersee; arrived at Hoboken, N. J., April 20,
and was demobilized at Camp Dix, N. J., April 27, 1919.
« The statements of fact appearing herein are based on the " History, Base Hospital No. 202, A. E. F., " by Lieut. Col.
William H. Bishop, M. C, while on duty as a member of the staff of that hospital . The history is on file in the Historical
Division, S. Q. O., Washington, D. C.—Ed.
742
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL
COMMANDING OFFICER
Lieut. Col. William H. Bishop, M. C, June, 1918, to April 27, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Lonnie W. Grove, M. C.
CHIEF OF MEDICAL SERVICE
Mai. J. H. Lawson, M. C.
BASE HOSPITAL NO. 204 ^
Base Hospital No. 204 came into existence September 30, 1918, when the
United States Military Hospital, Hursley Park, near Winchester, England,
which had been operating since April 20, 1918, was designated by the chief
surgeon of the American Expeditionary Forces as Base Hospital No. 204. This
hospital, when it was started on April 20, 1918, by the hospital unit I, consisted
of a group of 8 wards, each capable of accommodating 33 patients. These wards
together with a few smaller outlying isolation wards and other buildings, were
later known as the A group. The main group of wards, roofed and sided with
galvanized iron, were connected with each other and with the administration
building by corridors. Similarly constructed huts provided quarters, mess halls,
and kitchens for the staff and nurses. The total bed capacity was 360; 30 beds
of this number w^ere reserved for British patients.
On September 30, definite plans were adopted for the enlargement of this
institution; existing buildings were to be adapted as wards, kitchens, and per-
sonnel quarters; 16 new wards and nurses' quarters were under construction
when the work was stopped by the signing of the armistice.
The bed capacity of the hospital when completed w^as to be 2,000, with
additional 700 emergency beds. The total number of patients admitted during
the existence of the hospital, April 20, 1918, to December 24, 1918, was 3,678.
The greatest number of patients in the hospital at one time was 937, on Novem-
ber 15, 1918.
Base Hospital No. 204 was officially closed December 24, 1918, all of its
patients being transferred to other hospitals in England. Prior to that date the
personnel w^ere reassigned for duty with various organizations in the American
Expeditionarv Forces.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. William J. Mixter, M. C, September 30, 1918, to December 24,
1918.
CHIEF OF SURGICAL SERVICE
Maj. Thomas M. Jones, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Fred R. Jouett, M. C.
' The statements of fact appearing herein are based on the "History, Base Hospital No. 204, A. E. F. " by the
commanding oflBcer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D. C. Ed.
HOSPITALS
743
BASE HOSPITAL NO. 208 •
Base Hospital No. 208 came into existence on November 1, 1918, when
Camp Hospital No. 47, located at Autun, Soane et Loire, was officially des-
ignated Base Hospital No. 208. The hospital was located in a large three-
story stone building, which before the war had been a school, and during
the war, prior to its occupation by the United States, had been used by the
French as a temporary hospital. The building was first taken over by the
United States in June, 1918, but did not function as a hospital until the
first week in August, when Base Hospital No. 45 arrived and took possession.
This unit remained only a short time and was then transferred elsewhere.
On September 24 a medical officer and 50 enlisted men arrived and began
functioning as Camp Hospital No. 47. On November 1, 1918, Camp Hospital
No. 47 became Base Hospital No. 208, functioning as such until the middle
of December, 1918, when all patients were evacuated, the property was returned
to the medical supply depot, and on December 31, 1918, the entire personnel
left Autun for Bordeaux to take over Base Hospital No. 6.
The organization arrived at Bordeaux on January 2, 1919, and on January
15 took over all patients, property, and records of Base Hospital No. 6. During
its existence, Base Hospital No. 208 evacuated a total of 6,575 cases, of which
4,950 were ambulatory, without dressing. Base Hospital No. 208 ceased to
function June 1, 1919, and its personnel sailed on the Alplionso for the United
States on June 13; arrived in the United States June 24, 1919; and were demo-
bilized on June 27, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Gustavus M. Blech, M. C, November 1, 1918, to June 1.,
1919.
CHIEF OF SURGICAL SERVICE
Capt. Raymond M. Spivy, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Franklin A. Martin, M. C.
BASE HOSPITAL NO. 210 '
Base Hospital No. 210 was organized November 1, 1918, at Toul, Depart-
ment of Meurthe-et-Moselle, in the advance section, where it functioned
as a convalescent hospital for the Toul hospital center. The personnel com-
prised officers and enlisted men taken from various organizations on duty
at that center. A majority of the enlisted men were class A and B patients
assigned from other hospitals of the group.
The hospital was located in the Caserne Marechal Ney, which consisted
of an 8-acre parade ground in a rectangle, aroimd which three large 4-story
buildings, two 2-story buildings and three 1-story mess halls were grouped;
• The statements of fact appearing herein are based on the "History, Base Hospital No. 208, A. E. F.," by the com-
iiiiinding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.--Ed.
'The statements of fact appearing herein are based on the "History, Base Hospital No. 210, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. 0., Washington. D. C.—Ed.
744 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the total bed capacity was 3,500. The buildings when taken over were in a
very insanitary condition and required many repairs, but were well suited
for a hospital. The institution was opened for patients November 4, 1918.
On April 1, 1919, Base Hospital No. 210 ceased to function as a convalescent
hospital and took over the patients and quarters of Base Hospital No. 78,
the latter organization being under orders to return to the United States.
Base Hospital No. 210 operated as a hospital from April 1 to 27, when it was
closed and prepared for return to the United States. During its service as
a convalescent hospital, November 4, 1918, to March 31, 1919, it handled 5,845
patients. It was ordered to return to the United States, June 9, 1919; sailed
on that date from Brest on the New Amsterdam for New York; arrived June
19; and was demobihzed at the Presidio of San Francisco, Calif., on June 30, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Bertram F. Alden, M. C, November 1, 1918, to December
23, 1918.
Maj. Francis G. Aud, M. C, December 24, 1918, to June 30, 1919.
CHIEF OF SURGICAL SERVICE
Maj. Francis G. Aud, M. C.
CHIEF OF MEDICAL SERVICE
Capt. Thomas G. Miller, M. C.
BASE HOSPITAL NO. 214 »
Base Hospital No. 214 came into existence November 6, 1918, at Savenay,
Department Loire Inferieure, in the base section No. 1, when the neuropsy-
chiatric service of Base Hospital No. 8 was organized into an independent
unit, and designated Base Hospital No. 214. This hospital functioned as a
special hospital for mental and neurological patients and occupied a plant
consisting of 10 wooden, knock-down type of barracks. In January, 1919,
when the admission rate increased, the unit was assigned to a type A, 1,000-
bed hospital, the construction of which was not completed; and as special
construction was necessary, this was done chiefly by the patients.
The personnel of the institution changed a great deal, as it furnished
officers and enlisted men to supervise transportation of convoys of patients
to the United States, and exercised supervision until patients were delivered
to their destination there. The convoys consisted as a rule of from 50 to
200 cases, occasionally more. From November 1, 1918, to February 28, 1919,
this hospital admitted 6,093 cases; the greatest number treated at one time
was 700, including 40 officers.
Base Hospital No. 214 ceased to function June 21, 1919, and the personnel
returned to the United States on the Scranton; sailed from St. Nazaire for
New York July 6, 1919; arrived July 16, and were demobilized at Camp Dix,
N. J., July 22, 1919.
" The statements of fact appearing herein are based on the "History, Base Hospital No. 214, A. E. F.," by the
commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
745
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Sanger Brown, M. C, November 6, 1918, to March 20, 1919.
Lieut. Col. Jesse M. W. Scott, M. C, March 21, 1919, to July 22, 1919.
CHIEF OF THE SERVICES
Maj. Joseph B. Betts, M. C.
Maj. Charles D. Humes, M. C.
Lieut. Col. Sanger Brown, M. C.
Maj. J. J. Hughes, M. C.
Maj. Arthur H. Ruggles, M. C.
Maj. Henry M. Swift, M. C.
Maj. Joseph W. Moore, M. C.
BASE HOSPITAL NO. 216 »
Base Hospital No. 216 was organized November 1, 1918, at the Nantes
hospital center, Department Loire Inferieure, base section No. 1. The per-
sonnel were taken from base hospitals stationed within the center. The unit
was assigned to a standard type A, 1,000-bed hospital of cement, fiber con-
struction, with an emergency expansion to 1,800 beds. When taken over,
it contained about 1,200 patients, the overflow from Base Hospitals Nos. 11
and 38. The hospital handled chiefly medical cases. The greatest number
of patients in the hospital at one time was 1,514 on November 7, 1918.
In addition to its formal functions, the hospital was designated a special
hospital for all communicable diseases and all complicated cases of venereal
disease of the center; the latter service admitted a total of 590 cases. Base
Hospital No. 216 also functioned as a camp infirmary for the personnel of
the entire hospital center. In January, 1919, the hospital was designated as
the evacuation hospital for the center, and all patients evacuated directly to
the United States were sent through this unit. A total of 6,367 patients were
handled by the evacuation department.
Base Hospital No. 216 ceased to function on June 21, 1919, and its per-
sonnel returned to the United States; sailed from St. Nazaire, July 6, 1919,
on the Matsonia; arrived in the United States July 16, and were demobilized
at Camp Dix, N. J., July 21, 1919.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. Robert B. Pratt, M. C, November 1, 1918, to July 21, 1919.
CHIEF OF SURGICAL SERVICE
Maj. John F. Park, M. C.
CHIEF OF MEDICAL SERVICE
Maj. Henry H. Kleinpell, M. C.
•The statements of fact appearing herein are based on the "History, Base Hospital No. 216, A. E. F.," by the
commanding oflBcer of that hospital. The history is on file in the Historical Division, S. G. 0., Washington, D. C.—Ed.
746
ADMINISTRATION, AIMEEICAN EXPEDITIONARY FORCES
BASE HOSPITAL NO. 218 -
Base Hospital No. 218 came into existence November 5, 1918, at Poitiers,
France, Department of Vienne, intermediate section, when Camp Hospital No.
61 was designated Base Hospital No. 218. The hospital was located in the
following buildings: The Ancienne Seminaire, bed capacity 400, used largely
for surgical cases; the ficole de Theologie, bed capacity 325, used for medical
cases; part of the University of Poitiers, bed capacity 250; and the Caserne
d' Abbeville with bed capacity of 1,000. The total capacity of the hospita
was 2,000 beds. During its activity as a base hospital it cared for 1,114 sur-
gical and medical cases.
Base Hospital No. 218 was not a part of any hospital center and operated
independently. This organization functioned as a base hospital for only three
months, and on February 13, 1919, it reverted to its former status, that of
Camp Hospital No. 61. The majority of the personnel, including the command-
ing officer, were reassigned to Camp Hospital No. 61 for duty, and Base Hos-
pital No. 218 ceased to exist February 13, 1919.
PERSONNEL
COMMANDING OFFICER
Maj. Ernest L. Bell, M. C, November 5, 1918, to February 13, 1919.
CHIEF OF SURGICAL SERVICE
Capt. John W. McGuire, M. C.
CHIEF OF MEDICAL SERVICE
Capt. John P. Howser, M. C.
BASE HOSPITAL NO. 236:-
Base Hospital No. 236 came into existence November 18, 1918, at Carnac
and Quiberon, Department Morbihan, in base section No. 1, when Camp Hos-
pital No. 92 was designated Base Hospital No. 236. This hospital functioned
only a short time as a base hospital and was a part of the Vannes hospital
center. It operated in the towns of Carnac, Quiberon, and Plouharnel, with
a total bed capacity of 1,000. At Carnac the unit occupied 1 hotel and 5
villas, which were well suited for hospital purposes, and had a capacity of 200
beds. At Quiberon it occupied 12 small summer hotels and villas, scattered
over the towTi, only 2 of which held more than 100 beds. The hospitalization
at Quiberon was extremely difficult and unsatisfactory; there were neither
heat, light, nor bathing facilities. The patients were scattered all over the
town, were hard to control, and discipline was bad. The distance to the hos-
pital center at Vannes was 30 miles and to Carnac 10 miles; this made it very
difficult to supply and control the hospital. The unit functioned only two
months and dm-ing that time cared for 1,131 surgical and medical cases.
^ The statements of fact appearing herein are based on the "History, Base Hospital No. 218, A. E. F.," by the com-
numding oflBcer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C. — Ed.
» The statements of fact appearing herein are based on the "History, Base Hospital Xo. 2.36, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C . — Ed.
HOSPITALS
747
On January 18, 1919, Base Hospital No. 236 was dissolved and its person-
nel were transferred to Base Hospital No. 136 at Vannes. The buildings at
Carnac and Plouharnel were taken over and operated by Base Hospital No. 136.
PERSONNEL
COMMANDING OFFICER
Lieut. Col. William E. Butler, M. C, November 18, 1918, to January 18
1919.
CHIEF OF THE SERVICES
Capt. N. Worth Brown, M. C.
Fig. 147.— Base Hospital No. 230, Carnac
BASE HOSPITAL NO. 238 "
Base Hospital No. 238 was organized November 20, 1918, at Rimaucourt,
Department Haute Marne, in the advance section, and its personnel were
drawn from Base Hospitals Nos. 52, 58, 59, and 64, already stationed in that
center. This was the fifth base hospital to join the Rimaucom-t hospital center,
where it occupied a type A, 1,000-bed hospital. It was designated as a special
hospital for eye, ear, nose, and throat, skin and genitourinary diseases, and
contained the central laboratory and morgue. It also maintained an outdoor
chnic in all of its departments, and many patients from the surrounding area,
as well as from other hospitals of the center, were treated as ambulatory cases.
» The statements of fact appearing herein are based on the "History, Base Hospital No. 238, A. E. F.," by the com-
manding officer of that hospital. The history is on file in the Historical Division, S. G. 0., Washington, D. C.—Ed.
748
ADMINISTRATION, AMEEICAN EXPEDITIONARY FORCES
Whenever siu'gical, medical, or dental cases were found in the hospital, they
were transferred, upon the advice of the chief of the service concerned, to another
hospital.
Base Hospital No. 238 existed less than three months and during that time
cared for 802 patients. The unit ceased operating on January 26, 1919, and
was disbanded at Rimaucourt on February 15, 1919, and Base Hospital No.
238, the last base hospital to be organized in the World War, ceased to exist.
PERSONNEL
COMMANDING OFFICER
Capt. Robert E. Hale, M. C, November 20, 1918, to December 25, 1918.
Lieut. Col. Sidney J. Meyers, M. C, December 26, 1918, to Februarv 15,
1919.
CHIEF OF SURGICAL SERVICE
Maj. Edmund R. Brush, M. C.
CHIEF OF MEDICAL SERVICE
Maj. John J. Madigan, M. C.
CHAPTER XXV
CAMP HOSPITALS"
CAMP HOSPITAL NO. 1 ^
Camp Hospital No. 1 was established in July, 1917, at Gondrecourt,
Department Meuse, in the advance section, by Field Hospital No. 13. It was
located in temporary wooden barracks, of French construction, with a bed
capacity of 300, and it served the first training area. In the latter part of
October, 1917, Field Hospital No. 13 was relieved by Field Hospital No. 12
which, in turn, was relieved on November 12, 1917, by Field Hospital No. 1.
Field Hospital No. 3 relieved No. 1 in January, 1918, and Field Hospital No.
162 relieved the latter on April 7, 1918, and operated the hospital until July
18, 1918, when it was relieved by personnel permanently assigned. Camp
Hospital No. 1 ceased to function May 12, 1919; all of its remaining patients
on that date were transferred to Base Hospital No. 91, at Commercy. The
personnel of the hospital sailed for New York from St. Nazaire, June 14, 1919,
on the Santa Barbara and were demobilized June 28, 1919.
CAMP HOSPITAL NO. 2 =
Camp Hospital No. 2 was organized December 21, 1917, at Bassens,
Department Gironde, base section No. 2. The hospital, when first organized,
was located in two wards. Service de Sante type, of 60-bed capacity, and served
rest camp No. 4, near Bordeaux. Additional buildings were constructed from
time to time to accommodate the increasing number of patients, until, in Feb-
ruary, 1919, the bed capacity of the hospital was 600. The hospital ceased
functioning June 11, 1919. The detachment was skeletonized and sailed
from Bordeaux on June 17, 1919, on the Otsego, and was demobilized at Camp
Jackson, S. C, July 7, 1919.
CAMP HOSPITAL NO. 3
Camp Hospital No. 3 was established June 26, 1918, at Bourmont, De-
partment Haute Marne, advance section. The personnel came from the Amer-
ican Expeditionary Forces at large, and consisted of 1 0 officers and 60 enlisted
men. The hospital occupied a standard type B, 300-bed hospital and began
to function July 4, 1918, with the arrival of the 37th Division. It served the
" The numbers of the camp hospitals considered in this chapter do not form a complete series; that is to say, unless a
camp hospital, which had been given a definite number, actually operated it has not been included herein.— ^^d.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 1, A. E. F.," Gondre-
court, by the commanding oflicer of that hospital. The history is on file in the historical Division, S. O. 0., Washing-
ton, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 2, A. E. F.," Bassens, by
the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed
The statements of fact appearing herein are based on the "History, Camp Hospital No. 3, A. E. F.," Bourmont,
by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington,
D. C.~Ed.
749
750
ADMIXISTRATIOX, AMERICAN EXPEDITION'AK V FORCES
third training area, which at different times was occupied b}^ the 37th, 42d,
78th, 82d, 29th, and 26th Divisions. During its active service, July 4, 1918,
to March 26, 1919, the hospital received 2,332 medical and surgical cases.
Camp Hospital No. 3 ceased to function March 26, 1919. The personnel
sailed from Brest on the President Grant May 28, 1919, and were demobilized
at Camp Devens, Mass., June 14, 1919.
CAMP HOSPITAL NO. 4 '
Camp Hospital No. 4, at Joinville le Pont, in the district of Paris, was
established April 26, 1918, in a small group of old and dilapidated school build-
ings. At first there were neither modern plumbing nor sewer connections;
Fig. 148.— Camp Hospital No. 2, Bassens
no hot-water plant was available, and baths had to be prepared from water
heated on small oil stoves. The bed capacity at first was 300, w^hich later was
increased to 800 by the erection of several wooden barracks. The hospital
was operated by hospital unit C. Patients w^ere received first on May 24,
1918; the first battle casualties arrived July 17, 1918, 100 wounded being in
the convoy. The hospital continued to receive wounded until the armistice;
the largest number received in one day was 450, on July 30, 1918. It also
functioned as a post hospital for the district of Paris and received all the sick
and venereal cases from our military prisons in Paris. The largest number
of patients in hospital at one time was 825, on September 8, 1918. During
its existence, the hospital received 9,800 patients, about 25 per cent of which
•The statements of fact appearing herein are based on the "History, Camp Hospital No 4 A E F " JoinvUle le
Pont, by Lieut. Col. Samuel E. Lambert, M. C, while on duty as a member of the staff of that hospital ' The history
IS on file in the Historical Division, S. G. 0., Washington, D. C.—Ed.
HOSPITALS
751
were battle casualties. Camp Hospital No. 4 ceased to function on June 5,
1919, and its personnel (unit C) returned to the United States, sailing from
St. Nazaire July 3, 1919, on the Alaslan, and was demobilized at Camp Sher-
man, Ohio, July 21, 1919.
CAMP HOSPITAL NO. 5^
Camp Hospital No. 5 was established officially on February 27, 1918, at
Genicart, Department Gironde, base section No. 2. Prior to that time this
hospital was known as the Camp Infirmary and served rest camp No. 2, near
Bordeaux. The hospital buildings were wooden barracks of French construc-
Fii;. 14'J. — Camp Hospital No. 4, Joiiiville
tion and had a total bed capacity of 500. On November 24, 1918, rest camps
Nos. 1 and 2 were consolidated into the "Bordeaux embarkation camp," and
Camp Hospital No. 5 was designated as the entrance hospital of the camp.
The hospital ceased to function June 12, 1919, and its personnel were skele-
tonized to 1 officer and 20 enlisted men, who sailed from Bordeaux for the
United States July 1, 1919, and were demobilized at Camp Upton, N. Y.,
July 19, 1919.
/ The statements of fact appearing herein are based on the "History, Camp Hospital No. 5, A. E. F.," Genicart,
J'.v Maj. H. B. Montgomery, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
13901—27 48
752
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CAMP HOSPITAL NO. 7 "
Camp Hospital No. 7 was organized June 3, 1918, at Humes, Department
Haute Marne, advance section, and served the seventh training area. The
hospital occupied a type B, 300-bed unit, with emergency expansion to 370.
It was operated first by Evacuation Hospital No. 4 and later, in July, 1918,
by Field Hospital No. 310. When the latter organization was sent to the
front, the hospital was manned by personnel from the American Expeditionaiy
Forces at large. Patients were received first on July 27, 1918. During its
activity the hospital cared for 2,576 medical and 402 surgical cases. Camp
Hospital No. 7 ceased to function on March 17, 1919, its remaining patients
being then transferred to Base Hospital No. 53, at Langres.
Fig. l.^iO. — A ward interior, Camp Hospital No. 7, Humes
CAMP HOSPITAL NO. 8
Camp Hospital No. 8 was established June 26, 1918, at Montigny-le-Roi,
Department Haute Marne, advance section, its personnel being obtained from
the American Expeditionary Forces at large. It occupied a standard type B,
300-bed unit, the construction of which had been completed when the organi-
zation arrived; however, it was only about 50 per cent equipped. Camp
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 7, A. E. F.," Humes,
by Capt. J. P. McQuillin, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
* The statements of fact appearing herein are based on the "History, Camp Hospital No. 8, A. E. F.," Montigny-
le-Roi, by Maj. Virgil E. Simpson, M. C, while on duty as a member of the staff of that hospital. The history is on file in
the Historical Division, S. G. O., Washington, D. C. — Ed.
HOSPITALS
753
Hospital No. 8 served the eighth training area, which was occupied succes-
sively by the 83d, 91st, and 26th Divisions. During the influenza epidemic
in November and December, 1918, Field Hospitals Nos. 101 and 103 were
established on the hospital grounds and cared for the overflow of the camp
hospital. During its activity the hospital cared for 3,020 medical and 331
surgical cases. On April 22, 1919, all remaining patients were transferred to
Base Hospital No. 63, at Langres; Camp Hospital No. 8 ceased to function
on that date. The detachment proceeded to Brest, whence it sailed for New
York on June 10, 1919, on the Agamemnon, and was demobihzed at Camp
Sherman, Ohio, June 24, 1919.
CAMP HOSPITAL NO. 9 '
Camp Hospital No. 9 was established in June, 1918, at Chateau Villain,
Department Haute Marne, advance section. Its personnel were mobilized
at Blois from officers and enlisted men of the American Expeditionary Forces
at large, and arrived at station June 25, 1918. The hospital occupied a stand-
ard type B, 300-bed unit, with emergency expansion to 400. Construction of
the hospital had been completed prior to the arrival of the personnel; part
of the equipment was on hand. This hospital served the ninth training area,
and began to receive patients on June 26. During its active service it cared
for 3,390 surgical and medical cases. On March 25, 1919, all remaining patients
were transferred to other hospitals, and Camp Hospital No. 9 ceased to func-
tion. The personnel sailed for Newport News, Va., from Brest on the Freedom,
May 25, 1919, and were disbanded at Camp Sherman, Ohio, June 17, 1919.
CAMP HOSPITAL NO. 10'
Camp Hospital No. 10 was established in April, 1918, at Prauthoy,
Department Haute Marne, advance section, and began to operate April 20,
1918. It was a standard type B, 300-bed unit, with emergency expansion
to 360; it served the tenth training area, which was successively occupied by
the 32d, 29th, 79th, and 82d Divisions. During the months of April and May,
1918, the hospital was operated by the medical staff of the 32d Division and
upon departure of that division was operated temporarily by Evacuation
Hospital No. 5. On June 28, 1918, the permanent personnel of Camp Hospital
No. 5 arrived, and took charge July 1, 1918. The hospital ceased to function
on March 23, 1919, and its personnel was reassigned to other organizations
for duty.
CAMP HOSPITAL NO. 11^
Camp Hospital No. 11 was established March 12, 1918, at St. Nazaire,
base section No. 1. The personnel comprised Sanitary Squad No. 1 and
Field Hospital No. 44. When first organized, the hospital occupied a standard
• The statements of fact appearing herein are based on the "History, Camp Hospital No. 9, A. E. F.," Chateau
Villain, by Maj. Clarendon W. Brown, M. C, while on duty as a member of the staff of that hospital. The history is
on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
> The statements of fact appearing herein are based on the "History, Camp Hospital No. 10, A. E. F.," Prauthoy,
by Maj. John W. Emhardt, M. C, while on duty as a member of the staff of I hat hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
* The statements of fact appearing herein are based on the "History, Camp Hospital No. 11, A. E. F.," St. Nazaire,
by Maj. Ward Brinton, M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. G. O., Washington, D. C.— Ed.
754
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
type B, 300-bed unit, but later, when the activities of the port demanded
more hospital facilities, necessary buildings were added. On July 31, 1918,
a venereal segregation camp was established in connection with the hospi-
tal, and cared for all patients with venereal disease coming into that port.
In April, 1919, the hospital comprised 38 wooden barracks, with a total bed
capacity of 703. During its existence, this hospital cared for a total of 12,291
medical and surgical cases, including 5,085 cases of venereal disease. On
June 18, 1919, it was designated Infirmary, St. Nazaire, and ceased to function
as a camp hospital on that date. Its personnel, with exception of a skeleton-
ized unit, were reassigned to duty with the infirmary. The skeletonized
Camp Hospital No. 11, consisting of 1 officer and 4 enlisted men, sailed July
10, 1919, on the AmpMon, from St. Nazaire, and was demobilized at Camp
Sherman, Ohio, July 28, 1919.
CAMP HOSPITAL NO. 12'
Camp Hospital No. 12 came into existence October 12, 1917, at Le Valda-
hon, Department Doubs, advance section, when camp hospital, 1st Field
Artillery Brigade, A. E. F., was redesignated Camp Hospital No. 12. It
occupied a French military hospital, comprising three buildings of stone and
several Service de Sante type huts, with a total normal bed capacity of 300.
It served the fiftieth training area. During the influenza epidemic in Sep-
tember, 1918, the rate of admissions was so great that all vacant buildings in
the camp, including the Y. M. C. A. hut, were utilized for hospital purposes.
The greatest number of patients in hospital was on September 29, 1918, when
1,335 were being cared for. As the number of medical officers on duty was
entirely inadequate, line officers were assigned by the brigade commander to
assist in the administration of the hospital. Enlisted men of the line were
used for fatigue, in kitchen, office, and, in many instances, in ward work. Camp
Hospital No. 12 ceased to function on May 23, 1919; its personnel sailed on
June 24, 1919, from Brest for New York on the Huntington and were demobilized
at Camp Gordon, Ga., July 6, 1919.
CAMP HOSPITAL NO. 13 '
Camp Hospital No. 13 was established November 13, 1917, at Mailly,
Department Aube, advance section, its personnel being obtained from the
American Expeditionary Forces at large. The hospital occupied 17 Service
de Sante type barracks, built for and occupied by the Russians in 1916. Its
bed capacity was 450.
Camp Hospital No. 13 served our miscellaneous troops in the Mailly
area; during its active service, November 13, 1917, to December 31, 1918,
it cared for 5,656 medical and surgical cases. Camp Hospital No. 13 ceased
to function December 31, 1918, the property was returned to the French,
and the personnel assigned to other organizations for further duty.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 12, A. E. F.," Le Valda-
hon, by the commanding officer of that hospital. The history is on file in the Historical Division, S. O. O., Washington,
D. C. — Ed.
The statements of fact appearing herein are based on the "History, Camp Hospital No. 13, A. E. F. " Mailley,
by the commanding officer of that hospital. The history is on file in the Historical Division, S.' G. O., Washington,
HOSPITALS
755
CAMP HOSPITAL NO. 14 "
Camp Hospital No. 14 was established October 15, 1917, at Issoudun,
Department Indre, intermediate section, and served the third aviation instruc-
tion center. Personnel were obtained locally. When opened, the entire
hospital was housed in one American Red Cross building, 25 by 60 feet, but
later, when construction of the hospital had been completed, it consisted of 17
ward buildings, surgical building, quarters and messes for the personnel and
had a normal bed capacity of 575.
During its existence this hospital cared for approximately 7,000 surgical
and medical cases. Camp Hospital No. 14 ceased to function on April 15,
1919; its personnel sailed on May 25, 1919, from Bordeaux on the Chicago,
and were demobilized at Camp Dodge, Iowa, June 17, 1919.
CAMP HOSPITAL NO. 15 "
Camp Hospital No. 15 was established in October, 1917, at Coetquidan,
Department Hie et Vil, base section No. 1. Its personnel came from the
American Expeditionary Forces at large. It occupied three large stone build-
ings, and several Adrian barracks, and had a total bed capacity of 900. The
hospital served the Meucon Artillery training area and began to receive patients
November 1, 1917. In September, 1918, a venereal segregation camp was
estabhshed in connection with Camp Hospital No. 15. The greatest number
of patients in hospital at one time was 900 — in September, 1918. Camp Hos-
pital No. 15 ceased to function June 30, 1919, and its personnel sailed from
St. Nazaire for Newport News, Va., July 9, 1919, on the Bujord, and were
demobilized shortly afterward.
CAMP HOSPITAL NO. 19 ^
Camp Hospital No. 19 was established Decembei 23, 1917, at La Courtine,
Department Creuse, base section No. 2. The personnel came from the Ameri-
can Expeditionaiy Forces at large. When first opened, the hospital functioned
in three widely separated French buildings, in a training camp. At first its
bed capacity was 140; later, when construction was completed, it comprised
8 buildings, with a normal bed capacity of 500. During its existence the
hospital cared for 3,025 surgical and medical cases. Camp Hospital No. 19
ceased to function May 31, 1919; its personnel returned to the United States,
sailing from Bordeaux, June 20, 1919, on the Canandaigua, and were demobilized
at Camp Jackson, S. C, shortly afterward.
» The statements of fact appearing herein are based on the "History, Camp Hospital No. 14, A. E. F.," Issoudun,by
thecommandingofTicer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 15, A. E. F.," Coetqui-
dan, by Maj. William L. Edmundson, M. C, while on duty as a member of the stafi of that hospital. The history is
on file in the Historical Division, S. G. O., Washington, D. C. — Ed.
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 19, A. E. F.," La Cour-
tine, by First Lieut. James H. MacDuffie, M. C, while on duty as a member of the staff of that hospital. The history
is on file in the Historical Division, S. G. O., Washington, D. C. — Ed.
756
ADMINISTRATION, AMERICAN EXPEDITIONAKV FORCES
CAMP HOSPITAL NO. 20 «
Camp Hospital No. 20 was established November 11, 1917, at Camp de
Souge, Department Gironde, base section No. 2. It functioned in barrack-
type buildings, constructed by the United States Engineers, and had a bed
capacity of 750. This hospital served the troops in Camp de Souge, the second
aerial observation and balloon school, and several billeting areas. Camp
Hospital No. 20 ceased to operate May 2, 1919, and its personnel were reassigned
to other organizations for duty.
CAMP HOSPITAL NO. 21 ^
Camp Hospital No. 21 was established February 8, 1918, at Bourbonne-
les-Bains, Department Haute Marne, advance section. It served the eleventh
training area, which was occupied successively by the 29th, 78th, 82d, 92d,
Divisions, and the Sixth Army Corps. The hospital operated in a modern
building, a hotel, which had been constructed at the beginning of the war.
This building was of concrete and consisted of seven stories and a basement.
There was an electric elevator connecting all floors. The normal bed capacity
was 300. On April 10, 1918, hospital unit L arrived and took over Camp Hos-
pital No. 21. During its existence, the hospital cared for 5,455 medical and
surgical cases. It ceased to function April 25, 1919; unit L returned to the
United States, saihng from Marseille, May 15, 1919, and was demobilized at
Camp Dix, N. J., June 13, 1919.
CAMP HOSPITAL NO. 22 '
Camp Hospital No. 22 came into existence January 5, 1918, at Langres,
Department Haute Marne, advance section, when Camp Hospital A was taken
over by a medical detachment from Field Hospital No. 163 and was redesig-
nated Camp Hospital No. 22. This hospital had been operated since Novem-
ber 15, 1917, by a detachment from the sanitary unit of the 9th Infantry, and
had a bed capacity of 100. It occupied a three-story, stone building, situated
outside the inner walls of the fortification of Langres, and was one of the group
of buildings called Turenne Barracks. It served the seventh training area,
but the majority of its admissions were from Army candidate and Signal Corps
schools, at Langres. On June 11, 1918, the hospital was closed, but was re-
opened on June 26, 1918. It was finally closed on February 28, 1919, and its
personnel were reassigned to other organizations for duty.
« The statements of fact appearing herein are based on the "History, Camp Hospital No. 20, A. E. F.," Campde
Souge, by Lieut. Col. Edward F. Geddings, M. C, while on duty as a member of the stafT of that hospital. The history
is on file in the Historical Division, S. G. C, Washington, D. C. — Ed.
<■ The statements of fact appearing herein are based on the "History, Camp Hospital No. 21, A. E. F.," Bourbonne.
les-Bains, by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Wash-
ington, D. C.—Ed.
•The statements of fact appearing herein are based on the "History, Camp Hospital No. 22, A. E. F.,"
Langres, by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washing-
ton, D.C.—£d.
HOSPITALS
757
CAMP HOSPITAL NO. 23 '
Camp Hospital No. 23 was established January 8, 1918, at Langres, Depart-
ment Haute Marne, advance section, its personnel being taken from Field Hos-
pital No. 163 and Ambulance Company, No. 163. The building in which it
was located was part of the College de Jeunes Filles and had been occupied by
the French Medical Department. Its bed capacity was 100. Many improve-
ments had been made in the building, such as installation of running water,
shower baths, and flush latrines. It also contained a completely equipped
laboratory, pharmacy, and operating room. The hospital served the officers
at the Army school headquarters at Langres and averaged about 45 patients
Fk;. 151.— Camp Hospital No. 22, Langres
throughout its period of operation. The first patients were admitted Febru-
ary 1, 1918. During July, 1918, the Langres hospital center was opened; this,
together with Camp Hospital No. 24, made the existence of Camp Hospital
No. 23 no longer essential, so it was closed August 15, 1918, and its personnel
were reassigned to other organizations for duty.
CAMP HOSPITAL NO. 24 "
Camp Hospital No. 24 was established in January, 1918, at Langres,
Department Haute Marne, advance section, and was operated by Field Hos-
pital No. 165. This institution served the Langres training area and had a bed
' The statements of fact appearing herein are based on the "History, Camp Plospital No. 23, A. E. F.," Langres,
hy First Lieut. Alan C. Button, M. C, while on duty as a member of the staff of that hospital. The history is on file in
the Historical Division, S. O. O., Washington, D. C.—Ed.
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 24, A. E. F.," Langres,
by Maj. Alexander Nicoll, M. C, while on duty as a member of the staff of that hospital. The history is on file in
the Historical Division, S. (). O., Washington, D. C.—Ed.
758
ADMINISTRATION, AIMERICAN EXPEDITION AKY FORCES
capacity of 500. It occupied the French Hopital Complemcntair No. 3, and
consisted of a main building of 4 stories, an annex of 2 stories, and 2 other
buildings, 1 of which was used as the kitchen and the other as the morgue.
When we took them over, the hospital buildings were old and practically unfur-
nished; the entire plumbing system w^as in a poor condition. On March 13,
1918, hospital unit H, arrived and was assigned permanently to Camp Hospital
No. 24, which it took over on March 27, 1918. The unit renovated the buildings
and, after many difRculties, succeeded in installing some plumbing fixtures such
as flush toilets and baths. During its existence, 6,288 patients were admitted;
of these 4,487 were medical and 1,801 surgical cases. Camp Hospital No. 24
ceased to function March 15, 1919, and its personnel were transferred to
Can>p Hospital No. 118, Brest, for duty.
CAMP HOSPITAL NO. 25 '
Camp Hospital No. 25 was organized in January, 1918, at Blois, Depart-
ment Loir et Cher, intermediate section, its personnel being obtained from the
American Expeditionary Forces at large. It operated in 7 old, widely separated
French buildings, with a normal bed capacity of 939. This institution was
also used as a casual station for nurses. On July 3, 1918, Base Hospital No. 43
arrived and took over the operation of Camp Hospital No. 25. On January
20, 1919, Evacuation Hospital No. 35 relieved Base Hospital No. 43 and func-
tioned until March 12, 1919, when it was skeletonized to 1 officer and 4 enlisted
men, who were returned to the United States, and the hospital reverted to its
former status, that of Camp Hospital No. 25. The remaining personnel of
Evacuation Hospital No. 35 were transferred to Camp Hospital No. 25, remain-
ing until closure of the hospital on May 13, 1919. The personnel of Camp
Hospital No. 25 returned to the United States by way of Brest, sailing on the
America, June 9, 1919, and were demobilized at Camp Upton, N. Y., June 22,
1919.
CAMP HOSPITAL NO. 26 «
Camp Hospital No. 26 was organized April 26, 1918, at Noyers, Depart-
ment Loir et Cher, intermediate section, its personnel coming from Field Hospi-
tal No. 161. When established, the hospital occupied 15 wooden barracks, of
the Morajan type, each accommodating 32 patients. In addition to the hospi-
tal at Noyers, tw^o annexes were maintained, one of 200-bed capacity in H6spice
de St. Aignan, and another of 500-bed capacity, at Pont le Voy. The latter was
used as a convalescent hospital. Camp Hospital No. 26, w^hile considered a
1,500-bed hospital, often in emergency treated as many as 2,200 patients at one
time. It served the entire first replacement depot at St. Aignan-Noyers, and
up to December 31, 1918, admitted 15,967 medical and surgical cases. Its
dental department grew in proportion to the hospital, and at one time there were
23 dental officers on duty. Also it was used as a school, training dental assist-
ants for the whole American Expeditionary Forces. The hospital ceased to
function on June 12, 1919, and its personnel returned to the United States on the
Antigone. Sailing from St. Nazaire on June 18, 1919, the personnel arrived at
Camp Hill, Va., June 28, 1919, and were demobilized shortly afterwards.
• The statements of fact appearing herein are based on the "History, Camp Hospital No 25 \ E F " Blois by the
commandmg officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington D C ~Ed
The statements of fact appearing herein are based on the "History, Camp Hospital No 26 \ E F " Noyers by
Lieut. Col. William C. Riddell, M. C, while on duty as a member of the staff of that hospital. The history is on file in'the
Historical Division, S. G. O., Washington, D. C.~Ed.
Fii.. I'll'. — Camp Hospital No. 24, Laugres
760
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CAMP HOSPITAL NO. 27 '
Camp Hospital No. 27 was established February 4, 1918, at Tours, Depart-
ment Indre et Loire, intermediate section, and was operated by the personnel of
of Evacuation Ambulance Company No. 3. The hospital occupied a former
French military hospital, located in the ficole des Filles Superior, Tours. It
served the Arrondissement of Tours, which included about 20,000 troops and
approximately 18,000 German prisoners of war. When first taken over, the
hospital accommodated about 300 patients; later, the capacity was increased to
650. On March 5, 1918, Evacuation Ambulance Company No. 3 was relieved
by Mobile Hospital No. 1 (hospital unit K), which then took over Camp Hospi-
FiG. 153.— Interior, officers' ward, Camp Hospital No. 28, Nevers
tal No. 27. During the year ending February 4, 1919, this hospital admitted
4,063 medical and 937 surgical cases. Camp Hospital No. 27 ceased to function
in August, 1919; its personnel sailed from Brest for New York August 10, 1919,
and w^ere demobilized August 25, 1919.
CAMP HOSPITAL NO. 28 "
Camp Hospital No. 28 was established February 4, 1918, at Nevers, Depart-
ment Nievre, Intermediate section, its personnel being obtained from the
American Expeditionary Forces at large. It occupied a school building, L'ecole
I The statements of fact appearing herein are based on the "History, Camp Hospital No. 27, A. E. F.," Tours, by
First Lieut. Kenneth W. Pugh, M. C, while on duty as a member of the staff of that hospital. The History is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
y The statements of fact appearing herein are based on the "History, Camp Hospital No. 28, A. E. F.," Nevers by the
commanding officer of that hospital. The History is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
761
Normale d'Institiites, which at the time of the establishment of Camp Hospital
No. 28 was used by the French Government as a military hospital. The Capac-
ity of the hospital, as originally planned, was 150 beds, but later this was
increased to 450. Camp Hospital No. 28 served not only the troops at Nevers
but also those in the surrounding area, whose radius varied in extent from 20 to
40 miles. The number of troops ranged from 8,000 to 15,000. On March 7,
1918, hospital unit S reported for duty and took over the hospital. From
February 4, 1918, to December 1, 1918, the hospital admitted a total of 3,030
surgical and medical cases. Camp Hospital No. 28 ceased to function June 13,
1919; its personnel sailed from St. Nazaire June 23, 1919, on the Santa Cecilia,
and were demobilized at Camp Dix, N. J., July 10, 1919.
Fig. 154. — A group of wards. Camp Hospital No. 29, Le Courneau
CAMP HOSPITAL NO. 29 '
Camp Hospital No. 29 came into existence February 29, 1918, at Le
Courneau, Department Gironde, base section No. 2, its personnel coming
from the American Expeditionary Forces at large. The hospital was located
on the outskirts of a large camp, which later became known as Camp Hunt,
and occupied a number of buildings which had been used by the French as
a military hospital. The bed capacity of the entire plant was 960. It served
the miscellaneous troops in the Courneau area and at times received wounded
from the forward areas. During its existence, the hospital admitted a
total of 6,897 surgical and medical cases; the greatest number of patients
in hospital at one time was 1,017, on September 23, 1918. Camp Hospital
No. 29 ceased to function on March 1, 1919, and its personnel were reassigned
to other organizations in the American Expeditionary Forces for further duty.
' The statements offset appearing herein are based on the "History, Camp Hospital No. 29, A. E. F.," Le Courneau,
by Maj. John G. Towne, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. 0. O., Washington, D. C. — Ed.
762
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCE.'^
CAMP HOSPITAL NO. 31"
Camp Hospital No. 31 was established April 15, 1918, at Meucon, Depart-
ment Morbihan, base section No. 1, its personnel being taken from the American
Expeditionary Forces at large. The hospital occupied the site of what for-
merly had been the old French artillery training camp, and was erected to
serve the artillery training camp for the American Expeditionary Forces,
which was about 2 miles distant. It comprised 12 low buildings of wood
and stone, which had been used by the French as quarters for the troops in
training. In addition to these barracks, a new surgical building of brick and
stone and quarters for the personnel were built; the total capacity was 700
beds. It ceased to function April 3, 1919, and its personnel were reassigned
to other organizations for duty.
Fig. 155. — Camp Hospital No. .33, Camp Pontanezen
CAMP HOSPITAL NO. 33 *
Camp Hospital No. 33 was established January 15, 1918, at Camp Ponta-
nezen, Department Finistere, base section No. 5, by a detachment of 5 medical
officers and 40 enlisted men, detached from Base Hospital No. 34. \Yhen
first opened, the hospital was located in an old French concrete building, which
formerly had been used as barracks. Many difficulties were experienced at
this time in the care of the sick, as hospital supplies were very difficult to
obtain. Medical equipment consisted of the contents of medical and surgical
chests. Except for candles, there were no lighting facilities. On February
1, 1918, in addition to the old stone barracks then occupied by the hospital,
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 31, A. E. F.," Meucon,
by Lieut. Col. J. A . Worthington, M. C, while on duty as a member of the staff of that hospital. The history is on file
in the Historical Division, S. G. O., Washington, D. C. — Ed.
i> The statements of fact appearing herein are based on the "History, Camp Hospital No. 33, A. E. F., Camp Ponta-
nezen, by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. 0., Washington,
D. C.—Ed.
HOSPITALS
763
a fairly modern three-story, fireproof building was taken over. Later, when
increased hospital facilities were necessary, 8 Adrian-type barracks were
erected, to acoommodate 35 patients each, and four 300-foot barracks. These
structures completed the hospital plant inside the walls of Caserne de Pontan-
ezen. AVhen further expansion was necessary, 15 additional hospital buildings
were constructed in the area outside the wall of the caserne, immediately behind
the original hospital site, thus giving a maximum bed capacity of 2,600.
Twenty-four additional wards, kitchens, supply rooms, dispensary, officers'
and nurses' quarters were constructed in this area. Also, large huts w^ere
erected both on the inside and outside areas by the American Red Cross.
Camp Hospital No. 33 served the entire port of Brest. Although it treated
more patients than did the majority of the base hospitals in France, and served
the largest camp in the American Expeditionary Forces, it never was rated
as a base hospital.
Due to the absence of any sewerage system and to the climatic conditions,
the problem of sanitation was a serious one and became more complicated as
the number of patients in hospital increased. Latrines of the can type were
used, the cans being emptied by French contractors, who proved to be very
unsatisfactory. The difficulty in rendering these latrines fiyproof and sanitary
was practically insurmountable; the use of an incineration plant was impracti-
cable, due to the scarcity of wood and straw.
During the period from January 15, 1918, to June 30, 1919, this institu-
tion admitted 28,233 medical and surgical cases. The majority of its patients
were medical, which up to June 30, 1919, included 4,814 cases of mumps,
3,521 of influenza, and 2,205 of pneumonia.
Camp Hospital No. 33 ceased to function December 29, 1919; its personnel
sailed from Brest December 30, 1919, on the George Washington, and were
demobilized at Camp Dix, N. J., shortly afterward.
CAMP HOSPITAL NO. 34 ^
Camp Hospital No. 34 came into existence on March 20, 1918, w^hen the
camp infirmary at the American rest camp, Romsey, England, was designated
Camp Hospital No. 34. This infirmary had been in operation since December
26, 1917, the personnel to operate it being detailed temporarily from organi-
zations passing through the camp. At first, the hospital consisted of a small
permanent building and four British hospital tents, of a capacity of about 14
beds. In the fall of 1918, 300-bed hospital was being constructed. During
its existence as a camp hospital, it received 1,748 surgical and medical cases;
largest number of patients admitted in one month was 433, in September,
1918. Camp Hospital No. 34 ceased to function November 30, 1918, its
personnel being reassigned.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 34, A. E. F.," Romsey, by
the commanding officer of that hospital. The history is on file in the Historical Division, S. G. 0., Washington, D. C.—Ed.
764
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CAMP HOSPITAL NO. 35
Camp Hospital No. 35 was established Jaiuiary 19, 1918, at the American
rest camp, Winchester, England, its personnel being taken from the American
Expeditionary Forces casually at that camp. When opened, it was known
as the United States hospital, American rest camp, Winchester, England, and
on April 5, 1918, received its designation as Camp Hospital No. 35. It occupied
two groups of structures, situated about one-eighth of a mile apart, in portion
of the camp known as Avington Park. The capacity was intended to be 250
beds, but later additions were made so that the capacity of the hospital was
500, with an emergency expansion in tents to 679. The majority of the cases
admitted were medical, among which were the cases of communicable disease
among our troops arriving in England. During its existence, January 19, 1918,
to February 4, 1919, it cared for 5,226 medical and 177 surgical cases. Camp
Hospital No. 35 ceased to function February 4, 1919, and its personnel were
reassigned to other stations for further duty.
CAMP HOSPITAL NO. 36 »
Camp Hospital No. 36 was established in February, 1918, at Southampton,
England, to serve the Southampton rest area. At this time, the hospital was
temporarily quartered in tents and had a capacity of 80 beds. Construction
was begun on June 22, 1918, the type of construction being sectional huts.
The wards were arranged in pairs, each pair connected by an ablution block,
containing toilets, lavatories, and shower baths. The operating block and
mess halls were to be connected with all the wards by a covered corridor, 5
feet wide. The hospital was about 50 per cent completed when construction
was ordered stopped on November 28. During its existence, the hospital
cared for 1,462 medical and 48 surgical cases. Camp Hospital No. 36 ceased
operating December 2, 1918, and its personnel were reassigned to other
organizations for duty.
CAMP HOSPITAL NO. 37 ^
Camp Hospital No. 37 was established March 15, 1918, at Romarantin,
Department Loir et Cher, intermediate section, to serve Air Service production
center No. 2, located about 3 miles from Romarantin. The hospital was
located in a school for young girls and w^as an old three-story building of brick
and cement, having four wings and a cross bar forming the letter H; two of
these wings were occupied by the hospital, the other two were retained by the
school. Later, barracks, mess halls, and bathhouses were erected on the
grounds for the personnel and several tents for patients to provide for emer-
gency used and for contagious diseases. With these additions the bed capacity
i The statements of fact appearing herein are based on the "History, Camp Hospital No. 35, A. E. F.," Winches-
ter, England, by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. 0.,
Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 36, A. E. F.," South-
ampton, England, by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. 0.
Washington, D. C.—Ed.
I The statements of fact appearing herein are based on the " History, Camp Hospital No. 37, A. E. F.," Romarantin,
by Maj. Lucius F. Donohoe, M. C, while on duty as a member of the stafl of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.— Ed.
HOSPITALS
765
was increased from 150 to 235. During its existence 2,279 medical and 152
surgical cases were admitted. Camp Hospital No. 37 ceased to function Febru-
ary 28, 1919, when its designation was changed to infirmary, Air Service
production center No. 2.
CAMP HOSPITAL NO. 38 "
Camp Hospital No. 38 was established May 7, 1918, at Chatillon sur
Seine, Department Cote d'Or, advance section. Its personnel was taken
from the American Expeditionary Forces at large. It occupied hospital build-
ings taken over from the French, of 200-bed capacity, and served the personnel
and students of the Second Army Corps schools. The plumbing and sanitary
equipment of the hospital was very poor. During its existence, the hospital
cared for 1,771 medical and 378 surgical cases. Camp Hospital No. 38 ceased
to operate March 31, 1919; its personnel were returned to United States and
demobilized in April, 1919.
CAMP HOSPITAL NO. 39 '
Camp Hospital No. 39 was established March 1, 1918, at La Rochelle,
Department Charente Inferieure, base section No. 7, its personnel being
assigned from the American Expeditionary Forces at large. It was located
at a distance of about 23^ miles from La Rochelle, in an old stone building
known as the Chateau Perigny, and in several wooden barracks, erected by
the United States Engineers. The capacity of the hospital was 375 beds. It
served the La Rochelle and La Pallice areas and began to receive patients
on July 29, 1918. The base laboratory for base section No. 7 was located at
the hospital and performed all bacteriological work for that section. The
hospital ceased to operate May 16, 1919; its personnel returned to the United
States, sailing from Bordeaux for New York, on the Ohioan, June 9, 1919,
and were demobilized at Camp Dix, N. J., shortly afterward.
CAMP HOSPITAL NO. 40 '
Camp Hospital No. 40 was established in April, 1918, at the American
rest camp. Knotty Ash, Liverpool, England. When first established, it con-
sisted of a number of marquee tents of about 150-bed capacity and was intended
as a contagious disease hospital for the Liverpool rest camp. From May 27,
1918, to June 6, 1918, the hospital w^as operated by hospital unit Q and from
June 7, 1918, by hospital unit W. On August 10, 1918, a contract was let
for a permanent 500-bed hospital of brick and concrete construction. The
new institution consisted of two separate divisions, a general section and a
contagious disease section. These sections were so constructed as to permit
their use as a whole or independently of each other.
» The statements of fact appearing herein are based on the "History, Camp Hospital No. 38 .A. E. F.," Chatillon
sur Seine, by First Lieut. Joseph M. Weldon, M. C, while on duty as a member of the staff of that hospital. The history
is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
* The statements of fact appearing herein are based on the "History, Camp Hospital No. 39, A. E. F.," La Ro-
chelle, by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington,
n. C.~Ed.
•The statements of fact appearing herein are based on the "History, Camp Hospital No. 40, A. E. F.," Knotty
Ash, Liverpool, by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O.,
Washington, D. C.—Ed.
766
ADMIXrSTRATION, AMERICAN EXPEDITIONARY FORCES
The general section consisted of an administration buihling, a modern
surgery, six wards, kitchen, messes, and a large recreation hall. The buildings
wer'e connected by a canopied runway which started at the center of the admin-
istration building and traversed the entire block. Also there were a central
heating plant and quarters for the personnel. The contagious disease section
consisted of an administration building, 11 wards and a kitchen, all connected
by a canopied runway.
Due to the shortage of labor and to frequent strikes, the new hospital
was not ready for occupancy until the latter part of January, 1919, although
some parts o'^f it were put to use in December, 1918. During its existence,
the hospital cared for 3,909 medical and 901 surgical cases. The greatest
number of patients in hospital was 859, on September 30, 1918.
Fii;. lafi.— Canip Hospital No. 41, Ts-sur-Tillo
Camp Hospital No. 40 ceased to function April 30, 1919; its personnel
sailed from Brest May 4, 1919, on the Haverford, and were demobilized at
Camp Grant, 111., May 23, 1919.
CAMP HOSPITAL NO. 41 '
Camp Hospital No. 41 was opened on March 11, 1918, at Is-sur-Tille,
Department Cote d'Or, advance section, its personnel coming from the Ameri-
can Expeditionary Forces at large. It was of barrack construction and con-
sisted of an administration building, nine wards, supply building, mess halls,
and personnel quarters; its capacity when completed was 500 beds. It served
the command at Camp Williams, Is-sur-Tille, which at times numbered as many
as 24,000, and all the sick taken from troop trains passing through the regulat-
ing station at Is-sur-Tille. All cases for X ray, and all eye, ear, nose, and
throat cases needing special treatment were transferred from it to Base Hos-
'" The statements of fact appearing herein are based on the " History, Camp Hospital No. 41, A. E. F.," Is-sur-Tille,
by the commanding officer of that hospital. The history is on file in the Historical Division, S. O. O., Washington,
D. C.—Ed.
HOSPITALS
767
pital No. 17, at Dijon; also most of the laboratory work was done at the central
Medical Department laboratory at Dijon. Prior to October 1, 1918, all major
surgical cases and fracture cases were transferred to Dijon, and only minor
surgical and emergency cases were treated locally; however, after a large sur-
gical ward with modern operating room had been completed in October, all
surgical cases admitted were cared for at Camp Hospital No. 41.
During its first year, March 11, 1918, to March 31, 1919, the hospital
admitted 12,270 medical and surgical cases; the greatest number of patients
admitted in one month was 1,589, in December, 1918.
The hospital ceased to function May 23, 1919; its personnel sailed from
Brest, July 1, 1919, on the President Grant, and were demobilized at Camp
Devens, Mass., shortly afterwards.
CAMP HOSPITAL NO. 42 *
Camp Hospital No. 42 came into existence in May, 1918, at Bar-sur-Aube,
Department Aube, advance section, and was operated by the personnel of
Fifi. 157.— Camp Hospital No. i2, Bar-sur-Aube
Ambulance Company No. 161. It occupied a type B, 300-bed unit, constructed
by the United States Engineers, and served the thirteenth training area, which
was occupied successively by the Artillery headquarters of the Army, the 5th
and 36th Divisions, and headquarters of the first Army. It was not fully
equipped until the latter part of July and August, 1918, when it began to func-
tion to its full capacity. From June 5, 1918, to October 26, 1918, the hospital
was operated by Ambulance Company No. 42; subsequently by personnel
from the American Expeditionary Forces at large. From May 5, 1918, to
March 1, 1919, 3,274 patients were admitted; of these 3,039 were medical
and 235 surgical. The greatest number of patients in hospital was 478, on
September 27, 1918. Camp Hospital No. 42 ceased to function April 20, 1919;
its personnel sailed from Marseille, May 15, 1919, on the Canada and were
demobilized at Camp Dodge, Iowa., June 9, 1919.
* The statements of fact appearing herein are based on the "History, Camp Hospital No. 42, A. E. F.," Bar-sur-Aube,
by the commanding officer of that hospital. The history is on file in the Historical Division, P. G. 0., Washington.
1). C.-Ed.
13901—27 49
768
ai):mixistration, American expeditionary forces
CAMP HOSPITAL NO. 43 '
Camp Hospital Hospital No. 43 came into existence in April, 1918, at
Gievres, Department Loir et Cher, intermediate section, when the post hospital
there was designated Camp Hospital No. 43. The post hospital had been in
operation since November, 1917, and prior to February 25, 1918, was known as
the regimental infirmary, 15th Engineers. It served the various troops and
civilian laborers (Chinese and Spanish) stationed at Gievres. When first
established the hospital consisted of two wooden barracks; however, when
construction was completed in September, 1918, it operated in 24 buildings,
of 400-bed capacity. In addition to the barracks, about 20 hospital tents were
used constantly for the accommodation of the large number of mumps cases
brought in with arriving troops. In August, 1918, an X-ray machine was
installed, and the hospital functioned practically as a base hospital. Prior to
that time, all major surgical cases and fractures were transferred to Base Hos-
pital No. 9, at Chateauroux.
On February 10, 1919, Base Hospital No. 94, operating at Pruniers, ceased
to function as a base hospital and became a part of Camp Hospital No. 43. Base
Hospital No. 94 consisted of 50 buildings. On taking over this hospital, the
old camp hospital was designated a contagious-disease hospital and used for
contagious, skin, and venereal diseases. Camp Hospital No. 43 ceased oper-
ating in August, 1919, and its personnel were returned to United States.
CAMP HOSPITAL NO. 44
Camp Hospital No. 44 was established April 14, 1918, at Riom, Depart-
ment of Puy-de-Dome, intermediate section, its personnel coming from the
American Expeditionary Forces at large. The hospital occupied the pictur-
esque old Chateau de Miroble, which was leased from the owner, and is located
about 10 km. from the city of Clermont-Ferrand. The original function of
the establishment was to serve the seventh aviation instruction center. First
patient was admitted on April 25, 1918, and from July to December, 1918, the
bed capacity of 200, was not entirely utilized by the sick of the flying field;
many ambulatory and slightly wounded were received from Base Hospitals Nos.
20 and 30. Camp Hospital No. 44 ceased operating December 4, 1918, and the
personnel were distributed to other hospitals in the American Expeditionary
Forces.
CAMP HOSPITAL NO. 45 "
Camp Hospital No. 45 was established July 8, 1918, at Aix-les-Bains,
Department Savoie, intermediate section, its personnel coming from the
American Expeditionary Forces at large. The hospital occupied the Leon
Blanc Hospital, on the outskirts of Aix-les-Bains. The establishment served
the Aix-les-Bains leave area and cared for sick and injured from all the sur-
rounding areas. During the summer most of the patients were victims of
'The statementsof fact appearing herein are based on the"History, Camp Hospital No. 43, A. E. F.," Gievres, bythe
commanding officer of that hospital. The history is on file in the historical Division, S. G. O., Washington, D. C.,— Ed.
"> The statements of fact appearing herein are based on the "History, Camp Hospital So. 44, A. E. F.," Riora, by
the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed-
" The statements of fact appearing herein are based on the " History, Camp Hospital No. 45, A. E. F.," Aix-les-Bain.
by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C—
Ed.
HOSPITALS
769
bicycle accidents and mountain climbs. In the fall of the year, influenza
and pneumonia made its appearence and necessitated the erection of several
wooden barracks to accommodate the large increase of hospital admissions;
the bed capacity of hospital expanded from 70 to 260. Camp Hospital No.
45 ceased operating May 23, 1919; its personnel sailed from Brest June 29,
1919, on the General Washington, and were demobilized at Camp Grant, 111.,
July 12, 1919.
CAMP HOSPITAL NO. 46 »
Camp Hospital No. 46 was established May 16, 1918, at Landerneau,
a small town about 14 miles east of Brest, Department Finistere, base section
Fig. l.W.— Camp Hospital No. 45, Aix-les-Bains
No. 5. Its personnel were assigned from the American Expeditionary Forces
at large. It occupied a part of a large French convent school, the Pensionnat
du Calvare, which was suitable for hospital purposes, as it contained many
large well lighted and ventilated rooms; however, the sanitary arrangements
were exceedingly poor and no adequate water supply existed. A detach-
ment of United States Engineers was attached to the hospital to install the
necessary plumbing and to provide a sufficient water supph^; also several
wooden barracks for the personnel were constructed by the Engineers, and the
bed capacity of the hospital was increased from 250 to 300. Camp Hospital
" The slateitipnts of fact appearing herein are based on the " History, Camp Hospital No. 46, .\ . E. F.," Landerneau,
by Maj. James Breslin, M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. O. O., Washington, D. C.— Ed.
770
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
No. 46 was intended for convalescent patients only, but it received cases of
acute disease and of injury from its surrounding area. During December,
1918, only venereal cases en route to the United ^States were admitted. The
total number of patients admitted during its existence was 1,150. The hos-
pital was closed February 28, 1919, and its personnel were transferred to Camp
Pontanezen, Brest, for duty.
CAMP HOSPITAL NO. 47 "
Camp Hospital No. 47 was established in June, 1918, at Autun, Depart-
ment Saone et Loire, intermediate section, its personnel coming from the
American Expeditionary Forces at large. This organization remained until
Fiu. iri9.— Camp Hospital No. 46, Landerneau
July 30, 1918, when it was relieved by Base Hospital No. 45. The base hos-
pital unit remained until August 19, 1918, when it was transferred to Toul
for duty. The hospital remained vacant until September 24, 1918, when
casual personnel arrived and reestabUshed Camp Hospital No. 47, which then
occupied a French building, the Caserne Billard, originally a seminary and
later used by the French as barracks; its capacity was 500 beds. The first
patients were received October 10, 1918, from a hospital train, about 344 in
number and nearly all convalescing. This institution functioned as a camp
hospital until November 1, 1918, when its designation was changed to Base
Hospital No. 208.
"The statements of fact appearing herein are based on the "History, Camp Hospital No. 47, A. E. F.," Autun, by
the commanding officer of that hospital. The history is on file in the Historical Division, S. G. 0„ Washington, D. C.-Ed.
HOSPITALS
771
CAMP HOSPITAL NO. 48 «
Camp Hospital No. 48 came into existence in June, 1918, at Recey-sur-
Ource, Department Cote d'Or, advance section, and was operated by Field
Hospital No. 42. It occupied a type B, 300-bed unit and served the fourteenth
training area, which was occupied by the Sixth Division. On October 28, 1918,
Field Hospital No. 42 was relieved from duty at Camp Hospital No. 48 and
casual personnel were assigned in its place. Over 5,000 patients were cared
for in this institution. Camp Hospital No. 48 ceased to function on May 27,
1919; its personnel sailed from Brest on June 22, 1919, on the Montana, and
upon arrival in the United States were transferred to Camp Dodge, Iowa,
for demobilization.
Fk,. loo. Caiiiii lld^piial .\(]. 48, Recey-sur-Ource
CAMP HOSPITAL NO. 49 ^
Camp Hospital No. 49 was instituted in July, 1918, at Laignes, Depart-
ment Cote d'Or, advance section, and was operated by personnel from the
American Expeditionary Forces at large. It was located in a type B, 300-
bed unit and served the fifteenth training area, which was occupied by the
7th and, later, by the 80th Division. Only minor medical and emergency
surgical cases were treated; all major surgical cases were transferred to Base
Hospital No. 17 at Dijon. Patients were first admitted September 22, 1918;
and during its existence, 2,658 surgical and medical cases were cared for. The
greatest number of patients admitted in one month was 803, in December,
1918. Camp Hospital No. 49 ceased operating April 11, 1919, and its per-
sonnel were returned to the United States.
"The statements of fact appearing herein are based on the "History, Camp Hospital No. 48, A. E. F., "Recey-sur-Ource,
by Lieut. Col. Alva S. Pinto, M. C, while on duty as a member of the stafi of that hospital. The history is on file in
the Historical Division, S. G. O., Washington, D. C.—Ed.
'The statements of fact appearing herein are based on the "History, Camp Hospital No. 49, A. E. F.," Laignes,
by Capt. C. P. Gammon, M. C., while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.~Ed.
772
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CAMP HOSPITAL NO. 50 •
Camp Hospital No. 50 was established in September, 1918, at Tonnerro,
Department Yonne, advance section, its personnel coming from Sani-
tary Squads Nos. 8, 17, and 38. It occupied a type B, 300-bed unit and served
the sixteenth training area, which was successively occupied by the 81st
Division, First Army Corps, 36th and 80th Divisions. The majority of the
surgical cases cared for at this hospital were emergency and minor cases; all
major and chronic surgical conditions were transferred to Base Hospital No.
17, at Dijon. During its existence, the hospital cared for 4,120 surgical
and medical cases; the greatest number of patients admitted in one month
was 835, in February, 1919. Camp Hospital No. 50 ceased operating May
5, 1919;' its personnel sailed June 15, 1919, from St. Nazaire on the Texan,
and were demobilized at Camp Dix, N. J.
CAMP HOSPITAL NO. 51 '
Camp Hospital No. 51 was authorized June 19, 1918, at Roanne, Depart-
ment Loire, intermediate section. It occupied 2 separate groups of build-
ings about one-half mile apart, 1 consisting of 12 French wooden barracks, the
other of 4 stone buildings; the total capacity was 800 beds. Both of the
groups were well-equipped, containing modern lighting facilities and sewer
systems. In July, 1918, Base Hospital No. 48 was assigned to this station
for duty, but remained only a few days. The hospital remained unoccupied
until in September, 1918, when permanent personnel was assigned. The ma-
jority of the patients received were convalescents from the hospital center
at Vichy. During its existence, the hospital cared for approximately 3,000
surgical and medical cases; the greatest number of patients in hospital at one
time was 1,108. It ceased to operate November 21, 1918, and its personnel,
with the exception of a few officers, were transferred to Camp Hospital No.
57, at St. Amand, for duty.
CAMP HOSPITAL NO. 52 "
Camp Hospital No. 52 was established in August, 1918, at Le Mans,
Department Sarthe, intermediate section, its personnel being taken from the
American Expeditionary Forces at large. It was located in the old monas-
tery, which had been occupied by the French complementary hospital No.
49. The monastery was poorly suited for hospitalization, for its large halls
and high ceilings and stone floors made it damp and difficult to heat. Plumb-
ing and wiring were insufficient and a large force of men was required to keep
the building in repairs. In addition to the monastery,* 2 schools, a girls'
and a boys' normal school, each accommodating about 200 patients, were taken
« The statements of fact appearing herein are based on the "History, Camp Hcspital No. 50, A. E. F.," Tonnerre,
by Capt. Samuel L. Wadley, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
'The statements of fact appearing herein are based on the "History, Camp Hospital No. 51, A. E. F.," Roanne,
by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington,
D. C.—Ed.
« The statements of fact appearing herein are based on the "History, Camp Hospital No. 52, A. E. F.," Le Mans,
by the commanding officer of that hospital.' The history is on file in the Historical Division. S. G. O., Washington,
D. C —Ed. ■ •
HOSPITALS
773
over from the French. These schools were only a few hundred yards dis-
tant from the main building and were designated as annex Nos. 1 and 2, re-
spectively. Annex No. 3, a mumps camp under canvas, was erected about
750 yards from the main building; it accommodated about 750 patients. The
total normal bed capacity was 1,700, although in emergency as high as
2,000 patients were cared for at one time. The strength of personnel varied;
during the winter of 1918-19, it averaged 60 officers, 650 enlisted men, and
90 nurses. This institution served the 2d Depot Division area, which at times
contained as many as 200,000 troops. It handled a large number of patients,
and up to December 31, 1918, admitted among others over 4,500 cases of
mumps; the surgical service performed 380 operations. It was well equipped
in all departments and practically functioned as a base hospital. No battle
casualties were received. i
Camp Hospital No. 52 ceased operating July 1, 1919; its personnel sailed;
from Brest July 5, 1919, on the Prinz Friedrich Wilhelm,^ and were demobilized!
at Camp Gordon, Ga., July 23, 1919. [
CAMP HOSPITAL NO. 53" '
Camp Hospital No. 53 was organized in September, 1918, at Marseille,
Department Bouchet du Rhone, base section No. 6; its personnel came from'
the American Expeditionary Forces at large. It was located on the principal
street of Marseille, the Boulevard Prado, and occupied a large stone building'
formerly used as a theological institution. Its original bed capacity of 300 wasl
increased to 500. Camp Hospital No. 53 served the port of Marseille and was'
opened for patients on September 25, 1918. The hospital ceased to function!
in June, 1919; its personnel returned to the United States and were demobilized^
at Camp Taylor, Ky., on July 23, 1919. [
CAMP HOSPITAL NO. 54' •
Camp Hospital No. 54 was established in September, 1918, at'Beaulieu,!
Department Dordogne, base section No. 2, its personnel coming from the^
American Expeditionary Forces at large. It was located in Chateau la Roche, -
a fairly modern, three-story, country estate, built of stone; however, the cha-;
teau had been unoccupied for many years prior to the war, and it was not in a
good state of repair. The area served by the hospital soon was unexpectedly
occupied by the 84th Division, and much difficulty was experienced in obtaining
food, supplies, and transportation for the sick. The normal capacity of hos-
pital was 150 beds. On October 2, 1918, Field Hospital No. 333 took over the
hospital, and its designation was changed to Camp Hospital No. 78 (q. v.)
The personnel were transferred to the new organization for duty.
•The statements of fact appearing herein are based on the "History, Camp Hospital No. 53, A. E. F.," Marseille,
by Maj. S. Calvin Smith, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. O. O., Washington, D. C.—Ed.
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 54, A. E. F.," Beaulieu,
by Maj. Bernard J. Beanker, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.— Ed.
774
ad:mixistration, American expeditionary forces
CAMP HOSPITAL NO. 55^
Camp Hospital No. 55 was established during the month of January, 1918,
at Ferrieres, Department Loiret. It was located in an old stone monastery which
had been used as a hospital by the French during the early period of the war.
The personnel of this hospital was drawn from the United States Army Ambu-
lance Service with the French Army. The function of the hospital was to care
for the sick of that organization. It ceased ope'rating on May 18, 1919.
CAMP HOSPITAL NO. 56 "
Camp Hospital No. 56 was established July 29, 1918, at Avoine, Depart-
ment Indre et Loire, intermediate section, for the purpose of serving the Chinon
Fig. 161.— One of the buildings, Camp Hospital No. 56, Avoine
area. Its personnel were assigned from the American Expeditionary Forces at
large and averaged 3 medical officers and 21 enlisted men. It was located in a
modern chateau, about one-half mile from Avoine, and had a bed capacity of
80. The chateau was well equipped with baths, laundry, and a lighting plant,
and was situated on 25 acres of open ground. Camp Hospital No. 56 functioned
until January 14, 1919, when it was abandoned and the personnel were reas-
signed to other stations for duty.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. .5o, A. E. F ," Ferrieres,
by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington. D. C-
Ed,
» The statements of fact appearing herein are based on the "History, Camp Hospital No. 56, A. E F " \voine by
Capt. John E. McQuain, M. C, while on duty as a member of the staff of that hospital. The' hi'Jtory is on file in' the
Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
775
CAMP HOSPITAL NO. 57 -
Camp Hospital No. 57 was established in August, 1918, at St. Amand
Mont Rond, Department Cher, intermediate section, to care for the sick
and wounded of the 3d Depot Division. It was located m portion of the French
hospital of that city and occupied two 10-bed wards and four 2-bed rooms.
Through the courtesy of the sisters in charge of the hospital the operating
room was available for emergency use. The personnel came from Field Hos-
pital No. 303. On September 1, 1918, the hospital was moved to a building
which formerly had been a private school, accommodating about 150 patients.
Twelve beds for acute surgical cases were reserved at the French hospital
and all operations were performed at the latter institution. The number of
patients averaged from 120 to 160. The 3d Depot Division was discontinued
about November 1, 1918, and the personnel of the hospital were skeletonized
to 1 officer and 12 enlisted men. It continued to function until January 31, 1919,
when it was closed and the personnel were reassigned to other stations for
duty.
CAMP HOSPITAL NO. 59"
Camp Hospital No. 59 was established August 21, 1918, at Issoudun,
Department Indre, intermediate section, by casual personnel. It occupied
the buildings of the Ecole Sacre Coeur, a school for boys, a large four-story
building with a large park. Prior to its occupation by Camp Hospital No. 59,
this building had been used by the French Hopital Complementaire No. 43.
Many improvements and repairs were required as there were no baths of any
kind, the lighting facilities were uncertain, and sanitary appliances were inade-
quate. The capacity was 600 beds. Patients were received first on September
8, 1918, and during its existence the hospital admitted a total of 1,404 surgical
and medical cases. Three convoys of patients were received from the advanced
areas by hospital trains; the largest number of patients in hospital was 580,
September 20, 1918. During September, 1918, when the admission rate was
at its height. Field Hospital No. 156 was assigned to Camp Hospital No. 59
for temporary duty. On February 18, 1919, all patients were transferred to
Base Hospital No. 63, at Chateauroux, and the hospital ceased operating on
that date. Its personnel were reassigned to other stations for duty.
CAMP HOSPITAL NO. 61
Camp Hospital No. 61 was organized in August 1918 at Poitiers, Depart-
ment Vienne, intermediate section; its personnel were assigned from the Amer-
ican E.xpeditionary Forces, at large. It was located in the Ancienne Seminaire,
which had been occupied by the French Hopital Temporaire No. 16, and was
taken over with its entire equipment on August 28, 1918. On September 18,
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 57, A. E. F.," St. Amand
Mont Rond, by the commanding oflBcer of that hospital. The history is on file in the Historical Division, S. G. 0., Wash-
ington, D. C.—Ed.
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 59, A. E. F.," Issoudun,
by Maj. Charles O. Boswell, M. C, while on duty as a member of the staff of that hospital. The history is on file in
the Historical Division, S. G. O., Washington, D. C.—Ed.
» The statements of fact appearing herein are based on the "History, Camp Hospital No. 61, A. E. F.," Poitiers,
by First Lieut. John E. Treivweiler, M. C, while on duty as a member of the staff of that hospital. The history is on
file in the Historical Division, S. O. O., Washington, D. C.—Ed.
776
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
a part of the Ecole de Theologie, then occupied by Hopital Temporaire No. 21,
was taken over, bringing the normal bed capacity of the entire hospital up to
480. Patients were received first on September 22, 1918, and the first hos-
pital train arrived on November 5, 1918, with 471 battle casualties. On that
date the designation of Camp Hospital No. 61 was changed to Base Hospital
No. 218. The institution functioned as a base hospital until February 13, 1919,
when its status was again changed to that of Camp Hospital No. 61, where-
upon the greater part of the plant was discontinued and the buildings were
returned to the French; the bed capacity w^as reduced to 75. The hospital
was officially closed on May 28, 1919, its personnel sailed from Brest June 26,
1919, on the Noordam, and were demobilized at Camp Upton, N. Y.
Klu. ]IV2.- -Cainp lli,s|)it;il X(j. .VJ, l^oii.luii
CAMP HOSPITAL NO. 62 '
Camp Hospital No. 62 was organized in August, 1918, at Sancerre,
Department Cher, intermediate section. Its personnel came from the Amer-
ican Expeditionary Forces at large. It was located in the hotel Pont du Jour,
a four-story, steam-heated and electrically lighted structure of 125-bed capac-
ity, and served the 4th Depot Division. In addition to the hospital at
Sancerre, two auxiliary hospitals were opened about the middle of August,
1918, one at Veaugues, operated by Field Hospital No. 338, and one at Cosne,
operated by Field Hospital No. 339. These auxiliary hospitals were intended
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 62, A. E. F.," Sancerre,
by the commanding officer of that hospital. The history is on file in the Historical Division S O O Washinuton
D.C.— Ed. ■ ■'
HOSPITALS
777
for the treatment of infectious diseases only. Total number of patients
treated by Camp Hospital No. 62 was 841. It ceased to operate on November
1, 1918, and its personnel were reassigned to other stations for duty.
CAMP HOSPITAL NO. 64 ^
Camp Hospital No. 64 was established in August, 1918, at Chatillon, Depart-
ment Cote d 'Or, advance section, and occupied a type B,300-bed unit. The
enlisted personnel was assigned from Sanitary Squads Nos. 54 and 63, replaced
later by casuals. It was opened for the reception of patients on September 26,
1918. Camp Hospital No. 64 served the twelfth training area, then occupied
by the 81st Division; during its existence it received 1,340 medical and surgical
cases. The hospital ceased operating May 20, 1919, and the personnel sailed
for New York from St. Nazaire June 14, 1919, on the Santa Barbara.
Fig. 103.— Camp llDsjiital Xo. t;4, Chat illon-sur-Srim'
CAMP HOSPITAL NO. 65 ^
Camp Hospital N. 65 was established in October,1918, at Semur, Depart-
ment Cote d'Or, advance section, and was operated by personnel from the
American Expeditionary Forces at large. It was located in a type B, 300-bed
unit and served the twenty-first training area, then occupied by the 78th
Division. The hospital received both surgical and medical cases; the first
patients were admitted November 17, 1918. Since the operating room and
surgical wards were not opened until December 3, 1918, prior to that time all
surgical cases had to be transferred to Base Hospital No. 17 at Dijon.
Camp Hospital No. 65 ceased to function May 8, 1919; its personnel sailed May
30, 1919, from Marseille on the Madonta and were demobilized at Camp
Grant, 111., June 24, 1919.
The statements of fact appearing herein are based on the "History, Camp Hospital No. 64, A. E. F.," Chatillon,
by the commanding ofTiccr of that hospital. The history is on file in the Historical Division, S. G. O., Washington,
D. C.—Ed.
• The statements of fact appearing herein are based on the "History, Camp Hospital No. 65, A. E. F.," Semur,
by the commanding oflicor of that hospital. The history is on file in the Historical Division, S. O. 0., Washington,
D. C.~Ed.
778
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CAMP HOSPITAL NO. 66^
Camp Hospital No. 66 came into existence in August, 1918, when the
infirmary. Camp St. Sulpice, Department Gironde, base section No. 2, was
designated Camp Hospital No. 66. Personnel came from the American
Expeditionary Forces at large. At this time, the hospital operated in several
wooden barracks and tents. In November, 1918, a new hospital having been
completed, was taken over by Camp Hospital No. 66. It consisted of 28
barrack wards of corrugated iron, finished inside with beaver board and wood,
and accommodated 400 patients. It served the Libourne area, then occupied
by United States Engineers, a labor battalion, and prisoners of war. The
total population of the camp was approximately 10,000. The hospital ceased
to function June 9, 1919. The personnel sailed from Bordeaux June 19, 1919^
on the Infanta Isabella, arrived at Camp Merritt, N. J., June 30, 1919, and
were demobilized at Camp Upton, N. Y., shortly afterward.
CAMP HOSPITAL NO. 67 "
Camp Hospital No. 67 was established in November, 1918, at Chemilly,
Department Yonne, advance section, and was aperated by personnel taken from
the American Expeditionary Forces at large. On December 12, 1918, Field
Hospital No. 42, with its full equipment, was attached for duty. The hospital
was housed in several wooden barracks and served the nineteenth training
area. Patients were received first on December 23, 1918. There were but
very few troops Stationed in the area served by this hospital and the maximum
number of patients in hospital at any one time was 29. It ceased to function
March 25, 1919, and its personnel were reassigned to other stations for duty.
CAMP HOSPITAL NO. 68 "
Camp Hospital No. 68 was established September 18, 1918, at Bourges,
Department Cher, intermediate section, and was operated by personnel taken
from the American Expeditionary Forces at large. It occupied a part of the
College de Jeunes Filles, an old three-story stone building, which formerly
had been used by the French as a hospital. Later, another three-story build-
ing was taken over and operated as an annex to Camp Hospital No. 68. The
hospital was well equipped, and its normal bed capacity was 350, with emer-
gency expansion to 400. It was established for the care of the personnel at
the central records office and postal express service, which included 500 British
female employees (W. A. A. C.)
It ceased to function June 12, 1919; the personnel sailed from Brest July
1, 1919, on the President Grant and were demobilized at Camp Devens, Mass.,
July 13, 1919.
f The statements of fact appearing herein are based on the "History, Camp Hospital No. 66, A. E. F., " St. Sulpice,
by Lieut. Col. O. W. Pinkston, M. C, while on duty as a member of the staff of that hospital. The history is on file,
in the Historical Division, S. G. 0., Washington, D. C. — Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No, 67, A. E. F., " Chemilly
by the commanding officer of that hospital. The history is on file in the Historical Division S G O Washington,
D. C.~Ed. ■ ■'
* The statements of fact appearing herein are based on the " History, Camp Hospital No. 68, A. E. F., " Bourges, by
the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
HOSPITALS
779
CAMP HOSPITAL NO. 70 '
Camp Hospital No. 70 was established in September, 1918, at St. Florent
sur Cher, Department Cher, intermediate section, and was operated for a
time by Field Hospital No. 156. It was located in an old factory building of
300-bed capacity and served the 5th Depot Division, Field Hospital No. 156
was relieved from duty at the hospital, January 13, 1919, and was replaced by
a detachment of casuals. On January 25, 1919, all patients were evacuated
to Camp Hospital No. 59 at Issoudun, and the hospital ceased operating
January 31, 1919. The personnel were reassigned to other stations for duty.
Fig. 164.— Camp Hospital No. 68, Bouiges
CAMP HOSPITAL NO. 72 '
Camp Hospital No. 72 was established September 26, 1918, at Chateau-
dii-Loir, Department Sarthe, intermediate section, by personnel taken from
the American Expeditionary Forces at large. When first organized, it occupied
four rooms in the Hotel de la Gar, but on October 11, 1918, it was moved to
the Ecole Primarie Superieure des Garcons. The school was a modern, three-
• The statements of fact appearing herein are based on the "History, Camp Hospital No. 70, A. E. F.," St. Florent,
hy Capt. Harry C. Fulton, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
' The statements of fact appearing herein arc based on the "History, Camp Hospital No. 72, A. E. F.," Chatcau-
<lu-Loir, by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington,
D. C.-Ed.
780
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
story building of 26 rooms, well adapted for hospital purposes, and liad a hod
capacity of 300. The hospital served the Quartermaster Department depot
at Chateau-du-Loir and miscellaneous troops in that area. Camp Hospital
No. 72 ceased to function May 14, 1919; part of its personnel and all supplies
were transferred to Camp Hospital No. 114 at Ecommoy. The remaining
personnel sailed from Brest, June 25, 1919, on the Seattle, and were demobilized
at Camp Upton, N. Y., July 9, 1919.
Fic. 165— Camp Hospital No. 72, Chaieau-Gu-Loir
CAMP HOSPITAL NO. 73 *
Camp Hospital No. 73 was organized October 1, 1918, at Le Blanc, Depart-
ment Indre, intermediate section, for the purpose of caring for the sick of the
Field Artillery motor training camp there. It was established in the building
of the College des Garcons, in which there were adequate and ample facilities
for wards and quarters for the personnel. The personnel came from casuals
arriving overseas late in 1918. The total number of patients admitted was
150. The hospital was closed January 8, 1919, and its personnel were
reassigned to other stations for duty.
* The statements of fact appearing herein are based on the "History, Camp Hospital No. 73, A. E. F.," Le Blanc,
by Maj. George H. Stagner, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.— Ed.
HOSPITALS
781
CAMP HOSPITAL NO. 75 '
Camp Hospital No. 75 was established October 5, 1918, at Loches, Depart-
ment Indre et Loire, intermediate section. Its personnel came from the
American Expeditionary Forces at large. It was located in the buildings of the
normal school of Loches, and was of 300-bed capacity. The school was suitable
for hospital purposes and consisted of three separate buildings, all equipped
with modern sanitary fixtures, and running hot and cold water. The hospital
functioned until November 21, 1918, when it was closed and its personnel
were reassigned to other stations for duty.
CAMP HOSPITAL NO. 76 '
Camp Hospital No. 76 began about March 1, 1918, as a small regimental
infirmary of the 501st Engineers, located at Mehun sur Yevre, Department
Cher, intermediate section. At that time the entire infirmary was housed
in one Adrian barrack. Early in October, 1918, construction of the hos-
pital was begun by the 501st Engineers and it was completed within the month.
When completed, the hospital consisted of 10 barracks, all connected by a
closed corridor, and accommodated 150 patients. Tents also were erected
from time to time and the bed capacity of the hospital could be expanded
to 300 beds. The hospital served approximately 7,000 troops located in
various camps in that area. During its existence it cared for 2,936 medical
and 123 surgical cases. Camp Hospital No. 76 ceased operating June 10,
1919, and its personnel, with the exception of one officer and three enlisted
men, was reassigned to other stations for duty. The skeletonized Camp
Hospital No. 76 returned to the United States, sailing from St. Nazaire June
23, 1919.
CAMP HOSPITAL NO. 77 «
Camp Hospital No. 77 was established in October, 1918, at Montmorillon,
Department Vienne, intermediate section, by personnel from the medical
replacement unit No. 37. It was located in a school for boys, the Seminaire
Cardinal Pie, which was quite suitable for hospital purposes. The hospital
with a bed capacity of 200, served the Montmorillon training area. As there •
were no civilian doctors in the village of Montmorillon, the medical officers
at the hospital held daily sick call for the civilian population in the surround-
ing area. During the existence of this hospital, approximately 500 medical
and surgical cases were cared for. It ceased to operate November 28, 1918,
when all remaining patients were transferred to Base Hospital No. 28, at
Limoges. The personnel were reassigned to other medical organizations for
further duty.
'The statements of fact appearing herein are based on the "History, Camp Hospital No. 75, A. E. F.," Loches,
by Capt. C. H. Courtney, M. C. , while on duty as a member of the stalT of that hospital. The history is on file in the
Historical Division, S. O. O., Washington, D. C.—Ed.
"The statements of fact appearing herein are based on the "History, Camp Hospital No. 76, A. E. F.," Mehun
sur Yevre, by Maj. John C. O'Connor, M. C, while on duty as a member of the staff of that hospital. The history
is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
"The statements of fact appearing herein are based on the "History, Camp Hospital No. 77, A. E. F.," Mont-
morillon, by Capt. Frederick C. Warfel, M. C, while on duty as a member of the staff of that hospital. The history is
on file in the Historical Division, S. O. O., Washington, D. C.—Ed.
782
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CAMP HOSPITAL NO. 78 -
Camp Hospital No. 78 came into existence October 2, 1918, when the
designation of Camp Hospital No. 54, at Beaulieu, Department Dordogne,
base section No. 2, was changed to that of Camp Hospital No. 78. On that
date Field Hospital No. 333 took over and operated the hospital. The normal
bed capacity was 150, but dm-ing the epidemic of influenza in October, 1918,
6 ward tents, capacity of about 20 cots each, were erected on the hospital
grounds for convalescent patients. The hospital ceased to function with the
departure of the 84th Division on November 30, 1918, and its personnel was
reassigned. During its existence, 756 cases were admitted, including patients
cared for by Camp Hospital No. 54 (q. v.).
CAMP HOSPITAL NO. 79"
Camp Hospital No. 79 was opened on October 22, 1918, at St. Andre de
Cubzac, Department Gironde, base section No. 2, and was the outgrowth of
the infirmary, headquarters detachment of the 86th Division. It was located in
the Chateau du Bouilh, an old structure built in the sixteenth century, and
accommodated 90 patients. In addition to the building, three ward tents were
erected on the lawn of the chateau, making the total bed capacity 150. An
operating room was equipped to care for emergency surgery, and several major
operations were performed; 713 medical and surgical cases were admitted
during the existence of the hospital. Camp Hospital No. 79 served the east
Bordeaux area, which was occupied by troops awaiting entrance to the Bordeaux
embarkation camp. It ceased to function May 21, 1919, and its personnel were
transferred to other stations.
CAMP HOSPITAL NO. 82'
Camp Hospital No. 82 was organized on October 29, 1918, at Le Havre,
base section No. 4, and operated by personnel taken from the American Expedi-
tionary Forces at large. It was established for the care of troops passing
through the port of Le Havre and occupied the Hotel Frascati, a large modern
building, composed of three wings, inclosing a large court. This building had
been used as a hospital by the French ever since the outbreak of the war in 1914.
It was well suited for hospital purposes and accommodated about 400 patients.
Patients were received first on November 15, 1918; during its activity this
institution cared for 1,771 medical and surgical cases. The hospital operated
until April 30, 1919, when it was closed and the personnel were reassigned to
other hospitals for duty.
0 The statements of fact appearing herein are based on the "History, Camp Hospital No. 78, A. E. F.," Beaulieu,
by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington
D. C.—Ed.
r The statements of fact appearing herein are based on the "liistory. Camp Hospital No. "9, A. E. F.," St. Andre
de Cubzac, by Capt. Edward J. Strickler, M. C, while on duty as a member of the staff of that hospital. The history is
on fUe in the Historical Division, S. G. O., Washington, D. C. — Ed.
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 82, A. E. F.," Le Havre,
by the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington,
D. C.—Ed.
HOSPITALS
783
CAMP HOSPITAL NO. 85 '
Camp Hospital No. 85 was organized on November 8, 1918, at Montoir,
Department Loire Inferieure, base section No. 1, and was the outgrowth of the
former infirmary of that camp. The construction of the hospital was completed
during the month of November, 1918, and consisted of 28 wooden barracks of
400-bed capacity. It served the Pont Chateau area and supply depot; the
majority of patients received were cases of contagious and infectious diseases.
Total number of patients treated in hospital from August, 1918, to February 28,
1919, was 2,540. On June 6, 1919 Camp Hospital No. 85 reverted to its former
status, its personnel remaining on duty there.
CAMP HOSPITAL NO. 87 •
Camp Hospital No. 87 was established about October 1, 1918, at Cour
Cheverny, Department Loir et Cher. It was located in the Chateau Chautreiul,
with a total bed capacity of about 100, and its function was to care for the sick
of the Signal Corps replacement area. Personnel were drawn largely from the
attached medical personnel of the signal battalions. The hospital ceased oper-
ating on February 17, 1919.
CAMP HOSPITAL NO. 91'
Camp Hospital No. 91 was established in October, 1918, at La Boule,
Department Loire Inferieure, base section No. 1, by personnel from the Amer-
ican Expeditionary Forces at large. It occupied 5 hotels whose total bed
capacity was 800. All of the buildings were modern, electrically lighted, and
were suitable for hospital purposes. La Boule is a seaside summer resort
and the climate, except during November and December, is delightful; the
hospital was used principally as a convalescent home and received patients
from base and camp hospitals in base section No. 1. After January 2, 1919,
Camp Hospital No. 91 functioned as a centralization point for the Army
Nurse Corps under orders to return to the United States. It ceased to receive
patients on February 20, 1919, and was officially closed April 30, 1919. The
personnel were reassigned to other stations for further duty.
CAMP HOSPITAL NO. 92"
Camp Hospital No. 92 came into existence October 26, 1918, when the
designation of Convalescent Hospital No. 3, at Quiberon, Department Mor-
bihan, base section No. 1, was changed to Camp Hospital No. 92. It occupied
11 summer hotels, with a capacity of 990 beds. Patients received by this
hospital were largely convalescent wounded and gassed cases. The institution
functioned as a camp hospital until November 18, 1918, on which date its
designation was again changed to that of Base Hospital No. 236.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 85, A. E. F.," Montoir,
t>y the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington,
I). C.-Ed.
• The statements of fact appearing herein are based on the "History, Camp Hospital No. 87, A. E. F.," Cour Che-
verny, by Maj. A. H. Dunn, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. O. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 91 , A. E. F., " La Boule by
the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C.— Ed.
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 92, A. E. F.," Quiberon,
by the commanding officer of that hospital. The history is on file in the Historical Division, S.O. O., Washington, D.{\—£d.
13901—27 50
784
ADr^IINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
CAMP HOSPITAL NO. 93'
Camp Hospital No. 93 was organized October 29, 1918, at Clamecy,
Department Nievre, intermediate section, for the care of patients from the
Third Army Corps schools. When first established the hospital was located
in three French houses of a total bed capacity of 250. In December, 1918,
the French evacuated their Hospital Temporaire No. 3, located in the school
for girls, and this building with two barracks in the rear were obtained for Camp
Hospital No. 93. The school building, though well equipped, was in a bad
state of repair and required considerable renovating before it could satisfac-
torily be used. During its existence 1,359 surgical and medical cases were
admitted. The hospital ceased operating April 15, 1919, and was replaced by
the infirmary, Third Army Corps. The personnel returned to the United
States by way of Brest, sailing on the President Grant May 28, 1919, and were
demobilized at Camp Devens, Mass.
CAMP HOSPITAL NO. 94 '
Camp Hospital No. 94 was established in November, 1918, at Aytre,
Department Charent Inferieure, base section No. 7, its personnel coming
from Camp Hospitals Nos. 88 and 69. It was located in a 2-story wooden
barrack, 65-bed capacity, constructed by the 35th United States Engineers,
which organization it served. This hospital treated only slightly sick, all
cases requiring special attention being transferred to Camp Hospital No. 39,
at La Rochelle. Patients were admitted first on December 21, 1918. Two
hundred and four were received. From March 8, 1919, to its closing on April
9, 1919, it was used as a venereal disease hospital. Upon its closing, the per-
sonnel were reassigned to other stations for further duty.
CAMP HOSPITAL NO. 95 -
Camp Hospital No. 95 was organized in November, 1918, at Verneuil,
Department Nievre, intermediate section, and served the Verneuil area. At
the beginning it occupied 3 barracks of about 80-bed capacity; in January,
1919, it moved into a new plant consisting of 7 barracks of 108-bed capacity.
The facilities at first were very limited, so medical cases only were kept in the
hospital, all surgical cases being transferred to the hospital center at Mars,
a distance of about 18 miles. The hospital ceased operating on June 10, 1919;
its personnel sailed from St. Nazaire June 27, 1919, on the Kentuchian, and
were demobilized at Camp Upton, N. Y., July 13, 1919.
'The statements of fact appearing herein are based on the "History, Camp Hospital No. 93, A. E. F.," Clamecy,
by Maj. Joseph H. Sayer, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 94, A. E. F.," Aytre, by
Capt. Hugh B. Sprague, M. C, while on duty as a member of the stafi of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
^ The statements of fact appearing herein are based on the "History, Camp Hospital No. 95, A. E. F.," Verneuil, by
the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington, D. C— £d-
HOSPITALS
785
CAMP HOSPITAL NO. 96 «
Camp Hospital No. 96 was organized November 4,« 1918, at Angers,
Department Maine et Loire, base section No. 1, its personnel coming from
Camp Hospital No. 86. It occupied the Ecole Normale, a three-story school
building of masonry construction, well adapted for hospital purposes and
capable of accommodating 250 to 300 beds. It did not have any surgical
or special service facilities, all cases requiring these being transferred to Base
Hospital No. 27, also stationed at Angers. The hospital was estabUshed to
serve troops in the district of Angers, but with the cessation of hostihties the
necessity for this hospital ceased and on January 12, 1919, it was abandoned,
and the personnel reassigned to other stations for duty. During the period
of its operation it cared for 457 medical cases.
CAMP HOSPITAL NO. 97 ^
Camp Hospital No. 97 was organized in October, 1918, at St. Dizier,
Department Haute Marne, advance section, and was the outgrowth of the
American regulating station infirmary at St. Dizier. It was established in
several wooden barracks of 106-bed capacity and served the local troops and
casuals passing through the regulating station. Patients were received first
on November 15, 1918. The hospital ceased to function May 8, 1919; its
personnel sailed from St. Nazaire on June 16, 1919, on the Santa Paula, and
were demobilized at Camp Upton, N. Y., July 6, 1919.
CAMP HOSPITAL NO. 100°
Camp Hospital No. 100 was organized in November, 1918, at Belfort, in
the advance section, and was operated by Evacuation Hospital No. 28. It
was located in a group of buildings, the Caserne Rathenaus de Belfort,
formerly used by a French artillery regiment. The group included 30 large
buildings, constructed of reinforced concrete, with tile floors, electric lights,
modern plumbing, and steam heat, and accommodated 2,000 patients. The
group covered about 12 acres and was surrounded by a high stone wall. This
hospital was located close to the Alsace border and received and cared for
ex-prisoners of war, both American and British, picking them up at rail ends
and transporting them by trucks and ambulances to the hospital. The majority
of patients were medical cases; of these 955 were received, including 521
ex-British prisoners. The hospital ceased to operate January 2, 1919, and
Evacuation Hospital No. 28 proceeded with all its property to Nantes for duty.
CAMP HOSPITAL NO. 101 "
Camp Hospital No. 101 was estabhshed in December, 1918, at Auvours,
about 8 miles from Le Mans, Department Sarthe, intermediate section, and
» The statements of fact appearing herein are based on the "History, Camp Hospital No. 9fi, A. E. F.," Angers, by
Maj. W. E. Stewart, M. C, while on duty as a member of the start of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 97, A. E. F," St. Dizier, by
Maj. E. L. Martindale, IVf. C, while on duty as a member of the staff of that hospital. The history is on file in the Histori-
cal Division, S. O. O., Washington, D. C.—Ed.
' The statements of fact appearing herein arc based on the "History, Camp Hospital No. 100, A. E. F.," Belfort, by
the commanding ofTicer of that hospital. The history is on file in the Historical Division, S. O. O., Washington, D. C. — Ed.
' The statements of fact appearing herein arc based on the "History, Camp Hospital No. 101, A. E. F.," Auvours,
by Maj. Louis J. C. Bailey, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S. G. O., Washington, D. C.—Ed.
786
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
served the 2d Depot Division. The plant consisted of a number of wooden
barracks and tents and was of 1,100-bed capacity. It was operated by the
personnel of Evacuation Hospital No. 11. The hospital, with the exception of
pneumonia and influenza cases, cared for medical cases of a more or less minor
degree. No surgical work was undertaken, all surgical cases and cases requiring
special care were transferred to Camp Hospital No. 52, at Le Mans. The
largest daily admission was 138 cases; 526 was the greatest number of patients
in hospital at any one time. The hospital ceased to operate in June, 1919;
its personnel returned to the United States, sailing from St. Nazaire June 29,
1919, on the Susquehanna and were demobilized at Camp Dix, N. J., July
17, 1919.
CAMP HOSPITAL NO. 102
Camp Hospital No. 102 was established on December 18, 1918, at Virelade,
Department Gironde, base section No. 2, its personnel coming from the
American Expeditionary Forces at large. It was located in the Chateau
Virelade, an unoccupied, large chateau about 25 miles southeast of Bordeaux,
and served the La Brede billeting area, which was occupied successively by the
34th, 40th, 82d, and 78th Divisions. Patients were admitted first on December
18, 1918, and up to April 30, 1919. The hospital received a total of 802 surgical
and medical cases. Camp Hospital No. 102 ceased to operate May 16, 1919;
its personnel returned to the United States, sailing from Bordeaux on the
lovMJi June 10, 1919.
CAMP HOSPITAL NO. 103
Camp Hospital No. 103 w^as established January 14, 1919, at the embarka-
tion camp at Pauillac, Department Gironde, base section No. 2, in a small
hospital formerly used by the United States Navy. It consisted of five small
stone buildings, each having a capacity of about 49 patients. In addition to
the permanent buildings, several wooden barracks were erected, bringing the
total capacity of the hospital up to 471 beds. During its existence the hospital
cared for 2,153 patients, the majority of whom were medical cases. It ceased
to operate May 31, 1919, and its personnel returned to the United States,
CAMP HOSPITAL NO. 104 -
Camp Hospital No. 104 was established on February 5, 1919, at Lussac,
Department Gironde, base section No. 2, its personnel coming from the Amer-
ican Expeditionary Forces, at large. It was located in the Chateau Terrien,
a partially occupied chateau about one-half mile north of the village of Lussac.
The building contained 30 rooms, 2 inside flush-type toilets, with drains leading
into cesspools; a large tank on the third floor, with plumbing in fairly good
condition, furnished the chateau with water. Camp Hospital No. 104 was
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 102, A. E. F.," Virelade,
by Capt. Francis P. Richards, M. C, while on duty as a member of the staff of that hospital. The history is on file in
the Historical Division, S. G. O., AVashington, D. C. — Ed.
"J The statements of fact appearing herein are based on the "History, Camp Hospital No. 103, A. E. F.," Pauillac,
by Lieut. Col. M. A. Dailey, M. C, while on duty as a member of the staff of that hospital. The history is on file in
the Historical Division, S. G. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the " History, Camp Hospital No. 104, A. E. F., " Lussac, by the
commanding oflBcer of that hospital. The history is on file in the Historical Division, S. G. C, Washington, D. C.—Ei-
HOSPITALS
787
established to care for the sick and injured of the Libourne billeting area,
occupied by troops awaiting transportation to the United States. The area
covered about 16 square miles and the sick were collected by two ambulances
making regular morning rounds to infirmaries in the towns of the area. Patients
were received first on February 20, 1919, and the hospital functioned until
May 2, 1919, on which date all patients were transferred to Bordeaux. The
personnel returned to the United States, sailing from Bordeaux on June 10, 1919.
CAMP HOSPITAL NO. 105 /
Camp Hospital No. 105, was established February 6, 1919, at Salleboeuf,
Department Gironde, base section No. 2, to serve the eastern Bordeaux training
area, then occupied by troops awaiting transportation to the United States.
It was located in the Chateau St. Regis, and with the addition of several tents
had a capacity of 200 beds. Patients were admitted first on February 11, 1919,
and the hospital functioned until April 30, 1919, when all remaining patients
were transferred to Base Hospital No. 208 at Bordeaux.
CAMP HOSPITAL NO. 106 <>
Camp Hospital No. 106 was established February 4, 1919, at Blaye, Depart-
ment Gironde, base section No. 2, to serve troops in the Bordeaux area. The
contiguous area was not occupied and the hospital was closed on May 3, 1919.
During its existence only 14 patients were admitted.
CAMP HOSPITAL NO. 107 ^
Camp Hospital No. 107 came into existence March 1, 1919, when Base
Hospital No. 77 at Beaune, Department C6te d'Or, advance section, was
designated Camp Hospital No. 107. It was estabhshed in the buildings of
Base Hospital No. 77 and served the American Expeditionary Force Uni-
versity at Beaune. When taken over, it contained 635 patients. Its capacity
was 1,000 which later was reduced to 300. During its existence 813 medical
and 394 surgical cases were admitted. The hospital ceased to operate in
June, 1919; its personnel returned to the United States, sailing from Brest,
June 27, 1919, on the Manitou, and were demobilized at Camp Upton, N. Y.,
July 9, 1919.
CAMP HOSPITAL NO. 108 •
Camp Hospital No. 108 was organized March 1, 1919, at AUerey, Depart-
ment Saone et Loire, intermediate section, for the purpose of serving the farm
school subpost, American Expeditionary Force University, Allerey. It was
organized from the personnel of Base Hospital No. 97 and took over the
/ The statements of fact appearing herin are based on the " History, Camp Hospital No. 105, A. E. F., " Salleboeuf, by
Maj. F. H. Hurst, M. C, while on duty as a member of the stall of that hospital. The history is on file in the Historical
Division, S. G. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 106, A. E. F., " Blaye, by
Maj. John S. Sweeney, M. C, while on duty as a member of the staff of that hospital. The history is on file in the Histor-
ical Division, S. O. O., Washington, D. C.—Ed.
* The statements of fact appearing herein are based on the "History, Camp Hospital No. 107, A. E. F.," Beaune, by
the commanding officer of that hospital. The history is on file in the Historical Division, S. G. O., Washington. D. C. — Ed.
' The statements of fact herein are based on the "History, Camp Hospital No. 108, A. E. F.," Allerey, by Maj.
Thomas W. Grayson, M. C, while on duty as a member of the staff of that hospital. The history is on file in tho
Historical Division, S. O. O., Washington, D. C.—Ed.
788
ADMIXISTEATIOX, AMERICAN EXPEDITIONARY FORCES
patients and plant of the latter unit. During its two months of operation it
admitted 1,306 surgical and medical cases. The hospital ceased to operate
May 28, 1919, and its personnel returned to the United States on the Leviathan,
saiUng from Brest June 29, 1919. Demobilization of the unit took place July
12, 1919, at Camp Bowie, Tex.
/
CAMP HOSPITAL NO. 109 '
Camp Hospital No. 109 was established February 27, 1919, at Camp
Montierchaum, Department Indre, intermediate section, to serve troops in
that camp and vicinity. It operated in a group of several barrack-type build-
ings of 450-bed capacity, and was built on a low flat piece of land directly to
the northwest of Camp Montierchaum. For convenience of construction of
buildings and general appearance this site was excellent, but the problem of
drainage was very difficult. All classes of patients were admitted and cared for.
The hospital ceased to operate as a camp hospital on June 12, 1919, on which
date its designation was changed to camp infirmary, Camp Montierchaum.
The larger portion of the officers and enlisted men were transferred to other or-
ganizations for duty, and a skeletonized Camp Hospital No. 109, consisting of
1 officer and 4 enlisted men, was returned to the United States, sailing on the
Madowiska, June 28, 1919, from St. Nazaire, and was demobilized at Camp
Jackson, S. C, on July 12, 1919.
CAMP HOSPITAL NO. 110 "
Camp Hospital No. 110 was established in February, 1919, at La Suze,
Department Sarthe, intermediate section, for the care of troops in the Le
Mans embarkation center. It was operated by Field Hospital No. 122 and
Sanitary Train 106. The hospital occupied 15 wooden barracks and had a
normal bed capacity of 350. The site on which the hospital was located was
low and drainage was difficult. Because the water supply was unsatisfactory
a motorized filtering and treating plant was installed. The hospital ceased to
function June 10, 1919; its personnel sailed for the United States from St.
Nazaire June 24, 1919, on the Pocahontas, and were demobilized at Camp
Gordon, Ga., July 8, 1919.
CAMP HOSPITAL NO. Ill '
Camp Hospital No. Ill came into existence March 1, 1919, when the per-
sonnel of Field Hospital No. 123 was transferred to Solesmes, Department
Sarthe, intermediate section, to take over the care of 200 of our patients in
the French Hospital Temporaire No. 38, at that place. Camp Hospital No.
Ill occupied four floors in the abbey of the Benedictines at Solesmes. The
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 109, A. E. F.," Camp
Montierchaum, by Maj. Wayne H. Crum, M. C, while on duty as a member of the stafT of that hospital. The his-
tory is on file in the Historical Division, S. G. O., Washington, D. C.—Ed.
* The statements of fact appearing herein are based on the "History, Camp Hospital No. 110, A. E. F.," La
Suze, by Maj. George A. O'Connell, M. C, while on duty as a member of the staff of that hospital. The history is on
file in the Historical Division, S. G. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. Ill, A. E. F.," Solesmes,
by Maj. Cornelius F. Holton, M. C, while on duty as a member of the staff of that hospital. The history is on file in the
Historical Division, S.G.O., Washington, D. C.—Ed.
HOSPITALS
789
portion of tho building taken over was modern and excellently suited to hospital
purposes. The floors were divided into rooms, each room large enough to
accommodate five patients. The entire building was well lighted by elec-
tricity; heat was furnished by a central heating plant and distributed in all
rooms through radiators. The hospital cared for troops in the Sable area, then
occupied by the 77th Division; during its operation it cared for 1,538 medical
and surgical cases. It ceased to operate May 15, 1919; its personnel w^ere
returned to the United States and demobilized at Camp Upton, N. Y., June 30,
1919.
CAMP HOSPITAL NO. 118-
Camp Hospital No. 118 came into existence April 10, 1919, when the
Medical Department, United States Army, took over and operated what was
until then United States Naval Base Hospital No. 1 at Brest. Camp Hospital
No. 118 functioned from April 10, 1919, to August 15, 1919, and during that
time admitted 1,301 medical and 500 surgical cases.
CAMP HOSPITAL NO. 120 "
Camp Hospital No. 120 was established in April, 1919, at Le Mans, Depart-
ment Sarthe, intermediate section, and served the forwarding camp at that
station. The personnel was taken from Mobile Hospital No. 3, when that
organization was disbanded on April 4, 1919. The hospital was located in a
type A, 500-bed unit, and when first authorized was intended for a base hos-
pital. Admissions to this hospital were very light, as practically all surgical
and serious medical cases were transferred to Camp Hospital No. 52 at Le
Mans. The hospital was in active operation two months, and during that time
it cared for approximately 400 patients. It ceased to function June 11, 1919;
its personnel sailed from St. Nazaire July 5, 1919, on the South Bend and
were demobilized at Camp Gordon, Ga., July 22, 1919.
CAMP HOSPITAL NO. 121 »
Camp Hospital No. 121 came into existence June 3, 1919, when American
Kcd Cross Hospital No. 3, at Paris, was taken over by the Army Medical
Department, and designated Camp Hospital No. 121. The buildings were
situated in very attractive park grounds where also barracks had been erected
to house the enlisted personnel. The capacity of the hospital was 200, but
the number of patients in hospital never exceeded 130. Approximately 18
per cent of the patients at all times were American welfare workers and officers
of the allied armies. Camp Hospital No. 121 ceased to function December 8,
1919; the majority of its personnel were assigned for duty with the Army of
occupation, and the remainder returned to the United States.
The statements of fact appearing herein are based on the "History, Camp Hospital No. 118, A. E. F.," Brest, by
Capt. otto C. Hirsch, M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. O. O., Washington, D. C.—Ed.
' The statements of fact appearing herein are based on the "History, Camp Hospital No. 120, A. E. F.," Le Mans,
by Col. Henry C. Coe, M. C, while on duty as a member of the staff of that hospital. The history is on file in the His-
torical Division, S. O. O., Washington, D. C.—Ed.
° The statements of fact appearing herein are based on the "History, Camp Hospital No. 121, A. E. F.," Paris, by
Maj. L. O. Tarleton. M. C, while on duty as a member of the staff of that hospital. The history is on filo in the His-
torical Division, S. (}. O., Washington, D. C.—Ed.
790
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CAMP HOSPITAL NO. 122 "
Camp Hospital No. 122 was established April 26, 1919, at Antwerp, Bel-
gium, base section No. 9, to care for our troops in Belgium and Holland. With
the exception of small infirmaries in Brussels and Rotterdam, Camp Hospital
No. 122 was our only hospital in base section No. 9. It was the last hospital
to be established with the American Expeditionary Forces. It was located in
a large five-story building that formerly had been a seamen's home and was
quite suitable for hospital purposes. It had almost unlimited capacity, but
only 350 beds were set up, with same number in reserve. Complete surgical
equipment was also on hand. The hospital functioned about 11 weeks, and
during that time treated approximately 250 surgical and medical cases. It
ceased operating July 16, 1919; its personnel sailed from Brest, August 19,
1919, on the Troy, and were demobilized at Camp Devens, Mass., August
24, 1919.
" The statements of fact appearing herein are based on the "History, Camp Hospital No. 122, A.
Belgium, by Maj. William J. Jones, M. C, while on duty as a member of the staff of that hospital,
file in the Historical Division, S. G. 0., Washington, D. C. — Ed.
E. F." Antwerp,
The history is on
SECTION IV
EVACUATION OF PATIENTS TO THE UNITED STATES;
DISCONTINUANCE OF HOSPITALS
CHAPTER XXVI
EVACUATION OF PATIENTS TO THE UNITED STATES
Administrative matters concerning the selection of disabled members of
the American Expeditionary Forces for return therefrom to the United States,
and the transfer of such men from hospitals in the Services of Supply to base
ports and thence to suitable transports, were made a responsibility of the
hospitalization division of the chief surgeon's officer, A. E. F. As stated in
Chapter XIV, Section I, a particular section of this division, namely, the trans-
portation and evacuation section, was devoted to such matters.^
Early Medical Department plans for the return of the disabled to the
United States comprised extensive hospitalization at Savenay, in base section
No. 1, in order that selected cases might be collected there and evacuated
thence through the port of St. Nazaire; and at Beau Desert, near Bordeaux, for
evacuation through the latter place. Owing to the fact that Brest was not
considered at the time in the scheme of the return movement, hospital facilities
were not provided on a relatively large scale at that place until the latter months
of the war.^
During the first eight or nine months of the existence of the American
Expeditionary Forces, cases believed to be suitable for transfer to the United
States were relatively few in number, and comprised much the same type of
cases as would, in peace time, be considered unfit for further military service. ^
Such cases were selected initially in the various base hospitals of the American
Expeditionary Forces and, usually, transported by hospital train to the base
hospitals of the above-mentioned ports. Here the patients were surveyed by
a physical disability board; and if found suitable for transfer to the United
States, were prepared for the journey there. ^
The conditions of actual warfare and the difficulties incident to transporting
personnel to France prompted general headquarters, A. E. F., in March, 1918,
to depart from our peace-time custom of determining degrees of physical dis-
ability.^ In the conduct of the war it was essential that afi personnel be
utilized to the utmost. Thus, many cases of presumed disability, instead of
being returned to the United States, were retained thereafter in the American
Expeditionary Forces. The comprehensive order which general headquarters
issued on the subject, though it deals with the determination of the physically
fit as well as the unfit, is given here practically in full, so far as the present
subject is concerned:
The action of a disability board does not require review or approval by higher authority
except upon application to the convening authority by the commander of an organization of
791
792
ADMIXISTEATIOX, AMERICAN EXPEDITIONARY FORCES
which the officer or soldier examined is a member. In this latter case the action of the board
will he passed upon by the convening authority, whose action will be final. Reports will be
rendered on card form, in dupUcate, copies of which will be distributed, one to the statistical
section, adjutant general's office, general headquarters, A. E. F., and one to the organization
to which the officer or soldier is transferred.
The success of the evacuation service depended in great degree upon the
skill of disability boards, which the above quoted order prescribed, in selecting
those cases throughout the American Expeditionary Forces which were unfit
for further duty but were able to bear transportation both to the base ports and
to the United States.^ Selection by these boards of cases capable of performing
the land journey, but unable to withstand the difficulties incident to the sea
trip, led to congestion of the facilities for nontransportable cases at hospitals
near the base ports, reduced the elasticity of these hospitals, and limited their
embarkation facilities.^
As previously stated, patients in the American Expeditionary Forces in
France were embarked at one of the three following ports: Brest, St. Nazaire,
and Bordeaux; however, until after the armistice was signed the major portion
of them sailed from Brest, due to the fact that this port had the deepest harbor,
and in consequence it was to this harbor that our largest ships came with
troops from the United States. Since large ships could not dock at Brest,
patients had to be placed on improvised lighters and carried on them out to the
vessels, frequently in very rough weather. During the period of hostilities,
most patients that were embarked at Brest were prepared for transfer to the
United States at the hospital center at Savenay,^ since it was desirable that there
be a reservoir of patients from which a suitable number of them could be
embarked, without an appreciable loss of time, following notification from ship-
ping authorities that certain ships would be available.^
Promptly after the armistice began, the War Department notified General
Pershing that every effort would be made to expedite the early return of the
American Expeditionary Forces.* No necessity now obtained for so rigidly
adhering to the principles which prompted the promulgation of General Orders,
No. 41, quoted above. Now, not only were all patients classed D to be
returned to the United States as soon as their condition would permit, but also
all officers and soldiers in hospital who in the opinion of attending surgeons
could be safely transported and, in addition, required at least two months'
additional treatment.^ Exemptions to this general classification included men
with contagious ^ and venereal diseases.'' Pertinent parts of the instructions
covering the return of the disabled are as follows:
American Expeditionary Forces,
Headquarters, Services of Supply,
France, November 20, 1918.
Embarkation Instructions No. 1
(Personnel to be returned to the United States)
In order to carry out the poHcy outlined by general headquarters, the following regula-
tions concerning the return of hosi)ital patients and B and C class officers and soldiers to
the United States are published.
EVACUATION OF PATIENTS TO THE UNITED STATES
793
1. All officers and soldiers now in hospitals who will require at least two months' treat-
ment who, in the opinion of the attending surgeons, can safely be transported, and all officers
and soldiers who would be evacuated as of class D will, as rapidly as facilities permit, be
returned to the United States for continued treatment. The transportation of this class of
personnel on hospital trains to designated ports and from thence to hospital ships will be in
accordance with regulations to be prescribed by the chief surgeon.
2. All officers and soldiers in hospitals who are evacuated as of class C and all those
who are evacuated as of class B, who will require at least two months for restoration to class A,
will be returned to the United States in accordance with regulations hereinafter prescribed.
*****■(. ^
II
Officers and soldiers to be returned to the United States under this order, excluding hos-
pital patients referred to in paragraph 1, section I, shall be sent to depots and rest camps
at ports of embarkation, as follows: In the advance and intermediate sections to be sent
direct to the 1st Depot Division, St. Aignan-Noyers, for organization and equipment and
from thence to the rest camp, St. Nazaire, for transportation to the United States. In the
Paris district to be sent direct to base depot, Blois, for organization and equipment, and
from thence to rest camp, Brest, for transportation to the United States. In base sections
Nos. 4 and 5 to be sent direct to rest camp, Brest, where they will be organized and equipped
and returned to the United States. In base section No. 1 to be sent direct to rest camp,
St. Nazaire, for organization, equipment, and shipment. In base sections 2, 6, and 7 to be
sent to rest camp, Bordeaux, for organization, equipment, and shipment.
III. ORGANIZATION AND EQUIPMENT
1. All soldiers, upon arrival at the 1st Depot Division, at the base depot, Blois, or at a
rest camp at a base port, if sent directly there, shall be organized into casual companies
consisting of 2 officers and 150 enlisted men per company, the necessary medical attendants
(class B or C, if available), and medical supplies to accompany each company or group of
companies. White and colored troops to be organized separately. Such companies to be
serially numbered, with the added designation of the depot or rest camp at which the company
is organized. To avoid duplication of numbers assignment is made in blocks, as follows:
"Bordeaux Casual Companies Nos. 1 to 100"; "St. Nazaire Casual Companies Nos. 101 to
200"; "Brest Casual Companies Nos. 201' to 300"; "Blois Casual Companies Nos. 301 to
400"; "St. Aignan Casual Companies Nos. 401 to 500." When a block is exhausted at
any camp a new series will be started by adding 500 to the initial number of the previous
series; for example, Bordeaux's second series of numbers will be 501 to 600.
2. Each company will be physically examined for contagious diseases and deloused at
the depot or rest camp at which it is organized, and the commanding officer of the organization
will be furnished with a certificate showing its serial number and other designation and the
fact that each member has been thoroughly deloused and is free from contagious disease.
The proper sanitary inspection will also be made at base ports prior to embarkation.
3. When a company is organized each soldier will be provided with a neat and well-
fitting uniform and serviceable equipment * * *.
IV. DISPOSITION OF RECORDS
1. It is of the utmost importance that each soldier returned to the United States under
this order shall be accompanied by his qualification card, service record, all war-risk papers
pay card individual pay record book, and individual equipment record; and also that each
officer takes with him his original qualification card securely wrapped and sealed, his identity
card, and, if a captain or of lower rank, his officer's record book.
2. Commanding officers of hospitals will, upon the evacuation of B or C class personnel
Milder this order, .send immediate telegraphic notice, as far in advance of evacuation as pos-
sil)le; in the case of officers, to the statistical division, adjutant general's office, general head-
794
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
quarters, and in the case of soldiers, to the central records office, Bourges, stating the name,
rank, serial number, former organization, together with the depot or rest camp to which the
records are to be sent.
3. In the case of class B or C personnel on duty in the American Expeditionary J'orces
affected by this order, the commanding officer forwarding such personnel will be held respon-
sible that the proper records accompany them to the depot or rest camp to which sent.
4. Courier service will be estabhshed between the central records office and the two
depots and the three rest camps at which casuals and organizations are prepared for embarka-
tion, for the purpose of the prompt procurement of records. In the event that the central
records office is unable to furnish the required records, all data available, including the
statement that the records can not be obtained, will be forwarded with the organization with
which the soldier sails. The commanding officer of the rest camp shall furnish the central
records office with a list of enlisted men departing for the United States without their
individual records, showing the organization to which they belonged. The central records
office will forward such records as soon as obtained to The Adjutant General, Wash-
ington, D. C.
5. In the case of officers and soldiers sent direct to the United States as hospital cases,
as provided in paragraph 1, section I, of this order, telegraphic notice shall be sent as above,
stating the port at which the patients are to be embarked and directing that the records be
sent there, addressed to the commanding officer of the base hospital at the port of embarka-
tion, and plainly marked, "Records of hospital cases." The embarkation of hospital patients
shall not be delayed by reason of the failure to obtain the individual records. Every effort
shall be made, however, to obtain them in every case, as required by existing orders. The
evacuating hospital at port of embarkation will furnish the central records office with lists
of men returned to the United States without their records, by courier, accompanied b}^ any
records received too late to go with the patient.
V. REPORTS
The commanding generals of base depot, Blois, and the 1st Depot Division will send
telegraphic notification to the rest camp which they feed, immediately upon the departure
of an organization, giving the following information :
(a) Designation of organization.
(6) Date and hour of departure.
(c) Number of officers.
(d) Number of soldiers.
A duplicate of this telegram will be sent to the commanding general, Services of
Supply (G-1).
VI. GENERAL INSTRUCTIONS
1. Class B and C personnel of the Marine Corps will be organized into provisional
companies composed entirely of Marine Corps officers and soldiers. No attempt will be
made to segregate marines with reference to the geographical area from which they were
recruited in the United States.
2. Whenever casuals in sufficient numbers come from the same sections of the United
States, they will be formed into companies according to localities, in order that they may
be sent to the cantonment or camp nearest the place from which they entered the service.
This will not apply to hospital evacuations.
3. The commanding general, base section No. 3, will make necessary arrangements
for the return to the United States of hospital patients and class B and C personnel through
EngHsh ports and rest camps, in accordance with special instructions issued from these
headquarters.
4. The provisions of this bulletin do not apply to base section No. 8, concerning which
special arrangements will be made.
By command of Major General Harbord:
W. D. Connor, Chief of Staff.
Official:
L. H. Bash, Adjutant General.
EVACUATION OF PATIENTS TO THE UNITED STATES
795
Embarkation Instructions No. 4, headquarters, Services of Supply,
November 25, 1918, required that commanding officers of casual companies
organized for embarkation would be held responsible that the records of both
officers and enlisted men were completed. If a service record was not at hand
or was not procurable at the central records office, a supplementary record
was to be prepared from the best available data, usually consisting of
information from the soldier.
The effect of Embarkation Instructions No. 4 was to delay the evacuation
of patients, even more so from England than from France, since those of our
men who had been serving with the British, as in the American Second Corps,
and were evacuated through British hospitals after injury, often had their
records lost or delayed in transit. After the order above mentioned was
published, the commanding general of our troops in England estimated that
only 4 per cent of the records pertaining to our sick and wounded there were
obtainable, that many of these patients were selected and ready for embarkation,
and that ships were at the docks, with adequate space for the patients.^
It was now necessary to decide whether the best interests of the patients
would be served by prompt embarkation or their retention until service records
became available.^ If looked at solely from the standpoint of evacuation, it
mattered relatively little whether or not the incapacitated were accompanied
by service records; however, the difficulties of properly disposing of patients
in the United States after their arrival there precluded the possibility of
disregarding the necessity for service records accompanying the patients.
Therefore, subsequent promulgations dealing with the evacuation of sick
and wounded from France took into consideration not only the necessity for
facihtating the embarkation of patients, but also the great need for having
service records accompany patients so embarked.
In the early part of January, 1919, revised instructions concerning the
evacuation of sick and wounded from the American Expeditionary Forces
were issued by headquarters. Services of Supply.* These instructions contained
not only much that former embarkation instructions included, but also details
that would further insure the ready and accurate identification of each patient
so evacuated. That part which has present pertinence is as follows:
II. (1) All officers and soldiers in hospitals who will require at least two months' treatment
and who, in the opinion of the attendant surgeons, can safely be transported, and all officers
and soldiers who would be evacuated as of class D, will, as rapidly as facilities permit, be
returned to the United States for continued treatment. The transportation of this class
of personnel on hospital trains to designated ports and from thence to hospital ships will
be in accordance with regulations to be prescribed by the chief surgeon.
(2) In accordance with detailed instructions to be issued by the chief surgeon, convales-
cent or ambulant patients who require no special accommodations evacuated on any trans-
port will be organized into one or more detachments, each not exceeing 150 men, and under
command of an officer, to be selected wherever practicable from casual medical officers,
convalescents, or B or C class personnel. These detachments will be numbered serially,
beginning with No. 1 at each port of embarkation, as follows: (Convalescent Detachment
No. — , Bordeaux). The destination of the detachments to which these men are assigned
will be entered on the passenger lists, hospital records, and on the service record that is for-
warded with the soldier. The officer in command of each detachment is charged with the
duties outlined in Section I, paragraph 7.
796
ADMINISTRATION. AMERICAN EXPEDITIONARY FORCES
On each transport carrying sick and wounded not organized into casual detadunents,
as above indicated, a medical officer will be put in charge of the sick and wounded, and such
officer will be charged with the duties outlined in Section I, paragraph 7. On naval trans-
ports the duties of this officer will be discharged after consultation and in full accord with the
naval authorities.
To insure accurate identification, in addition to proper notations on the jjassenger lists
and hospital records, the sailing number of the transport will be entered, in each case, on the
service records of all sick and wounded not organized into casual detachments.
(3) Commanding officers of hospitals will, upon evacuation of officers, send immediate
telegraphic notice, as far in advance of evacuation as possible, to the statistical division,
adjutant general's office, at general headquarters, stating their name, rank, and organiza-
tion, together with the hospital, depot, or embarkation camp to which their records are to
be sent.
(4) Daily courier service will be maintained by the postal express service between the
central records office and the evacuation hospitals at base sections Nos. 1, 2, and 5, for the
purpose of the prompt procurement of records of enlisted men received at these hospitals
without them. Requests submitted by this courier system (and those submitted as out-
lined in Section III, par. 4) will be given preference by the central records office. In the
event that the central records office is unable to furnish the required records, all data avail-
able, including statement from the central records office that the records can not be furnished
by that office, will be forwarded with the organization with which the soldier sails. When
records can not be obtained, steps should be taken to provide supplementary records and
payments as outlined in Section I, paragraph 10. The commanding officers of such hospitals
are charged with arranging for the payment of all patients prior to evacuation. The evacua-
tion hospitals at ports of embarkation will furnish the central records office, by courier,
with a li^t of names of men returned to the United States without their records, showing the
organizations to which the men belong. (Notation in red ink under man's name on pas-
senger list furnished central records office may be used in lieu of list.) The central records
office will forward such records, as soon as obtained, to The Adjutant General, Washington,
D. C. Records received too late to accompany hospital patients will be forwarded by base
port personnel adjutant to The Adjutant General's office, Washington, D. C, with a letter
of transmittal, giving the organization to which the men belong and the name of the boat
on which they sailed; a copy of this letter will be sent by courier to the central records office.
On January 5, 1919, general orders were promulgated by general head-
quarters, A. E. F., prescribing that all soldiers in hospitals, classified for return
to the United States under the provisions outlined above, with the exception
of class D patients, were to be transferred to specified overseas casual
camps. Patients classed D were to be transferred to hospitals at Savenay,
Bordeaux, or Brest, and carried on casual rolls. Prior to embarkation all
soldiers were to be transferred from casual camp or hospital to a properly
numbered casual company, convalescent detachment, or sailing convoy ior
transportation to the United States.^ Soldiers selected for transfer to the
United States were to be dropped from the rolls of their organizations, and the
service records of these soldiers were required, when obtainable, to be completed
by the hospital commander, and to accompany the men upon transfer.
On February 2, 1919, further instructions were issued by general head-
quarters, A. E. F.,^'^ to the effect that officers and soldiers admitted to hospital
would not be dropped from the rolls of their organizations, except when the
hospital to which the officers or soldiers were admitted was not in the vicinity
of the organization, thus precluding the organization from carrying the patients
concerned as present sick. In the event it was necessary to drop patients in
hospital from the rolls of their organizations (for example, when the hospital
EVACUATION OF PATIENTS TO THE UNITED STATES
797
was not in the vicinity of the Organization or when patients carried present
sick by organizations were selected for transfer to some other hospital),
commanding officers of organizations, upon proper notification, furnished
commanding officers of hospitals with the service records of the men concerned.
Commanding officers of hospitals were directed to make proper notations on
the service records of men evacuated. Service records were to accompany
men when evacuated.
EVACUATION OF SICK AND WOUNDED FROM THE PORT OF ST. NAZAIRE, BASE
SECTION NO» 1
DURING THE PERIOD OF HOSTILITIES
In the evacuation of sick and wounded from the port of St. Nazaire the
factors always to be considered were comfort to the patients, and at the same
time as much speed as possible. The element of speed was made necessary
by the fact that the arrival of vessels invariably was kept secret until the last
few hours before arrival. Then, as a rule, only tentative arrangements could
be made, for a great deal depended on the size and the number of the transports.
At this port there were adequate docking facilities, so that each ship
usually found a berth alongside a dock." Thus little trouble was experienced
in loading of the disabled.
As soon as the base surgeon's office received new^s of the expected arrival
of a convoy the hospital center at Savenay, the main center of evacuation of
class D patients, was notified, and the names of the ships were given if known."
In this way tentative plans could be made, for by referring to a list provided
by the Navy Medical Department the number of patients of each type capable
of being loaded aboard each of the ships could be calculated. It now remained
to find out from the Transport Service the most convenient time for loading
the transports and the docks to which they were to be moored.
The passenger lists were made out at Base Hospital No. 8 under the fol-
lowing headings:"
Litter
Walking
Surgical
Medical
Mental
Total
Litter
Walking
T. B.
others
Restraint
Others
A medium-sized transport could carry 50 bed cases, 500 walking cases,
and 30 to 40 officers of either type." If mental cases were to be sent, the
number was usually about 35, 1 attendant being required for every 8 mental
cases. In order to further facilitate matters, a naval representative proceeded
to Base Hospital No. 8 for the purpose of tagging each patient, designating the
compartment of the ship, if possible, and showing a serial number corresponding
to that on the passenger list.
Choosing patients fit to travel and whose records were complete w^as
a duty of the base hospital." The passenger lists were made out there also,
798 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
and, based on the total number of patients, bfankets (three per man) and mess
kits were drawn and placed aboard the hospital train. If the patients were
destined to return home on a hospital ship, no mess gear or blankets were
required, the ship being amply supplied with these essentials.
The loading of the hospital train was in charge of the evacuation officer."
In addition to seeing that the proper patients were placed aboard, it was his
duty to see that each man was tagged, had his medical envelope attached to
his clothing, and had his blankets and mess kit, and that the lists of patients
and the records were delivered the commanding officer of the train. On
occasions it became necessary for the evacuation officer to accompany the
patients to the base port. In this event he in person turned over to the detrain-
ing officer the records of the patients and the passenger lists. If the evacuation
officer did not board the train, the above-mentioned records and equipment
were turned over to the commanding officer of the train.
"When the loading of the train was well under way, the evacuating officer
notified the railway transport officer, who arranged a schedule for the train
over the French railroad." On this particular division a schedule was usually
possible every 20 minutes. Thus the time of the departure of the train could
be anticipated almost to the minute. The train having left the sidetrack
running up to the hospital, the commanding officer of the hospital or his adju-
tant notified the base surgeon, whose office was in the city (St. Nazaire) in
which the detraining and embarkation occurred.
From the base surgeon's office the various auxiliary departments were
called on the telephone." The naval liaison officer was notified; also, the officer
in charge of the ambulance battalion was notified of the probable time of
arrival of the train, and was instructed as to what kind and how much equip-
ment to bring with him. The detraining officer was notified. In this way
all was in readiness when the train backed into the railroad yards, the ambulances
were lined up beside the track, the detraining officer w^as on hand, and the
necessary arrangements were made aboard the ship to be loaded. It may be
well to state here that it was customary to load but one boat at a time." This
avoided confusion and misplacing patients and records.
The detraining officer boarded the staff car, procured the passenger lists
and records, and signed receipt for mess kits and blankets." He then ascer-
tained the position in the trains of the cars containing the various types of
patients. As a rule, the walking cases were kept in cars by themselves, the
bedridden in other cars, and the officers and nurses, if any, in still another
section. Having obtained this information, he planned the method of unload-
ing accordingly and gave instructions to the commanding officer of the ambu-
lance convoy. These instructions varied with each evacuation, for there were
several factors to be considered. Among these factors were: (a) The type of
train (if American, the bunks and beddings were fixtures on the train; if French,
the men were lying on litters in racks of three tiers, covered with blankets, the
property of the train); (6) the relative proportion of the litter and walking
cases; (c) the position in the train of patients of each group; (d) the time of
day and the weather.
In the case of an American hospital train it proved best to have on hand a
large extra supply of blankets and litters, for none of the train's equipment
EVACUATION OF PATIENTS TO THE UNITED STATES
799
could very readily be used." The extra supplies, carried in small motor trucks,
kept up with the ambulances as they unloaded first one car and then another.
By keeping the two types of machines abreast, patients with extension appa-
ratus too long or too awkward for the small Ford machine could be placed in
a G. M. C. Furthermore, when things were running smoothly the detail easily
could load two ambulances at once at each of the several train doors. Seldom
more than two cars could be worked at one and the same time, for to do this
13 men were required at each car, 4 to handle the litters in the car, 8 outside,
and a noncommissioned officer to direct in case of the temporary absence of
one of the officers. Then, too, too much speed at the train congested loading
at the ship, since the checking required some time, and the litter bearers could
progress with only moderate rapidity in the narrow passageways and up the
steep stairways. They might further be detained by having to wait some time
for the patients to be transferred from litter to bunk. In order not to lose
property, it was the rule for each pair of men to return with the litter on which
they carried their patient aboard. In order not to lose time, sitting or walking
patients were transferred in G. M. C.'s Fords, and even in motor lorries, during
the time the litter cases were being handled. Therefore there were no idle
vehicles. The detraining officer proceeded by first ambulance to the trans-
ports, carrying records and passenger lists, so that checking might begin the
moment the first patient arrived.
PROCEDURE DURING THE ARMISTICE
The signature of the armistice, on the 11th of November, marked the
turning point with respect to the policy of evacuation of the sick and wounded
of the American Expeditionary Forces. The secrecy surrounding arrivals and
departures of ships and the haste required in loading them no longer obtained.
Every effort was made to keep the proper authorities advised of the expected
arrival of transports, and once they arrived, due consideration could be paid
to the comfort of the patients — speed was not the important factor that it had
been."
On November 25, 1918, the work of the evacuation of patients to the United
States from base section No. 1 was officially placed under the base commander
by the following letter from the commanding general, Services of Supply:
American Expeditionary Forces,
Headquarters Services of Supply,
First Section, General Staff,
November 25, 1918.
From: Commanding general.
To: C. O., base section No. 1; C. G., base section No. 2; C. G., base section No. 5.
Subject: Evacuation service.
*******
2. The responsibility for the evacuation of personnel to transports is vested in base sec-
tion commanders, and the details will normally be executed through their staffs. Naval
medical liaison officers have been detailed to duty at ports of embarkation, and the utiliza-
tion of the services of these officers along the lines indicated in this correspondence should
materially assist these staff officers in handling this important work.
Bv order of the C. G. ^ ^
J. B. Cavanaugh,
Assistant Chief of Staff, G-1.
13901—27 51
800
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
On December 2, 1918, additional instructions were given by the chief
surgeon, A. E. F., in the following letter, and three hospital trains were assigned
permanently to the section for the transportation of sick and wounded between
hospitals of the section and from hospitals to transports:
American Expeditionary Forces,
Office of the Chief Surgeon, A. P. O. No. 717,
December 2, 1918.
From: Chief surgeon.
To: Surgeon base section No. 1
Subject: Evacuation of patients to the United States.
1. The chief surgeon desires that you assume charge of the evacuation of all patients
selected for transfer to the United States from the hospital centers, Angers, Nantes, Savenay,
and St. Nazaire. When such patients are selected at these hospitals, use the hospital trains
50 and 51, now assigned to you, to collect them at Savenay for final scrutiny, assembly of
records and equipment, with clothing, blankets, mess kit, and toilet articles.
2. It is very essential that improper cases for transfer to the United States be not all
assembled at Savenay, resulting in congestion of nontransportable cases there, so that you
are advised to have the cases which are moved from Angers and Nantes selected from those
able to bear the journey to the United States. Also, take advantage of the fact that men
discharged from hospitals of classes B and C who are able to join casual companies may be
sent to the casual concentration camp at St. Nazaire.
3. Keep this office informed of your needs in the way of personnel, transportation,
supplies, and equipment, in order that the deficiencies may be promptly met. A copy of
this letter has been sent to the commanding officer, hospital centers. Angers, Nantes, Savenay,
and Base Hospital No. 101, St. Nazaire.
By direction:
R. M. Culler, Colonel, Medical Corps.
When this port was designated as one of the three principal ports of embar-
kation, plans immediately were made to cope with the situation, and in the
medical, as well as in all the other departments, an evacuation branch was
inaugurated. "The general system used previously was not materially changed.
However, instead of relying upon casual organizations at the rest camp to
furnish details of litter bearers and ambulance drivers, an ambulance company
was asigned to the duty. Soon it was found that in addition an evacuation
ambulance company and a field hospital unit could be used, the three organi-
zations working as a battalion."
Furthermore, the regulating branch in the office of the base surgeon took
on added responsibilities, and in order to systematize and standardize the
reports required by the different departments several mimeographed forms
were promulgated.
The following circular letter was sent to all base hospitals and camp hospi-
tals, hospital centers and convalescent camps in Base Section No. 1 :
Services of Supply,
Office of the Surgeon, Base Section No. 1,
France, November 21, 1.918,
Circular Letter A-16.
From: The surgeon.
To: The commanding officer.
Subject: Report of patients to be evacuated to the United States.
1. In order to facilitate the evacuation of patients to the United States, it is requested
that you submit daily telegraphic or telephonic report to this office giving the following
information by numbers of patients in your hospital ready to be evacuated to the United
States :
EVACUATION OF PATIENTS TO THE UNITED STATES
801
(1) .Stretcher cases in sick bay.
(2) Requiring dressings, in standees.
(3) Requiring no dressings:
(a) Requiring help.
(6) Not recjuiring help.
(4) Tuberculosis.
(5) Mental.
2. The report should reach this office by 10 a.m., daily.
3. Report should be made as given in the form below:
Hase Surgeon, St. Nazaire:
Base Hospital twenty seven November twentv second re circular letter A sixteen one
133 two 145 three A231 B 452 four 99 five 63. '
Smith.
Chas. L. Fcster,
Colonel, Medical Corps, United States Army.
This report enabled the base surgeon to keep constantly on hand such data
as the total number of class D patients in the base section, the total number of
htter patients, tuberculosis, mental, and other groups. As soon as these data
were received they were tabulated, so that at the end of each day it was possible
to tell in a moment how many class D patients were in the section, how many
at a particular hospital, which hospital was overcrowded, and which one needed
first consideration when an opportunity to evacuate presented.
A "Capacity and adaptability report" w^as made up as follows:"
Ambulatory surgical
requiring dressings
Medical and surgical
in standees
Officers in
rooms
Tubercu-
lous
patients
surgical
ing atten-
Mental patients
Total number of pa-
tients
Number of
bunks to be
reserved
Name of transport
Litter cases.
Attendants
Patients
Attendants
Bed
Walking
Medical or
not requiri
tion
Restraint
others
Attendants
Officers
Enlisted
men
This report was a great help also in that it covered all the essential points
with respect to a transport's fitness to receive patients." It was designed with
the concurrence of the naval medical representative, and was used by him,
and by the Army medical officer assigned to the duty of passing judgment
upon arriving transports. Upon receipt of this form the data were transcribed
to permanent records in the office of the surgeon, where they were available
lor ready reference when the ship returned to this port. A copy of the report
was sent to the hospital center at Savenay, where it was used in preparing the
passenger lists. In order not to delay matters, how^ever, the data usually were
read over the telephone to the commanding officer of the hospital center, and
the report sent as confirmation.
-\. "space" report w^as used in connection with all transports, and was sent
l)y coiu'ier to the evacuation officer at the evacuation camp, base section No. 1,
and to the superintendent. Army Transport Service." Thus, if for any reason
any part of a ship could not be utilized by the Medical Department, it could
1)0 utilized in returning to the United States such casual and class B and C
officers and men as might be awaiting transportation.
802 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The following "Evacuation report" was rendered to the chief surgeon,
A. E. F., for each ship loaded with patients for transportation to the United
States: ^'
1. The following is list of patients evacuated from this port, above date, aboard
(Name of transport .)
MEDICAL
Tuberculosis
Mental:
Restraint
Others
All other sick
Total sick
Sitting cases
Litter cases
SURGICAL
General surgical
Fractures, upper extremities
Fractures, femurs
Other fractures
Total fractures
Sitting
Litter
Grand total
This report was made instead of the lengthy one required by paragraph
4-F, Circular No. 38, chief surgeon's office, July 1, 1918, and was rendered in
the case of all saihngs subsequent to December 1, 1918, to comply with letter,
chief surgeon's office, dated November 22, 1918, quoted above." One copy of
this report was sent to the commanding officer, base section No. 1, and one copy
was held for file, the essential data being tabulated upon a permanent form in
the office of the base surgeon, for ready reference."
Other reports, occasionally required, were readily compiled from the data
obtained in the manner outlined above." Thus a memorandum to the chief
surgeon's office was sent from the office of the base surgeon each week end, of
the total number of class D patients remaining in the section." A the end of
the month, a letter covering the total number of patients of each class evacuated
to the United States was forwarded to the chief surgeon, A. E. F., and copies
were sent to the commanding officer, base section No. 1, and to the naval fiaison
officer."
The following extract from the Annual Report of Surgeon General, United
States Navy, 1919, concerns the part played by the Navy in the return of sick
and wounded from the American Expeditionary Forces:
At a very early stage of the war arose the problem of how to return the sick and wounded
to America. The ideal solution would have been for the Army to return its casualties in
ambulance ships ow^ned, manned, and equipped by its Medical Department and convoyed
by the Navy. This w^as impossible, and the next measure considered was the vise of the Navy
hospital ship Solace, with its capacity for returning 200 casualties a month, and the use later
of two other hospital ships in process of equipment able to bring back .300 sick apiece per
month. The Army's estimate of a minimum of 5,000 returnable casualties per month showed
EVACUATION OF PATIENTS TO THE UNITED STATES
803
these resources to be utterly inadequate even had these three vessels not been required for
their original and legitimate purpose of caring for the Navy sick. Out of this situation
developed the arrangement by which all Navy transports would, on the westward passage,
serve to the limit of capacity for the return of Army sick and wounded, and a schedule of
each ship's carrying capacity was forthwith gotten up and generally promulgated for the guid-
ance of all concerned. This proved the best arrangement possible under the circumstances
and was entirely satisfactory whenever the limit of a given ship's capacity was not exceeded.
Unfortunately it was not always sufficiently clear that the complement of a troop ship bound
east by no means corresponded to its capacity for adequate care of returning sick and wounded.
The pressure at evacuation centers in France was, of course, enormous and it extended to
ports of embarkation, but the Navy took the position from the start that what was good
enough for healthy men being rushed to the front was by no means sufficient for the maimed
and sick who had done their bit and were entitled to the best possible care and professional
attention the moment their retrograde movement began. To subject the sick to the over-
crowding of troop compartments for a 10-day voyage was to jeopardize their chances of
recovery. The troop quarters, with their three and four tiers of standee bunks, on iron decks
remote from mess room, toilet, and open-air recreation were absolutely out of the question for
the lame and disabled, the bedridden, the surgical cases requiring one or many daily dressings
and, of course, during the period of the submarine menace common humanity demanded that
the number of totally disabled and helpless passengers be not out of proportion to the facilities
for carrying them to and caring for them in rafts and fifeboats should "abandon ship" be
necessary. The captain of the ship and the senior naval medical officer were judged by the
Navy Department to have sufficient appreciation of the need for rapid evacuation, combined
with a practical knowledge of conditions at sea, to determine not the maximum carrying
l)ower but the maximum of facilities approximating the required hospital service for sick and
wounded on each ship. The much talked of "hommes 40, chevaux 8" car was not esteemed
an appropriate means of transfer rearward for the disabled ashore, and it was not proposed to
give them an analogous service on a 1-day voyage on the water.
Had it been only a question of attendant personnel, the whole matter would have been
much simplified, but the humane treatment of the returning casualties included a variety of
other considerations. There was a limit to the number of attendants that could work in
confined ship spaces without falling over each other, especially when the ship was darkened
in the submarine zone. The proper handling of contagious cases, the tuberculous, the insane,
involved nice adaptation of numbers and special requirements to available space and facilities.
Conferences of the bureaus concerned, beginning November, 1917, led to the drawing up
of a formal agreement by which the Navy undertook to handle all sick and wounded for which
it could provide adequate space, the prime basis of adequate treatment, on troopships manned
by the Navy, and to furnish the services of its three hospital ships in excess of its own needs
only.
In their joint report of February 7, 1918, to you, the Surgeon Generals of the two services
agre'ed that the Navy hospital ships were entirely unavailable for Army purposes as sick
transports, their capacity being small and their services completely utilized with moVjile
units of the fleet. The Navy transports were agreed upon as the best available means of
returning Army sick and woimded, the number to be carried being limited to available space
after the Navy sick and the sick of the troops in transit had been provided for. There was
also a joint recommendation for the purvey of six ambulance ships, of 500 or more capacity,
for Army use.
Your letter of January 22, 1918, to the honorable Secretary of War definitely assigned to
Army use the facilities for handling Army sick and wounded returning to the United States
available on Navy transports then in service and of others that might be subsequently
obtained, and the two Navy hospital ships Comfort and Mercy were also offered when the
services of these vessels could be spared from naval use. It was stated that no increase in
facilities for this purpose were contemplated by the Navy, but that, should the Army find
these repatriation provisions insufficient, naval personnel would be provided to man and
operate such vessels as the Army might procure. The substance of this letter was reiterated
in your letter of January 29. Again, in your letter of February 15 to the honorable Secretary
of War, it was clearly pointed out that the Navy would man and operate any number of
hospital ships provided by the Army, said ships to be ready in all respects for occupation.
804
ADMINISTRATION, AMERICAN EXPEDITIONAin FORCES
The following was the agreement approved l)y yourself and the lioiiorahle Secretarv of
War, March 28, 1918:
(o) That the sick and wounded being brought from France or England to the United
States will be brought in naval hospital ships or transports, whichever may be most suitable
and available, except in special cases where transportation by commercial liners may he
authorized.
(6) The Army will be in charge of the embarkation and disembarkation of all Arniv
patients.
(c) The Navy will be ciiarged with the care of these i)atients while on board shij)s of the
Navy acting as transports or otherwise.
(d) At the recpiest of the Navj-, the Army will render such assistance in ijersoimcl and
materiel as may be necessary.
The following schedule shows the classified sick-carrying capacity of the great majority
of the transports in service on December 1, 1918. The figures fluctuated more or less with
alterations in internal structural details made for better ventilation or other sanitary con-
siderations. On some transports increased passenger service went hand in hand with im-
proved disposition of living spaces; in others, it was reduced. In every case, the numbers of
different types that could be treated with gratifying results de{)ended absolutely on the type
and general structure of the ship, which, in the main, was fixed and not susceptible of modifica-
tion.
Revised I able for rated capacity for troops invalided home September 5, 1918, on principal naval
transports
Aeolus
Agamemmon_..
America
Antigone - _
Calamares
DeKalb
Finland
George Washington
Great Northern
Hancock
Harrisburg
Henderson
Huron
Konigen der Nederlanden-
Kroonland
Leviathan
Lenape
Louisville
Madawaska
Mai lory
Manchuria
Martha Washington
Matsonia
Maui
Mercury
Mongolia
Mount Vernon
Northern Pacific
Orizaba
Pastores
Plattsburg
Pocahontas
Powhatan
President Grant
Princess Matoika
Rijndam
Siboney
Sierra
Susquehanna _ _
Tenadores
Von Steuben
Wilhelmina
Zeelandia
Total
bed-
ridden
in sick-
bay
bunks
24
38
59
40
42
12
40
60
40
20
38
50
38
24
40
100
20
45
40
20
38
50
16
30
44
33
40
44
40
25
38
39
40
55
35
50
50
30
45
40
Able to
walk, re-
quiring
surgical
dress-
ings; in
troop
standees
100
130
140
110
100
150
200
500
400
550
200
350
110
300
200
1,000
100
300
100
100
300
150
100
100
110
300
130
510
500
100
200
120
300
110
150
1,000
500
200
130
100
"200
100
500
Mental
cases
Tuber-
culosis,
in isola-
tion or
on open
decks
Able to
walk, re-
quiring
no at-
tention;
in rooms
for
officers
f)
8
4o
3
5
8
5
2
Ifi
SfiO
Conva-
lescent ,
requir-
ing no
special
atten-
tion; in
troop
standees
Hammock.
* Cot
25
16
25
30
20
55
10
30
25
10
40
30
10
10
25
25
25
90
25
15
45
25
25-150
25
16
40
25
25
25
20
60
10
30
145
230
215
100
80
50
150
500
116
40
100
64
140
80
150
400
44
100
105
40
175
100
90
100
120
170
140
120
90
50
100
130
5"
200 I
150 !
155 1
90
100
105
42
103
100
76
2,580
3,000
3,600
1,660
1,100
1.000
3,350
4,600
2,200
•750
2,200
1,164
2,250
1,500
2,600
1,000
1,000
1,800
1,750
1,200
2,850
2,250
2,000
2,000
2,300
2,850
1,800
1,700
2,000
1,000
2,000
2, 180
1,400
4,400
3,000
1,800
2,000
1,300
1,850
1,150
'650
1.500
1,100
EVACUATION OF PATIENTS TO THE UNITED STATES
805
DETAILS OF EVACUATION
In July and August the demand for return of sick and wounded to the United States at
the hands of embarkation officials in France increased, and pressure was constantly exerted
on commanding officers to exceed their allotted complement of sick, notably in the case of the
Kroonland, Finland, and Calamares. But whenever sympathy for the congested embarkation
areas and for the sufferers in them got the better of the judgment of ships' officers and induced
them to exceed the allotted complements the resulting overcrowding led later to complaint
about overcrowing in transit. The suggestion was received from various quarters that a
ship be modified in structure so as to bring back in same only in large numbers. These sug-
gestions had in view only the evacuation from France of this unfortunate class. They did not
extend to a practical consideration of how they would be cared for en masse amid the dis-
comforts and inconveniences of life at sea and the extremely small chance they would have
of surviving in the event of attack or disaster to such a ship. Neither was it appreciated by
those unfamiliar with the sea that in moments of danger from enemy or stress of weather the
presence on board of hundreds of insane would jeopardize the safety of a ship and its comple-
ment.
The medic-al officers and hospital corpsmen of the Navy Transport Service deserve the
greatest credit for their faithfulness and skill in the repeated ocean crossings with their sani-
tary work on the outward, their hospital work on the homeward bound voyage — and the clean-
ing up, alterations, improvements, constantly going on during brief stays in home ports.
This credit has been accorded them by the vast majority of the men to whom they ministered,
and the only criticism of the medical aspect of the Navy transport service has arisen when
more patients were assigned them than regulations warranted or when men were put aboard
unfit or unprepared for the voyage or with misleading diagnoses.
As late as September, 1918, it was necessary to specify, and in December to repeat tlie
request, that at least three hours before sick for return to the United States were sent along-
side the transport, its officers should be furnished with quadruplicate lists separate from that
of passengers, showing sources of patients, their rank, company, regiment, organization, and
diagnosis. Our internal arrangements had long been so perfected that when once this advance
information was regularly supplied, the walking patients would be assigned to compart-
ments, the sick to wards, the bedridden carried to beds without a moment's delay, and by
tfie time the ship w'as well out of the harbor litters were beside each bedridden case, with men
detailed as bearers, and provision had been made or instructions given for any exigency that
might arise requiring "abandon ship."
Gradually as system and order in the evacuation of the sick and wounded developed all
along the line, some of the overwhelming burdens were lightened and at the same time a better
service was given. Before the armistice was signed liaison between the two branches of the
service was so perfected that some of the early and radical mistakes of evacuation from shore
to ship have since been avoided, and it was no longer possible to find one transport returning
overloaded w^hile a vastly larger one sailed practically empty from a near-by port. Much
of the dissatisfaction with the carrying (adequate caring) capacity of our transports was felt
ashore and grew out of methods of coastward routing and distribution of invalid cases in
France. This waned as an orderly distribution was evolved based on proper advance informa-
tion of ships' arrival and the accommodations they afforded.
In transporting the insane our medical officers had to follow the rule of holding to the
diagnosis furnished by the medical attendants who had had the cases under observation and
study in camps and hospitals ashore prior to embarkation. Every medical man knows the
plausible speech and the docile behavior which the most dangerous maniac may assume for
even long periods, only to break out in his true light when suspicion has been allayed. The
overworked transport surgeon was not in a position to undertake the cure of the insane on an
ocean vovage, nor had he the time, even if he pretended to the special skill required, to go into
the niceties of differential diagnosis. When patients were no longer sent aboard indiscrimi-
natelv an hour before sailing, without papers, descriptive lists, or diagnosis, but carefully
tagged and sorted as surgical, medical, ambulant, or bedridden, contagious, nervous, and
insane, etc., it was his duty to see that the insane were humanely treated, and humanity here
806
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
consisted in preventing their jumping overboard or falling down the engine-room hatch,
running amuck aVjout the ship, incommoding other patients — in a word, in restraining them
and delivering them alive in America. The bulk of the transports were provided with areas
inclosed by metal screens, having access to air and light on deck, with a sentry to keep away
the thoughtless or inquisitive, and attendants on watch day and night, every sanitary detail
being observed in regard to these unfortunates. Passengers who saw unkindness in this
restraint or declined to accept the diagnosis made by the Arm surgeons conversant with the
cases before embarkation were not prepared to accept the responsibility for a different pro-
cedure nor could they relieve the ship's surgeon of his. In some cases groups of insane were
put aboard our transports under the care of medical officers and attendants detailed for the
voyage from the service to which thej^ belonged, and under these circumstances those officers
and attendants quartered and handled their charges as they saw fit without the advice or
interference of the ship's authorities.
During the most active period of our military campaign the heaviest w^ork of our medical
officers on transports flowed from the requirement of surgical cases, many of whom required
three or four changes of dressing daily. The most trying work was that of ministering to
men sent home to die, a certain proportion of whom, of course, expired within a day or two
of sailing.
***** * *
As our battleships and cruisers are normally provided with facilities for caring for the
sick of their crews, estimated at not over 3 per cent for a force of from 600 to 1,000 men
on each of these vessels, they were manifestly not adapted in any way nor used for the
repatriation of sick and wounded.
Upon the signing of the armistice and with the initial movement for the return of our
troops from abroad, steps were taken to utilize certain German ships w^hich had been unable
to go to sea owing to the preponderance of allied naval power and were still in German
harbors. One of the best of this class was the Imperator, which was rapidly converted for
transport purposes and, like the rest, was manned by a Navy crew composed in the main
of officers and men already abroad and no longer required for campaigning. Other vessels
of this category were the Graf Waldersee, Cap Finisterre, Kaiserine Augusta Victoria, Mobile,
Patricia, Philippines, Pretoria, Prince Frederick Wilhelm, Zeppelin.
EEFERENCES
(1) Report of the chief surgeon, A. E. F., to the Surgeon General on the activities of the
chief surgeon's office, A. E. F., to May 1, 1919. On file, Historical Division, S. G. 0.
(2) Report on the evacuation of sick and wounded, A. E. F., to the United States, undated,
made to the Surgeon General by Col. R. M. Culler, M. C. On file, Historical Divi-
sion, S. G. O.
(3) G. O. No. 41, G. H. Q., A. E. F., March 14, 1918.
(4) G. O. No. 206, G. H. Q., A. E. F., November 15, 1918.
(5) Embarkation Instruction No. 1, Hq. S. O. S., A. E. F., November 20, 1918.
(6) Embarkation Instruction No. 6, Hq. S. O. S., A. E. F., November 26^ 1918
(7) G. O. No. 215, G. H. Q., A. E. F., November 25, 1918.
(8) Embarkation Instruction No. 13, Hq. S. O. S., A. E. F., January 4 1919
(9) G. O. No. 5, G. H. Q., A. E. F., Januarv 5, 1919.
(10) G. O. No. 23, G. H. Q., A. E. F., February 2, 1919.
(11) Report on the evacuation of sick and wounded from the port of St. Nazaire, undated,
made to the surgeon, base section No. 1, by First Lieut. Edward P. Heller, M. C.
On file, Historical Division, S. G. O.
CHAPTER XXVII
DISCONTINUANCE OF HOSPITALS
With the signing of the armistice on November 11, 1918, retrenchment
of activities in the American Expeditionary Forces was begun. On that day
general headquarters, A. E. F. directed all chiefs of supply services, American
Expeditionary Forces, to make immediate reports to the commanding general,
Services of Supply, as to what projects and constructive activities had now
become nonessential.^
As a result of these instructions, the commanding general, Services of
Supply, on November 14, 1918, directed that the following action would imme-
diately be taken :^ Cessation of further procurement, cancellation of such con-
tracts as could be canceled, suspension of construction, stopping of further
shipments from the United States of supplies or material already purchased.
In addition, each chief of a supply service was directed to study the situation
in so far as it pertained to his department and to make further recommendations
concerning reductions. That part of this order which affected the hospital
situation was as follows:
*******
(a) Provide normal hospitalization on a basis of 7}/2 per cent of total strength instead
of 15 per cent as hitherto.
{h) All contracts for hospital tentage will be canceled.
*******
{(1) French contracts for beds and mattresses, mobile hospitals, and mobile surgical
units, in excess of the needs of 30 divisions, will be canceled.
(/) The authorization for construction of hospital centers at Evreux, Alencon, Dourdan,
and Liffol-le-Grand is canceled.
{g) The authorized increase of 5,000 beds at Rimaucourt is canceled.
{h) Construction work now under wa}^ upon the following hospital centers will be
stopped: Avoine, La Suze, Montoir, Reignac, and Landerneau. At Beau Desert and
Savenay the projects shall be limited to 10 units.
{i) At hospital centers, not above enumerated, all buildings which have been started
will be completed.
*******
Because of the many patients in hospital, obviously compliance with some
of the above-mentioned instructions could not immediately be carried out; for
example, the reduction of the percentage of hospital beds from 15 to 7}/2 was
contingent upon the rapidity with which patients in hospital could either be
returned to duty or sent to the United States.^ As a matter of fact, not only did
the number of hospital beds increase after the signing of the armistice, but also
the number of base hospital units.* Thus, though on November 7 there were
118 base hospitals (or hospitals operating as such) in the American Expedi-
tionary Forces, exclusive of Italy, providing 147,379 normal beds, these num-
bers were gradually increased until on December 26 there were 127 base hos-
pitals (or hospitals operating as such) with 159,029 normal beds. On the other
807
808
AD^rINISTRATION, AMERICAN' EXPEDITIONARY FORCES
hand, emergency beds numbered 83,377 in base hospitals on November 7
(subsequently increased to 86,000), and since these beds were used for the less
seriously sick or wounded, and the admission of wounded naturally ceased shortly
following the armistice, such beds could be dispensed with fairly rapidly, so
that by January 2, 1919, their number had fallen from 86,000 to zero. At this
time the number of patients was 93,494/
From this time on the number of base hospitals could progressively be
diminished, in that more facilities were provided for transferring patients in
them to the United States, and the diminution could keep pace with such
transfers. In this connection it is necessary to consider two factors: General
instructions for the return of units from the American Expeditionary Forces
to the United States, and the selection of units whose services were no longer
required.
General instructions affecting the return of organizations to the United
States were issued by general headquarters, A. E. F., and by headquarters,
Services of Supply; that is to say, general headquarters prescribed in general
terms the manner of selecting organizations for return : Troops in the Services
of Supply, which included the units of stationary hospitals, were to be returned
to the United States in the order in which their services could be spared and,
so far as possible, in the order of their arrival in France.^ More specific instruc-
tions were issued by general headquarters, but these pertained to such matters
as embarkation instructions, the transfer and attachment to returning organi-
zations, of excess personnel;'' the disposition of property and funds, discharge
of officers and enlisted men, etc' To headquarters, Services of Supply, were
left the details of transferring designated units and attached personnel to the
United States.
In so far as the selection of hospital units for return to the United States
is concerned, as mentioned above, this was contingent upon the use that had
to be made of the hospitals. Naturally the movement of hospital units formed
but a very small part of the return movement as a whole. Transportation
difficulties which obtained during active hostilities still existed, reflecting in
the following manner on hospitals in the Services of Supply: Throughout De-
cember, 1918, totally inadequate transportation could be secured for the return
of men, in hospitals and fit for duty, to their proper organizations, thus leaving
in hospital at the end of that month approximately 30,000 men who otherwise
should not have been there.' As this would have caused the Medical Depart-
ment reports to show a relatively high and fictitious morbidity in the American
Expeditionary Forces, the chief surgeon, A. E. F., on January 23, 1919, adopted
the plan of showing on his daily report of relation of patients to beds, class A
patients separate from bona fide patients.*
Other factors obtained which influenced the selection of hospital units for
return to the United States. These were location, with relationship to lines
of communication; whether or not a hospital unit occupied a French building
which would be needed for military or other purposes by the French. In
Chapter XVI, Section I, which concerns the hospitalization scheme of the
American Expeditionary Forces, references are made to the fact that it was
necessary for us to go far afield for locations for some of our hospitals; that is,
some had to be placed well off our lines of communication, thus making them
EVACUATION OF PATIENTS TO THE UNITED STATES
809
not readily accessible. In addition, though some of the places where our
hospitals were located proved usable during the period of hostilities, nevertheless,
since no sufficient reason existed during the armistice for continuing them,'
especially if physical characteristics militated against their use, such places
were slated early for abandonment. Thus on December 31, 1918, the chief
surgeon, A. E. F., reported to the commanding general. Services of Supply,
that plans were well under way for the abandonment of the following hospitals
in French buildings: * Base Hospital No. 66, at Neuf chateau; No. 23 and No.
36, at Vittel; No. 31 and No. 32, at Contrexeville; No. 20, at Chatel Guy on;
No. 30, at Royat; No. 71, at Pau; No. 98, at Lourdes; No. 218, at Poitiers; No.
208, at Autun; No. 63, at Caen; No. 85, at Paris. In addition, it was his plan
to abandon the hospital center at Allerey at an early date, because it had been
rendered practically useless through the excessive muddiness of the locality.^
Aside from the urgent necessity for returning to the French as many as
possible of their buildings we had been using as hospitals, the abandonment of
hospitals had to be governed to a great extent by their positions on the line of
communications; that is to say, though, on the one hand, it was possible to
foresee early that certain hospitals could be abandoned, or hospital centers
compressed, in the advance and intermediate sections; on the other hand, in
the base sections, particularly Nos. 1, 2, and 5, hospitahzation not only had to be
kept at a pre-armistice status, but also increased to make possible an adequate
preparation of the homeward-bound sick and wounded.*
The discontinuance of hospitalization then, involved at first principally
the advance and intermediate sections.'' As to the advance section, on January
1, 1919, there were 29 base hospitals or hospitals acting as such.* Therewcre
four principal hospital centers, namely, Toul, Bazoilles, Vittel-Contrexeville,
and Rimaucourt. In the changed nature of affairs brought about by the signing
of the armistice, some of these continued to be of importance, others did not.
Reference was made above to the fact that the Vittel-Contrexeville center
was slated for abandonment as soon as its patients could with safety be evac-
uated to other hospitals. On the other hand, because of the convenient
location of the Toul and Bazoilles centers, in so far as the Third Army, and
other organizations in the locality, were concerned, these centers remained •
relatively uncompressed for the first three months of 1919; however, in April,
when the number of patients in these centers had materially been reduced, the
major portion of their component hospitals ceased operating, and early in
May the centers were discontinued.* The Vittel-Contrexeville center was
emptied of patients early in February and ceased to operate.* Rimaucourt
comprised only five base hospitals at the beginning of 1919.* These were
reduced to two by the end of January, to care for the relatively few remaining
patients; then to one during the week ending April 24, when the center ceased
to exist as such.*
During the period January 1 to May 31, 1918, in which the major part of
the activities of hospital discontinuance occurred, the number of patients in the
advance section diminished from 22,521 to 1,233.* These 1,233 patients were
being cared for in five base hospitals located as follows: Commercy, Rimau-
court, Langres, Chaumont, and Dijon.*
810
ADMINISTRATION, AIMERICAN EXPEDITIONARY FORCES
On January 1 the intermediate section contained 46 base hospitals, most
of which were in the following hospital centers: Beaime, Allerey, Mars, Mesves,
Vichy, Clermont-Ferrand, Orleans, and Tours.'' The principal of these were
the first five named. The hospitals as a whole contained 69,802 patients,
more than thrice the number in any other one section.* As stated previously,
the hospital center at Allerey was not desirable for hospital purposes after the
first of the year 1919, consequently by the end of the first week in February
it had been reduced in size from seven operating hospitals to one; this remaining
base hospital in turn was replaced by camp hospital personnel during the week
ending March 6.* A similar experience befell the hospital center at Beaune,
except that here an additional week intervened between the conversion of the
last base hospital to a camp hospital.' Beaune and Allerey then were used for
purposes of the American Expeditionary Forces University.^ The hospital
centers at Mars and at Mesves were larger than the other centers; in fact, the
center at Mesves attained proportions unequalled by any other center in the
American Expeditionary Forces.* Both were increased in the number of
component base hospital units following the signing of the armistice, Mars
to 8 and Mesves to 12.*
Both centers continued to operate until May, meanwhile experiencing a
gradual compression; so that by April 24, each contained but one operating
base hospital.* Mesves ceased to be hospital center during the week ending
May 8; Mars several weeks subsequently, due to the fact that its base hospital
units, though not operating, were awaiting orders to move to a base port.*
The Vichy center comprised five base hospitals, or hospitals operating as such,
on January 1, 1919.* These were all in French buildings, principally hotels;
hence, despite the fact that the center had developed into a special center for
the treatment of head injuries, it was compressed to three hospitals by the
middle of January ; to one by February 20, and ceased to exist during the week
ending March 13.* The Clermont-Ferrand center, being a late development,
comprised only four hospitals when the armistice was signed, all in separate
localities.* The hospital at Clermont-Ferrand was never operated; the hospital
at Le Mont Dore was never used to more than 70 per cent capacity.* At the
• beginning of the year 1919, these two last-mentioned units had ceased to exist,
in so far as the center was concerned.* During January, the patients were
evacuated from the remaining two base hospitals of the center, and by the
23d of the month they had ceased to operate.* At the end of May, only two
base hospitals were in operation in the intermediate section. These comprised
the Tours center, and contained 513 patients.*
In the base sections under consideration — that is, Nos. 1, 2, and 5 — it was
necessary to maintain hospitalization on a relatively large scale until well
toward the end of the existence of the American Expeditionary Forces.* Par-
ticularly was this true when the hospitals w^ere adjacent to the ports. Where
this was not so, as in the case of the centers at Limoges and Perigueux, the
hospitals W3re handled in much the same w^ay as those in the intermediate
section; thi,t is, they were compressed, w^hen in centers, and closed when
operating independently as rapidly as the evacuation of patients permitted.*
EVACUATION OF PATIENTS TO THE UNITED STATES
811
On June 16, 1919, only 12 base hospitals remained in operation in the
American Expeditionary Forces. These, with their locations, were as follows:
Base Hospital No. 57, Paris; No. 65, Kerhuon; No. 88, Savenay; Nos. 113,
118, and 119, Savenay; No. 121, Beau Desert; No. 214, Savenay; 216, Nantes!
All but the first four of these had ceased functioning by the end of June; the
first four were discontinued in July.^^
The gradual reduction in the number of base hospital units in the Ameri-
can Expeditionary Forces was not merely a question of releasing the units
when they were no longer needed; on the contrary, a certain amount of shift-
ing of the units was necessary so that those units earliest in France could be
released and, at the same time, there would be no interference with the opera-
tion of a hospital. This was particularly true of hospitals operating independ-
ently. Thus, for example, in January, 1919, Base Hospital No. 6, Bordeaux,
was replaced by Base Hospital No. 208; Base Hospital No. 9, at Chateauroux,
was replaced by Base Hospital No. 36; Base Hospital No. 27, Angers, was re-
placed by Base Hospital No. 85.* Also, evacuation hospital units were used
to replace base hospital units, to permit the latter units to return early to the
United States.*
In so far as camp hospitals are concerned, since these were not used for
battle casualties, but rather for the temporary care of the sick of troops in their
respective locahties, the discontinuance of them necessarily was contingent
upon the cessation of troop activities; therefore, a given camp hospital had to
be kept open until the very last of such activities. There were 56 camp hospi-
tals in the American Expeditionary Forces on January 1, 1919,* and though,
on the one hand, it was possible soon to discontinue some of them at different
places, on the other hand, it was necessary to establish new ones, for example,
at the American embarkation center and at the base ports.* Also, some base
hospital activities were taken over by camp hospitals.* Thus the reduction in
the total number of camp hospitals in the American Expeditionary Forces was
not nearly so rapid as was the case with the base hospitals, and on April 30,
50 camp hospitals remained in operation. However, during the following
month, this number was reduced to 29,* and by the middle of June, only 11
existed.^''"
In respect to the actual closing of a hospital, there is no necessity for going
into great detail as to this. Suffice it to say that when the chief surgeon,
A. E. F., reached the decision that a hospital unit soon could be returned to
the United States, he notified the assistant chief of staff, G-4, headquarters,
Services of Supply, of that fact, and usually at the same time gave advance
notice to the hospital unit concerned. G-4 gave final notice to the unit at
the proper time, whereupon the officer commanding the unit, after having
accomplished certain administrative matters referred to below, reported to
G-1, Services of Supply the fact of the unit's readiness to move in order that
this section of the general staff. Services of Supply, charged with the move-
ment of troops, could make proper provisions.'^ The unit then joined the
general movement to the base ports and took its turn in embarking.
• For details concerning the final disposition of the few remaining camp hospitals, see Sec. VI of this volume— Ed.
812
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Since no medical property was to be returned to the United States,'*
except combat equipment and certain articles including sur<;ical instruments,
scientific laboratory equipment, and X-ray equipment,'^ it was necessary for
each hospital unit to pack its supplies and equipment with a view of having
them stored subsequently in one of the medical supply depots. Circular No.
72, chief surgeon's office, A. E. F., which is given in the appendix to this
volume, covers the method that was to be used in preparing equipment for
shipment. In view of the inadequacy of space in the medical supply depots
and transportation, most supplies pertaining to Services of Supply constructed
hospitals remained where they were, ultimately to be turned over to the
French. Of course, in so far as those of our hospitals which occupied French
buildings are concerned, all supplies and equipment had to be removed.
The disposition of records was as follows : Certain records accompanied the
unit to the United States, there to be sent finally to The Adjutant General.'"
These included the correspondence book and document file, morning reports,
sick reports, general reports, local orders, war diary. Retained records, such
as retained muster rolls, were to be sent to the office of the chief surgeon,
A. E. F.'** In addition the chief surgeon, A. E. F., required each hospital,
upon finally closing its work as an organization in the American Expeditionary
Forces, to send to his oflflce a final sick and wounded report and the retained
register cards (Form 52 M. D.)'^
REFERENCES
(1) G. O. No. 202, G. H. Q., A. E. F., November 11, 1918.
(2) G. O. No. 54, headquarters, S. O. S., A. E. F., November 14, 1918.
(3) War diary, chief surgeon's office, A. E. F., November, 1918.
(4) Daily report of relation of patients to beds in base hospitals, A. E. F., made by the
officer in charge, hospitalization division, chief surgeon's office, A. E. F. Copies on
file. Historical Division, S. G. O.
(5) G. O. No. 35, G. H. Q., A. E. F., Feburary 21, 1919.
(6) G. O. No. 17, G. H. Q., A. E. F., January 25, 1919.
(7) G. O. No. 20, G. H. Q., A. E. F., January 30, 1919.
(8) First indorsement from the chief surgeon, A. E. F., December 31, 1918, to the assist-
ant chief of staff, G-4, headquarters, S. O. S. On file, A. G. O., World War Division,
Chief Surgeon's Files 322.32911.
(9) Memorandum for the assistant chief of staff, G-1, headquarters, S. O. S., from the
chief surgeon, A. E. F., March 17, 1919. On file, A. G. O., World War Division,
Chief Surgeon's Files, A. E. F., 320.23.
(10) Memorandum for the statistical division. Central prisoners of war, Inclosure No. 1,
A. E. F., from the chief surgeon, A. E. F., June 16, 1919. On file, A. G. O., World
War Division, Chief Surgeon's Files, A. E. F., 322.32911.
(11) Based on the histories of the separate base-hospital units, A. E. F., prepared for the
chief surgeon, A. E. F. These histories are on file in the Historical Division, S. G. 0.
(12) Circular No. 66, chief surgeon's office, A. E. F., February 4, 1919.
(13) Embarkation Instructions No. 13, headquarters, S. O. S., December 31, 1918.
(14) Final report of Gen. John J. Pershing, September 1, 1919.
(15) Embarkation Instructions No. 13, headquarters, S. O. S., January 4, 1919.
(16) Letter from the commanding general, A. F. T. F., to The Adjutant General of the
Army, January 7, 1920. Subject: Report on the operation of the A. F. T. F.
Copy on file, A. G. O., World War Division, 370.22 E. E.
(17) Circular No. 73, W. D., November 18, 1918.
(18) Circular No. 61, chief surgeon's office, A. E. F., December 18, 1918.
SECTION V
THE ARMY OF OCCUPATION IN GERMANY
CHAPTER XXVIII
THE AMERICAN FORCES IN GERMANY
Inunediately after the signing of the armistice, the American Third Army,"
was organized as an army of occupation in Germany, in accordance with
the armistice terms. ^ The territory assigned to the American Third Army
was the historic Moselle Valley from the borders of Luxemburg to the Rhine.'
The area contained about 1,000,000 people, with only two large towns — Treves,
with 45,000 inhabitants, and Coblenz, with 65,000. '
The maximum number of American troops ever in German}^ was in Feb-
ruary, 1919, when the number totaled 10,426 officers and 251,833 men.^ On
July 1, 1919, the Third Army had been reduced to 5,095 officers and 100,695
men, and its designation was changed July 2, 1919, to the American forces
in Germany.' On October 1 the forces consisted of some 510 officers and
10,556 men.'
MEDICAL SERVICE
Though, as stated above, the change in designation of the Third Army to
that of American forces in Germany, was not effected until the summer of 1919,
it will be convenient here to consider our medical activities in Germany from
the beginning of that year.
The surgeon's office. Third Army, continued to have the same general
composition after location of the Third Army in Germany as it had had prior
to that event;'' however, a department of sanitation, with much broader
interests, was established in the first part of 1919, after the army had been
stabilized in the area of occupation.^
As army epidemiologist was attached to the office of the sanitary inspector.-
His work w^as the collection and compilation of data on sickness in the army,
the dissemination of this information in the publication of memoranda and a
Weekly Health Bulletin, and the formulation of measures for the control of
communicable disease. Field work by the epidemiologist was not required,
because no extensive outbreak of infectious disease, aside from widespread
influenza, occurred.
Territorial sanitation by sanitary squads as army units was not considered
necessary after the combat divisions had become stabilized in the areas. ^ It
was decided by headquarters of the army that the divisions with the usual
» For the oomposition of the American Third Army and its march into Germany, consult Sec. VH, Vol. VIII, of thi.s
history.— f^d.
<> Con.sult Vol. VIII, Sec. VII, ('haiJ. XXXVIII, for details concerning the composition of the ofBce of the surgeon.
Third Army.
813
814
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
divisional medical personnel would be able to carry on continuous sanitary
work in their permanent areas without the assistance of a separate army sani-
tary force. This plan proved satisfactory and, as records of sanitary condi-
tions in the various areas were kept in the office of the army sanitary inspector,
no difficulty was experienced in furnishing incoming divisions with the essential
information regarding the sanitary conditions of the areas which they were
entering.^
In the area of occupation about 10 per cent of the troops were quartered
in barracks, while about 90 per cent were billeted with civilians in cities
and villages.2 The civil sanitary arrangements varied from crude, primitive
methods of water supply and refuse disposal to the fairly well organized san-
itary systems of the larger cities. The number of soldiers in this area, at first
approximately 250,000, practically doubled the population.^ So severely did
this increased density of population tax the general living arrangements, water
supplies, and conservancy system, that a considerable part of the sanitary work
of the Third Army was concerned with increasing the capacity of these rural
and municipal systems. In this work, water supplies were increased, barracks
built to obviate overcrowding, and mess halls erected to provide shelter for
men at meals.^
Infectious diseases, with conditions highly favorable to their transmission
to troops, were found to be prevalent among the civilians, the most important
widespread epidemic diseases being typhoid fever and diphtheria.^ Arrange-
ments for dealing with the civil phases of the situation were in the hands of
the chief sanitary officer, civil affairs, advance general headquarters, at Treves.
By a close coordination between the medical organization of the Third Army,
the chief sanitary officer of the section of civil affairs, and local German health
officials' reports, on infectious diseases among civilians and reports of typhoid
fever carriers were obtained systematically.^ Through this system the Army
exercised control over disease among the civilians and enforced various meas-
ures for improvement of civil sanitation.
Provision of facilities for disinfestation and bathing were urgent sanitary
problems during January, 1919.^ At that time approximately 90 per cent of
the men were infested with lice, consequent upon the lack of bathing and
delousing facilities in the zone of combat and on the march. Upon the stabili-
zation of troops in this area energetic efforts were made to free the command
of these vermin. Only one Foden-Thresh machine was available, and the facili-
ties for bathing were inadequate. Much improvised apparatus was constructed
by division medical establishments and by the engineers; Serbian barrels,
Canadian hot-air disinfestors, cave disinfectors, and steam barrels, supplied
with steam from tractor engines or factories, were set up throughout the area.
By these means, augmented later by standard steam disinfestors and portable
shower baths, louse infestation was rapidly reduced, until by May 31, 1919,
the degree of infestation as determined by inspection, was not above 1 per
cent.^
During the first three months of 1919 the general camp sanitation of
organizations of the Army was greatly improved.^ The problems depending
for solution upon the supply of lumber and other materials were efficiently
THE AEMY OF OCCUPATION IN GERMANY
815
handled by divisions and the Corps of Engineers.^ Improved construction
of kitchens, screening of food receptacles, fly-proofing of latrines, and removal
of manure piles and other breeding places of flies had progressed well toward
completion before the commencement of the season when flies might prove
prevalent. Supplies of clothing were ample; food supplies were sufficient,
of good quality, and generally handled with cleanliness during transportation.
Efforts to provide men with amusements which give them facilities for sports
and other recreation were extensive and very beneficial.
The water-supply service was found to be the only sanitary work requiring
a definite Army organization as distinct from that of the divisions.^ The
organization of the water-supply service was begun in the surgeon's office in
January, 1919, when it was found that purification of water supplies at their
sources would be necessary. Many of the towns in the area of occupation were
supplied by water systems carrying tap lines to the houses. A number of
these supplies were found on examination to be polluted, particularly in the
towns in valleys of the Rhine, Moselle, and Ahr Rivers.^ Since chlorination
of water in water sterilizing bags was an inadequate control of drinking water
for men who had free access to water from taps in houses, a water-supply
service was organized under officers of the Sanitary Corps, with one section
in the surgeon's office and another section in the office of the army chief engi-
neer.^ The section in the surgeon's office was engaged chiefly in conducting
surveys and examinations of water supplies and recommending the installa-
tion of apparatus for systematic chlorination of water at suitable points. In
this work the division field laboratories were being utilized as extensively
as possible and proved of great value. The section in the chief engineer's
office was concerned primarily with the assembling, construction, and installa-
tion of apparatus and the training and provision of personnel to operate the
plants.
The first evacuation hospitals which operated in Germany were Evacua-
tion Hospital No. 3, which reached Treves on December 3, 1918, and Evacua-
tion Hospital No. 12, which arrived at the same city on December 4} The
former relieved a Fourth Corps field hospital which had taken over a German
hospital on December 1.
During the week ending December 15, when the divisions reached their
final areas, additional evacuation hospitals arrived. It was planned to have
these evacuation hospitals function as base hospitals in order that as many
patients as possible might be retained in the Army and returned to duty. To
this end these hospitals were staffed and equipped as completely as possible
with well-trained personnel and with adequate suppHes.^ Without exception,
they were unusually well housed in suitable buildings, a few of which had been
constructed for hospital purposes; others were in large schools and military
barracks previously used by the Germans to care for the sick.^
It was the poHcy, as far as possible, to group the hospitals in centers so
that special services could be more highly developed.- The large area over
which the Third Army spread made it necessary, however, to place a few
isolated hospitals at outlying points. The largest center was situated in
Coblenz.- Here Evacuation Hospital No. 6 was established in a splendidly
13901—27 52
816
AD:^riNISTRATION, AMEEICAX EXPEDITIONARY FORCES
equipped German military hospital. This was used for surgical and ortho-
pedic cases and for sick officers and nurses. Evacuation Hospital No. 2 had
a urological and contagious service. Evacuation Hospital No. 4, located
in a schoolhouse on Oberwerth Island, had the eye, ear, nose, and throat cases,
as well as medical service. Evacuation Hospital No. 14 took over the Bruder-
haus hospital and, later, a military hospital in Ehrcnbreitstein. This in-
cluded neuropsychiatric and medical services and in addition was used as the
triage to which all patients received in Coblenz were sent and thence distributed
to other hospitals.
The second center, at Treves, consisted of Evacuation Hospitals No. 3 and
No. 12.2 jj^ ^j^g former, surgical, orthopedic, eye, ear, nose, and throat, and
medical services were developed; in the latter, urological, neuropsychiatric,
contagious, and medical services.
To serve the more remote areas, Evacuation Hospital No. 8 was located in
May en and Evacuation Hospital No. 7 in Prum.^ In order to care properly
for the 42d Division, at the extreme left of the area, evacuation on Hospital
No. 26 was established at Neuenahr in a large hotel providing 1,000 beds.^
The Sixth Corps was attached to the Third Army during the first two
weeks in April, 1919, and with, it Evacuation Hospital No. 13, at Wolferdange,
near the city of Luxemburg.^ This hospital remained attached to the Third
Army after the disbanding of the Sixth Corps. It was established in a chateau
affording 150 beds. Additional beds to the total of 500 were provided in tents.
Because of its limited capacity the hospital continued to function more as an
evacuation hospital, sending many of its cases to the center at Treves. ^
Some of the divisional and corps field hospital were put in operation, but
retained only those cases which could be returned to duty in a few days. An
exception was made in the case of the 90th Division, which occupied a large
area.^ Here it was considered advisable, because of the long distance to
Treves, to equip a field hospital at Cues with female nurses and a good medical
staff in order that pneumonia cases might be hospitalized.
During March, 1919, certain of the evacuation hospitals which had been
longest in the American Expeditionary Forces were relieved by others with a
shorter term of service overseas, as follows: No. 2 by No. 49, No. 6 by No. 27,
No. 4 by No. 22, No. 8 by No. 30, No. 7 by No. 29, and No. 3 by No. 19.^
Evacuation Hospital No. 16 relieved Evacuation Hospital No. 14 on April 3.^
The retention, with one exception, of the commanding officers and of some of
the medical directors of the relieved hospitals resulted in a continuity of poficy.
The decrease in the size of the Third Army led to the closing of the following
evacuation hospitals in May:^ Evacuation Hospital No. 9, Coblenz; Evacuation
Hospital No. 12, Treves; Evacuation Hospital No. 29, Brum. None of the
special services in these hospitals was discontinued, however, each being carried
on in one of the. hospitals remaining. It was assured that with the contraction
of the medical activities coincident with that in the size of the army, the char-
acter and adequacy of the service did not suffer.
The epidemic of respiratory infections during January and February
necessitated frequent evacuations to the services of supplies. ^ Occasionally the
congestion of the hospitals in the Coblenz center was lessened by sending con-
THE ARMY OF OCCUPATION IN GERMANY
817
valescent patients to Treves. Following the stabilization of the army in the
occupied area, however, patients to be evacuated to the services of supplies
were collected at the hospital centers.
Subsequent to the early part of March, 1919, the steady decline in the
hospital admission rate made it possible to retain a much larger number of
patients in the army until they could be sent to duty or it could be demonstrated
that they should be returned to the United States. This policy created the
necessity for convalescent sections in the hospital centers.^ One of these was
organized at Evacuation Hospital No. 19, Treves; one at Evacuation Hospital
No. 9, Coblenz; and one at Evacuation Hospital No. 26, Neuenahr.
The Third Army laboratory service consisted of 2 Army laboratories, 10
evacuation hospital laboratories, 7 divisional laboratories, and limited laboratory
facilities in isolated field hospitals, with 47 commissioned officers.^ The
laboratories were so distributed and their work so divided and coordinated that
the entire army had immediate access to excellent pathological, bacteriological,
chemical, and serological facilities. In addition to the routine work of the
service, extensive bacteriological surveys of the water supplies in the Third
Army area and surveys for chronic carriers of typhoid, paratyphoid, and
dysentery bacilli among the troops were made. Several research problems
were taken up, one on the earliest evidence of tuberculosis infection; another on
the pneumonias; and still others, prompted by the interest of interested officers.
The major part of the professional work in the hospitals and divisions of the
army fell upon the internists, due to the fact that by far the greater number of
cases admitted to hospital were for medical, rather than surgical, conditions.^
Since the evacuation hospitals had been organized principally for surgical
work, it was appreciated that their personnel and equipment would not be
adequate for the type of cases now to be treated, consequently in January, 1919,
the staffs were supplemented with a number of internists.^ A medical service
under a competent chief was maintained in each hospital, and much shifting
of personnel was done to put each service on the most efficient footing possible.
As the Third Army was reduced in size, more particularly during the
release of the final divisions, the various evacuation hospitals were closed and
returned to the United States, until Evacuation Hospital No. 27 alone re-
mained. This occupied the buildings of the former German military hospital
at Coblenz, which, as will be referred to below, became the base hospital for the
American forces in Germany.
When the office of the surgeon. Third Army, became that of the chief
surgeon, American forces in Germany, this difference obtained: - Whereas, the
Third Army was a part of the American Expeditionary Forces, the American
forces in Germany were subordinate only to the War Department, consequently
there was now no intermediate officer between the chief surgeon and the
Surgeon General, inlso far as matters purely medical were concerned. .
Also, certain changes in the Medical Department units were effected.
As finally organized the Medical Department of the American forces in
Germany was as follows : ^
Chief surgeon's office.
Attending surgeon's and dental surgeon's office.
Medical supply depot.
818
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Base hospital, including —
Convalescent camp.
Field Hospital No. 13.
Evacuation Ambulance Company No. 26.
Hospital Train No. 70.
Field Hospital No. 6.
Field Hospital No. 8.
Ambulance Company No. 6.
Provisional Sanitary Train, 2d Brigade.
Port surgeon's office, Antwerp.
Port hospital, Antwerp.
Medical Department personnel on duty with the various organizations operating
infirmaries and prophylactic stations.
Veterinary service (chief veterinary officer in office of chief surgeon and veterinary
officers on duty with mounted organizations) .
Polish typhus relief expedition (attached) .
With the replacement of troops of the army of occupation by regular
troops, the plan of hospitalization necessarily changed.^ Instead of evacuating
to the United States each patient not expected to return to duty within a
short period, a practice hitherto obtaining, all except surgeon's certificate
of disability cases were to be retained and treated in Germany. Accordingly,
a base hospital was established, and the sick from the various organizations
were collected daily and treated in this hospital.^
The base hospital, American forces in Germany, was located in the
western section of the city of Coblenz.^ It occupied a group of buildings which
at one time comprised the Germany garrison hospital of Coblenz, and was
used by the Germans in part as a hospital and in part as a medical supply depot.
There were 13 two-story concrete buildings, with whitestone foundations,
stone-lined entrances and windows; they all were of modern type and in good
repair, and had a normal bed capacity of 460.
Collecting daily and treating sick in the base hospital not only assured
the proper segregation of cases of contagious disease, but also gave the patients
the benefit of the best modern diagnostic methods and treatment by special-
ists.2 But as the base hospital soon became overcrowded, it had to be enlarged
by building a number of temporary frame wards. ^
At first, five temporary buildings were added. These, with 152 beds,
were located across the street from the hospital. Subsequently nine additional
wooden frame buildings, of the Adrian type, were constructed. These buildings
were heated by stoves, illuminated by electricity, and had modern sewerage
connections and flush latrines. A series of wooden buildings (Adrian hut type)
which were a part of the hospital was used as quarters for the detachment,
Medical Department, and for the supply depot of the base hospital.
The increase in the activities of the base hospital also necessitated the
establishment of a convalescent camp in connection with it.^ Such a camp,
with a bed capacity of 500, was opened on September 24, 1919. It was estab-
lished primarily for the treatment of convalescent venereal patients, and
throughout the period under consideration was utilized to its full capacity.^
Antwerp bemg a supply base for the American forces in Germany," it was
necessary to provide for the local hospitalization of our troops there.^ Early
THE AEMY OF OCCUPATION IN GERMANY
819
arrangements were effected with the Belgian mihtary authorities by which any
members of the United States Army in Antwerp, when in need of medical or
surgical attention, might be taken care of at the Hopital Militaire d'Anvers.
This arrangement worked very well, but had several drawbacks, among which
may be mentioned the fact that any soldiers so treated were not under the
control of the United States Army from the time that they were admitted to the
Belgian hospital until they were discharged. There was also alwaj^s more or
less difficulty about getting men discharged on time and in some cases fraudulent
release occurred through the Belgians not being famihar with the United States
Army procedure. Ultimately a small port hospital of 75 beds was opened.^
Hospital Train No. 70 was turned over to the American forces in Germany
and placed in use, evacuating disability cases to Antwerp, Belgium, for return
to the United States
The amount of sickness among the American troops in Germany was never
excessive.^ Taking into consideration that these forces were made up mostly
of recruits, the sick rate for communicable diseases was very low, although some
of the contagious diseases, such as diphtheria, measles, and scarlet fever, were
at times above the normal pre-war rate. No serious epidemics occurred. The
good health of the command was attributed to the mild, equable climate of the
Rhine Valley; to the good health and sanitation of the civil population; to the
excellent housing conditions of the troops, most of them being in comfortable
barracks; and to the careful supervision of sanitation by medical and line
officers. With the exception of the control of venereal diseases, no difficult
health problems presented themselves.
REFERENCES
(1) Annual Report of the Chief of Staff, U. S. Army, 1920, 239-41.
(2) Annual Report of the Surgeon General, U. S. Army, 1920, 368-91.
CHAPTER XXIX
DEPARTMENT OF SANITATION AND PUBLIC HEALTH, GERMAN
OCCUPIED TERRITORY"
The office of the department of sanitation and public health for civil
affairs in German occupied territory was established pursuant to the pro-
visions of General Orders, No. 1, advance general headquarters, A. E. F.,
Treves, Germany, December 13, 1918; however, the organization of the office
had been begun by verbal orders issued by the commander in chief, A. E. F.,
about one week previously. It was the duty of this department to supervise
and control the civil sanitary service in the occupied area with a view of pro-
tecting the health of the troops of the American Army of occupation and of
guaranteeing to the civil population adequate medical service. The personnel
of the department consisted of 12 officers, 4 nurses, and 9 enlisted men.
DISTRIBUTION OF TROOPS
The army of occupation, i. e., the third Army of the American Expedition-
ary Forces, consisted of eight divisions organized into three corps, with head-
quarters at Coblenz. These troops occupied an area west of the Rhine along
the Moselle River, roughly 80 miles from southwest to northeast, from Treves
to Coblenz, and about 50 miles in width, together with the northern half of the
Coblenz bridgehead east of the Rhine. This territory included the kreise
(circles) of Prum, Bitburg, Treves, Saarblirg, Daun, Wittlich, and Berncastel,
in the Government district of Trier, and Adenau, Ahrweiler, Cochem, Alayen,
Coblenz, and Neuweid, in the Government district of Coblenz, with most of
the Government administrative area of Montabaur, in Hesse Nassau. The
estimated civil population of the territory occupied, and with whose sanitary
control this division was charged, totaled 835,000.
GERMAN PUBLIC HEALTH SERVICE
Information was obtained concerning the personnel and organization of
tlie German public health service by personal interviews with the civil officials
in Treves and Coblenz and by a study of published regulations and reports of
the service. It was found that it was administered by civil officials appointed
by the Minister of the Interior. In each of the Government administrative
areas, a civil medical officer was charged directly with the supervision of sanitary
matters within his area; he was responsible to the administrative head of the
district. As health officer of the community, he was the technical adviser of
the administration with reference to all sanitary and public health matters.
In general he supervised water supply and sewage disposal; received reports of
communicable diseases and saw that lawful measures against their spread were
• Based on: Report on the Department of Sanitation and Public Health, Civil Affairs, Treves, Germany. Period
Dec. 7, 1918, to May 28, 1919, dated Nov. 1, 1919, by Col. Henry A. Shaw, M. C. On file. Historical Divi.sion, S. G. O.
821
822 • ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
enforced; made sanitary inspections of food supplies, including milk, meat,
etc.; supervised the sanitation of schools and the medical examination of public
prostitutes. He could not initiate sanitary regulations, but he kept in touch
with all matters affecting the health of the community, and was held respon-
sible for making proper and timely recommendations for the prevention of
disease and the general improvement of sanitary conditions. He made weekly
reports of communicable diseases and yearly reports of general health con-
ditions to the administrative head of the district.
COORDINATION OF THE CIVIL AND MILITARY SANITARY SERVICE
As the German public health service appeared to be adequate and sufficient
for the needs of the civil population, the manifest policy was to continue the
organization in force, with such supervisory control and assistance by the
American Mihtary Establishment as might be found necessary. This was
satisfactorily effected by directing division commanders to supervise the
administration of the civil sanitary service within their divisional limits. As
these areas corresponded fairly closely with administrative areas, division
surgeons were enabled to cooperate effectively with the local health officer,
obtaining from him information concerning the health of the civil population
and the sanitary conditions of the country and at the same time giving him
information concerning the health conditions of the military units. In this
the work of the civil and military'" organizations was coordinated, each report-
ing to the other essential data affecting public health.
Reports from division surgeons of cases of communicable disease in both
civil and military populations reached the office of the chief sanitary officer
through the chief surgeon, Third Army. Weekly reports of communicable
diseases in the civil community were also received from the chief German
sanitary official of the district of Treves and of Coblenz. Cases of typhoid
fever were in addition reported from the director of the German laboratory
at Treves. Division surgeons made a special monthly report to the chief
sanitary officer through channels regarding important matters pertaining to
pubhc health and sanitation in the civil population, a separate report being
rendered for each administrative area. Thus, reports were received and
tabulated from both civil and military sources enabling the chief sanitary
officer to keep in touch with health conditions in both communities.
MEDICAL SERVICE FOR THE CIVIL POPULATION
One of the first endeavors of the office was to get in touch with the German
civil sanitary officials both in Trier and in Coblenz for the purpose of obtaining
information concerning the adequacy of the established public health service
with respect to personnel an ^ material, and also to learn w^hether the needs of
the civil population were satisfied as to medical attendance, hospital and
laboratory facilities, and medical supplies and drugs. Though the public
health service, as noted above, was found to be generally adequate and com-
petent, it was reported that there were insufficient German physicians to care
for the civil population in the occupied territory.
THE AEMY OF OCCUPATION IN GERMANY
823
HOSPITALS
All hospitals were under the administration of the Minister of the Interior
of Prussia and made regular reports concerning the number of beds, the char-
acter of patients, the number of admissions and discharges, and the causes of
death. In the entire district of Coblenz there were reported to be 39 institu-
tions for the care of the sick, with a total of 3,825 beds, and of these only 2,282
were occupied. In the Treves district there were 2,214 beds available, this
number being sufficient to care for the needs of the civil population. The total
number of beds in Coblenz was approximately 5 per cent of the population and
in Treves 2.2 per cent. In both districts the number of hospital beds had been
increased during the war to care for soldiers and was larger than the number
that sufficed in time of peace.
The civilian authorities were informed that in emergency, and also in case
of communicable disease, where isolation could not be promptly obtained by
German civilians, such patients would be admitted to American military
hospitals.
LABORATORIES
A well-equipped laboratory under the control of the public health service
had been established in Treves and was found to be very efficiently administered.
MEDICAL SUPPLIES AND DRUGS
Reports from hospitals, laboratories, public health officials, physicians, and
druggists showed that many of the essential medical supplies and drugs were
either exhausted or to be found in extremely limited quantities. Such were
gauze, cotton, and soap for surgical work; rubber articles; certain drugs, as
iodine and the iodides, sulphur, boric acid, camphor, and the vegetable cathar-
tics. Estimates were made of the needs of the population based on the num-
ber of hospital beds, and recommendation made that certain enumerated sup-
plies and drugs be furnished by the Medical Department, United States Army,
to German hospitals and laboratories in the occupied area. These recommenda-
tions were approved in substance, and the necessary measures taken to carry
them into effect. The cost of the supplies was charged to the German Gov-
ernment.
HEALTH CONDITIONS
A comprehensive study was made of the health of the civil community in
Germany during the war and particularly in the occupied area, the material
for which was drawn from official reports from civil and military sources, from
interviews with German physicians and civil officials, from vital statistics
published by the German Government, and from personal examination of
various groups of the German population.
VITAL STATISTICS
Births. — The average birth rate for this region during several years pre-
vious to the war had been about 30 per thousand; in 1914 it was 23.8; in 1917,
15.6, and in 1918, 16.1. Illegitimate births in the occupied area in Germany
showed little variation in the rural districts before and during the war, but in
the cities the rate was about doubled in 1917 and 1918 as compared with 1915.
824
ADMINISTKATION, AMERICAN EXPEDITIOXAKY FORCES
Deaths. — In the occupied area the death rate for several years previous to
the war averaged 15 per thousand inhabitants; in 1915 it was 20.5 and in 1918,
27.2.
Communicable diseases. — There had been a marked increase in the number
of communicable diseases in Prussia in 1914 and 1915. This was to be expected
on account of war conditions involving rapid mobilization of troops and billeting
with civilians; many localities were left with insufficient medical personnel. In
the American area the most notable increase in these diseases had been in
typhoid fever, tuberculosis, diphtheria, and especially dysentery; previous to
the war this disease had been almost negligible in this region, but it appeared in
Trier in 1914 and in Coblenz in 1915, increasing during the following years;
in Coblenz there were over 700 cases in 1917, and in Treves more than 1,000 in
1917, and nearly 1,900 in 1918.
Among the civil population of Germany, tuberculosis in all its forms had
more than doubled during the war, a fact shown chiefly in death statistics, as
living cases were not reported. A corresponding increase of tuberculosis among
the living was indicated by the fact that the Government insurance offices in
the cities of Trier and Saarbrucken paid benefits to 48 cases of pulmonary
tuberculosis in 1914; the number rapidly increased during the war and in
1918, 208 persons received insurance for this disease. Of all the etiological
factors entering into this increase the shortage of food was most important.
This increase had been much less marked among the comparatively well-fed
rural population than among the city dwellers who were more strictly rationed.
One of the most interesting matters for investigation was the food problem
in Germany, since this question in one form or another was met with at every
turn.
To solve the problem of a diminished food supply, Germany proposed
national rationing. This was begun early in 1915, first in regard to bread and
then extended in the same year to potatoes and meat and finally to nearly every
essential food product. The rationed articles could be obtained only on tickets,
in specified amounts and at prices fixed by the Government. After the
failure of the potato crop in the fall of 1916, food conditions went from bad
to worse, so that before the end of the war the ration allowances in most parts
of Germany were less than half the usually accepted estimates for physiological
requirements for health. In general, it may be stated that the allowances in
1914 averaged about 3,000 calories for various localities; in 1915, about 2,000
calories; in 1916 and 1917 about 1,500 calories, and in 1918 between 1,200 and
1,500 calories. In December, 1918, the allowances for Cologne were 1,480
for Coblenz 1,490, and for Treves 1,408 calories. The rationed articles for this
period in Treves were as follows for one week :
FOOD PROBLEM
Grams
Calories
Cost in
marks
Bread, whole rye, d-pound loaf
Potatoes, 1 pound per day
Sugar
Meat, including 25 grams sausage..
Fat (margarine)
:\Iarmalade, cereals, dried soup, etc
2,000
3,500
156
150
50
594
4,800
3,073
620
260
450
650
0.96
.63
.18
.62
.43
.81
Total.
Per day
6, 450
1 1.8
9,853
1,408
3.6i
.52
1 Pounds.
THE ARMY OF OCCUPATION IX GERMANY
825
Because of illicit traffic in food supplies, hoarding was practiced by farm-
ers and by the wealthy, and among these there was not so great inconvenience
and distress as among the poor in the large cities.
FOOD VALUE OF THE RATION
That the ration allowance during the latter months of the war was piti-
fully inadequate is shown by a glance at the following figures:
Protein __ _ .._I)er cent.
Fat _.- do...
Carbohydrates do...
Total calories
Average
Treves
diet
ration
12-15
8.3
18-20
10
60-65
81.7
3,000
1,408
The ration was diminished both relatively and absolutely in protein and
fat, and in caloric value reduced almost one-half in carbohydrates, and more
than half in total amount. The dietary of the poor people was somewhat
augmented by the addition of such vegetables as cabbage, carrots, beets, and
greens, which could be purchased during the winter in open market at very
reasonable prices. While these vegetables added to the bulk of food, its
caloric value was probably not increased much more than 175 or 200 units.
EFFECTS OF FOOD SHORTAGE
It was difficult to estimate the effect on the civil population of this inforced
reduction in diet; in any event, the results related only to a limited portion
of the inhabitants. In general, farmers and country people had enough for
their own needs and more; the well-to-do always found ways to procure an
abundance of food. Those who suffered real physical privation were the poor
in the cities; this class has been estimated from 10 to as high as 25 per cent
of the total population; the lower figure was probably nearer the truth.
This loss of weight was not an unmixed evil, as there was evidence, at the
time of our occupation, of improved physical condition of the obese and over-
fed, the gouty and the diabetic.
Children of school age, 6 to 13 years, were found to have suft'ered directly
as the result of improper and insufficient nourishment. Two thousand five
hundred children in Treves and vicinity were found in general to be under the
average normal height and weight of German children during peace times.
A large number were found to be small in stature and thin in build, pale and
anemic and with poor nutrition; these conditions were found most frequent
and most marked among the poor. Reports to the same effect were received
from numerous sources in Germany.
In a comprehensive psychiatric survey of the school children of Treves, it
was found that, chiefly as the result of malnutrition, there was a lowering of the
whole standard of school work; loss of nervous energy exhibited by 40 per cent
of the children; an increase in the number of border-line defectives of not
more than 1 per cent of the total school population; and an increase in the
number of children failing to pass their grades from 8 per cent in pre-war
826
ADMINISTEATION, AIMERICAN EXPEDITIONARY FORCES
years to 15 per cent in 1917 and 1918. These conditions were, however, not
found in nearly so marked a degree in the cities of Cologne, Bonn, and Coblenz.
War edema so commonly seen throughout Germany was very generally
attributed to insufficient nourishment. The British, it was learned, noted that
it appeared when fat was markedly reduced in the dietary, and that the symp-
toms cleared up when fat was added.
As a result of the food survey which this office began early in January, the
following report (in part) was made January 31 to the officer in charge, civil
affairs :
The evidence at hand indicates undernourishment of babies and j'oung children.
Nursing mothers are not properly nourished, and their babies do not gain in weight as they
should. Bottle-fed babies can not be properly fed on account of the lack of milk. Children
are undernourished mainly by reason of the lack of fats and milk. In regard to the sick,
one of the most important considerations is a proper diet. There is ample evidence that sick
are dying or that convalescence is greatly lengthened on account of lack of a nourishing
and easily digestible diet. White bread, rice, milk, and some easily digested fats are essential.
With regard to the general population, there is no doubt that the middle class and
poorer people who can not afford to pay exorbitant prices for food are undernourished, and
in many cases resistance is thereby lowered so that they become more susceptible to disease.
As it is manifestly impossible to secure a perfectly even distribution of all the food available
in the American area, it is almost certain that some of the essential articles of diet in the
ration allowance will before the next harvest become exhausted in certain localities, such as
the industrial centers, and that it will be impracticable, perhaps impossible, to supply such
districts from German food stocks. It is therefore believed that our Government should
have on hand the necessary supplies to make good these deficiencies and- should be able to
control the distribution. It is probable the first serious cry for food will be for bread. The
present dietary is deficient in protein and fat. The deficiencies would be made up by wheat,
which is rich in protein, and by pork, which in addition to protein is rich in fat. Potatoes
will probably be demanded in certain localities, as this vegetable is even more of a staple
than bread. Rice is an excellent substitute for potatoes. In addition, bacon or margarine
might be economically issued to replace the deficient fat. Canned beef or canned salmon
would form valuable additions to the present dietary and if on hand in excess might be used
to advantage.
The following recommendations were made at the same time :
That steps be taken to increase the dietary of nursing women, children, and the sick
by the addition of wheat flour, rice, condensed milk, and butter or margarine .
That the United States Government be prepared to issue to the general population
wheat flour (preferably whole wheat), meat (preferably pork), bacon or margarine, and rice.
The food situation in the American area remained practically unchanged
during the winter of 1918-19 and early spring of 1919. The component parts
of the ration varied somewhat from time to time, the general situation getting
rather worse than better, until with the opening of spring and the advent of a
wealth of green vegetables conditions began to improve. On April 20, 1919,
the first American food was brought in and sold to German civilians, increasing
the ration to about 2,100 calories. Articles on sale consisted of flour, rice,
canned milk, bacon, canned beef, and canned salmon, but unfortunately the
prices were so high that very little of the food reached those who were most
in need of it.
An investigation of the physique of school children in Treves indicated
that many of the physical defects noted and much of the suffering and hardship
THE ARMY OF OCCUPATION IN GEEMANY
827
endured by them were due to the unhygienic surroundings in which they lived.
With a view of obtaining definite information as to the living conditions of the
poorer portion of the population, a house-to-house survey, including over
1,000 families, was made by American Army nurses accompanied by German
social welfare nurses. This survey showed that because of overwork, neglect
of homes and children, and especially because of the war ration, disease,
especially tuberculosis, had increased among the poor people in the city of
Treves. The following facts in their report are quoted:
Average number of persons per family 7. 1
Average number of rooms occupied per family 3. 52
Average number living children per family 4. 08
Average number dead children per family 2. 07
Number of families with sickness at time of visit 757
Number of families with history of tuberculosis 282
Number of families with some member tuberculous 379
Average earnings per family per week, marks 61. 02
Average cost of living per family per week, marks 51. 89
(At the time of this survey, the value of the mark was about 8 cents.)
SECTION VI
MEDICAL DEPARTMENT ACTIVITIES, AMERICAN FORCES
IN FRANCE
The American forces in France was created under General Orders, No. 88,
G. H. Q., A. E. F., August 22, 1919, as the organization to take over from the
American Expeditionary Forces the commajid and control formerly exercised
by the American Expeditionary Forces, except that part which was in occupied
Germany, in the Grand Duchy of Luxemburg, and in Belgium. The American
forces in France was in reality a continuation of the former services of supplv
A. E. F.'
The activities of the chief surgeon's office, A. E. F., became continuous
with those of the office of the chief surgeon, American forces in France,^ and
were of the same character but on a much reduced scale, as indicated in the
preceeding paragraph. The summarized report of the chief surgeon, American
forces in France, covers the final steps in the discontinuance of the affairs of
our forces in France.
PERSONNEL
Activities connected with the personnel of the Medical Department
involved the orderly return to the United States for demobihzation of the
large sanitary personnel remaining in France on July 1, 1919. Release of
temporary officers and men was facilitated, and they were replaced by regular
officers and men where necessary. Various regular officers were selected and
detailed to the Polish typhus relief expedition. Close liaison was maintained
with the American forces in Germany, and many specially qualified officers
and men were supplied them as needed and as they could be spared from
France. Owing to defective reports, several thousand individuals were unac-
counted for on the personnel records. To overcome this error, special details
were put in the central records office and the adjutant general's office; all
sailing lists were secured and checked, the central post-office records were con-
sulted. By these means the personnel records were made very nearly com-
plete before being finally forwarded to War Department.^
FINANCE
Claims for services rendered or supplies delivered to various hospitals
and units throughout France were investigated, and vouchers prepared and
paid during the above period as follows:
Month (1919)
Number of
vouchers
paid
Total amount
109
11
52
— 63
28
52
$18, 682. 55
5, 001. 92
1,692. 23
0, 997. 64
Sept. 1-1]
Sept. 11-30
October _ - . .
Xoveinber
829
830 ADMINISTBATION, AMERICAN EXPEDITIONARY FORCES
Many of the accounts paid during this period were of long standing, the
original bills having apparently been lost. Investigations of these charges
were difficult on account of insufficient receipts or orders having been given
by American officers who received the supplies or engaged the services, and on
account of the impossibihty of getting in touch with the officers or units they
having returned to the United States.^
After November 15 no further payments were made by the Medical De-
partment, but all vouchers were prepared and submitted to the quartermaster
disbursing officer for payment. After the medical disbursing officer ceased to
function a total number of 70 claims for services rendered or supplies delivered
(many of these being final settlements covering a series of transactions with
the various persons or companies and requiring a complete check of all bills
rendered and paid in order to avoid duplication) were investigated and vouchers
prepared for submission to the quartermaster for payment.-
Bills for hospital treatment of allied soldiers in American hospitals were
prepared from the reports of the hospitals and submitted to the various govern-
ments in accordance with prevailing orders.^
Government
Number
of bills
Amount
355,490.75 francs
£5 2s.
£1 lOs.
393 francs.
60.50 francs.
Government
Number
of bills
Amount
French
46
2
2
4
2
Rumanian --
3
75
10
1
315.50 francs.
44,171 francs.
7,372 francs
169 francs.
English
English Y. M. 0. A
Belgian
Polish
Bills from the French Government for dehvery of supplies and for treat-
ment of American soldiers in French hospitals were checked (115 bills received
during this period). These bills, as well as the bills submitted to the French
Government, were included in the general settlement between the French
Government and the liquidation commission of November 29, 1919.^
Invoices covering supplies sold by the Medical Department to private
individuals, firms, and allied governments, or liberated countries were checked,
and bills prepared and submitted covering same. The volume of this work is
indicated by the following tabulation:-
Supplies sold to —
Number
of bills
Total amount
of sales
French
3
$20, 613. 60
9, 620. 00
1,718,544. 25
358, 331. 22
Serbian
1
Polish
9
Estonian
2
Supplies sold to —
Number
of bills
Ukrainian 10
Latvia 1
Lithuanian 5
Sales to private concerns
Total amount
of sales
$1, 132, 161. 33
160, 099. 07
669, 838. 58
65,569.21
Vouchers prepared, covering supplies delivered to the American Expedi-
tionary Forces in France, by the British Government for submission to London
for payment.
SUPPLIES
Besides the issue of supplies for current use, the supply division handled the
shipment to the United States of a considerable amount of property ordered
returned; transferred to the Red Cross $10,000,000 worth of supplies as provided
MEDICAL DEPARTMEXT ACTIVITIES, AMERICAN FORCES IX FRAXCE 831
by act of Congress; made deliveries to various purchasers as indicated under the
finance heading, and finally delivered the balance to the French Government
under the purchase agreement. A preliminary settlement of the accountability
of many organization medical supply officers was made.
HOSPITALIZATION
Sufficient hospitalization constantly was maintained, but base and camp
hospitals were released as rapidly as they could be spared, so that by the end of
f919 all had been disposed of. Arrangements were made for civil hospitaliza-
tion in Paris during December. The liability of the Government for the medical
care of civilian employees has been eliminated by the adoption of a new form of
contract. Full information as to securing civilian attendance for officers and
men to whom Army medical attendance might not be available was published for
use of personnel on detached service.
SANITATION
The chief activity under this heading was the continuance of the most vigor-
ous antivenereal campaign, and the establishment and maintenance of four large
segregation camps, at Gievres, Bordeaux, St. Nazaire, and Brest, for the treat-
ment of venereal diseases. At the end of the period the few remaining venereal
cases were returned as patients for the completion of their treatment in the
United States. These activities were successful in carrying out the purpose that
only venereally clean personnel should be demobilized. The inspections and
detention also eliminated lousiness and skin infections among returning troops.
Fortunately, there were no epidemic outbreaks of disease to handle during the
period.
TRANSPORTATION
One hospital train was transferred to the American Forces in Germany.
The others were released as they could be spared, the last one early in October,
shortly after the repatriation of the last sick prisoners of war. Since that time
necessary railway transportation has been successfully carried out by ordinary
train, necessary attendants being assigned. Motor transportation has been
similarly disposed of by turning it in as rapidly as it could be dispensed with.
SICK AND WOUNDED RECORDS
The main sick and wounded records were shipped to the United States in the
summer of 1919. A branch of this office continued to collect and tabulate
records of American patients in French hospitals until November 30, when the
work was completed. Current records were checked for correctness and
transmitted to the Surgeon General as received.
REFERENCES
(1) Letter from tlie coiniuaiidiiig general, American forces in France, to The Adjutant
General of the Army, January 7, 1920. Subject: Report on operations of the
American forces in France. On file, A. G. O., World War Division, 370.2. EE.
(2) Letter from the chief surgeon, American forces in France, to the commanding general,
American forces in France, December 30, 1919. Subject: Report from July 1 to
December 30, 1919. On file, A. G. O., World War Division, 319.1.
13901—27 53
APPENDIX
833
REPORT ON ORGANIZATION, EQUIPMENT, AND FUNCTIONS OF
THE MEDICAL DEPARTMENT
INTRODUCTION
To meet tlie manifold requirements of both trench and mobile warfare the Medical
Dei)artment of the American Expeditionary Forces was modified in both personnel and
e(iuipment to such an extent that the resultant changes bore but small relation to existent
tables of organization and equipment manuals. Adoption of the modified general staff
system necessitated expansion of the office of the chief surgeon, A. E. F., and its division
into bureaus, the work of all imder the chief surgeon being coordinated through the assistant
chief of staff, G-4 (coordination), of the American Expeditionary Forces, under whose juris-
diction fell all the services which under the former staff organization enjoyed autonomy,
the chiefs of services being members of the administrative staff of the commander in chief.
This control of the services by the A. C. of S., G-4, was applied to the armies, and there
being no A. C. of S., G-4, in corps and divisions, the A. C. of S., G-1 (administrative),
assumed the coordinating function. Formal inspection of troops made by the surgeons
of armies, corps, and divisions, or by the sanitary inspectors, were under the A. C. of S.,
G-5 (training), for efficiency, and under the A. C. of S., G-4, for supply, the last two duties
being under G-1 for corps and divisions.
The office of the chief surgeon, A. E. F., being moved from general headquarters to the
licadcjuarters, S. of S., it was necessary to detail an officer of the Medical Corps for duty
at general headcjuarters as deputy of t le chief surgeon, A. E. F., who would advise him upon
all (luestions arising with reference to the Medical Department for adjustment, and who
was empowered to act for the chief surgeon in emergency. This detail was authorized by
G. O. 31, A. E. F., 1918, which order announced the policy of the division of staff control,
and established the five general staff sections at general head(iuarters.
Expediency demanded that mobile operating units, composed of surgical and X-ray
equipment for two operating teams, packed in heavy chests, be supplied in the proportion of
one to each division for use in the nontransportable hospital. So-called mobile hospitals
with a capacity of 150 beds and 2 special camions, .self-propelled, for the necessary surgical
and X-ray equipment, each camion with a trailer containing a small frame-and-canvas hut,
in the proportion of one to each division in line, were found necessary by reason of the lack
of adequate evacuation hospitals during the first engagements of American forces. Experi-
ence and lack of transportation both counseled the abandonment of these two units.
Neither was mobile in any sense of the word and they were of little use, especially the mobile
hospital, which possessed but little bed space in proportion to its operating capacity. The
latter suffered also from the disadvantage of special camions, which should never be
« Pursuant to directions of Brig. Gen. Walter D. McCaw, M. C, chief surgeon, A. E. F., a hoard of officers was con-
vened, subsequent to the signing of the armistice, at general headquarters, A. E. F., to investigate and report upon the
conduct of the Medical Department, A. E. P., and to make recommendations, w^ith a view to the improvement of that
department. This board, consisting of Col. A. N. Stark, M. C; Col. Leon C. Garcia, M. C; and Col. Albert P. Clark,
M. C, made an exhaustive study of the organization, personnel, equipment, service, and transportation of the Medical
Department, A. E. F., and submitted the findings given herein, in April, 1919. Pertinent editorial comment in the form
of appropriate footnotes has been made in order that the most salient features of the board's report may be compared by
the reader with the present organization of the Medical Department of the Army of the United States as perfected up to
this date (July, 1926).— ^:rf.
'■ The relative lack of mobility of the so-called mobile hospitals employed by the American E.xpeditionary Forces in
France was largely due to the utilization of the only type of tentage and equipment available. These hospitals were de-
vised by the French during the period of trench warfare. In the absence of adequate hospitalization, especially as regards
evacuation hospitals, the mobile hospitals of the American Expeditionary Forces played a very important role in bridging
over our difficult ies. The field hospital for nontransportable wounded, recommended by the board, has been provided for.
It is known as a "surgical hospital" and has a normal capacity for 2.50 patients. See Tables of Organization, m-W.—Ed.
835
836
ADMINISTBATION, AMEEICAN EXPEDITIONARY FORCES
employed, and they required half the number of trucks needed to move an evacuation
hospital. A properly equipped field hospital for nontransportable wounded has been devel-
oped. These must be designated corps' units and will become a part of the tactical reserves
at the disposition of the corps surgeon. They will be organized upon a basis of one for each
division of the forces. The functions and organization of these units will be fully discussed
under the part devoted to the corps surgeon.
Tables of organization in force at the time of the enemy offensive of 1918 did not afford
sufficient enhsted personnel and nursing staff for the proper conduct of evacuation hospitals,
necessitating the stripping of base hospitals for nurses and other medical organizations for
enlisted personnel, even labor troops being employed to obtain the requisite number, this
number, found by experience to be proper, being given, with the duties, in the chapter devoted
to evacuation hospitals.
Standardization of equipment is as necessary to efficiency in the medical service of an
army as it is in any industry, and to that end the ward tent has been modified to be used
for all purposes by the Medical Department in the field, all other makes being discarded
for various reasons, such as weight, comphcated system of erection, small interior space to
spread of canvas, inflammabihty, and difficulty in transportation. The surgical. X-ray,
and fighting equipment, together with the medical and other equipment, has been simpHfied
and so arranged that the evacuation hospital is, as nearly as possible, a multiple of the field
hospital in all essential particulars.
Prompt and correct disposition of the slightly wounded and sick of an army taxed the
resources of the Medical Department because of lack of an institution similar to the French
depot d'eclopes, it being recognized that these cases should not be evacuated from the army
zone with great resultant depletion of combat troops, and the solution of this vexing problem
has been met by the estabfishment of the army convalescent camp, which is explained in
detail in the chapter devoted to that subject."
Due to the absence of civil population in the combat zone, the difficulties of having
laundry work done for hospitals was enormous, the small so-called mobile laundries pur-
chased in France being too fragile to permit traction over the rough roads, and as experience
has proven the absurdity of collecting within the combat zone more mechanical appliances
than necessity demanded, it has been decided to have one large demimobile laundry, on flat
cars if possible, in the vicinity of the main army medical supply depot to which hospitals
could send the bulk of soiled linen to be exchanged for fresh. Divisional field hospitals,
corps, nontransportable hospitals, and evacuation hospitals have, in addition, a small gaso-
line motor-driven laundry for operating-room and ward linen.
Much has been said for and against the horse-drawn ambulance, but the fact remains
that this form of transportation for sick and wounded was seldom used and at these times
only in the dense Argonne Forest, where motor vehicles could not progress but where the
wheeled litter would have proven more valuable than the horse-drawn vehicle.
A motor-propelled vehicle may not keep pace with an infantry column without destruc-
tion of the gears, and utility being pari passu with standardization, it has been decided to
employ a four-wheeled medical wagon with cut-under front wheels, springs, and roller bear-
ings to permit traction when the artillery has commandeered the animals or they have been
killed, this wagon to carry the battalion combat equipment and also to be provided with
litters that it may be employed for ambulance purposes, all these wagons being stationed
at the camp of the supply company.'* The heavy pack saddle to bear combat equipment
was never used, and as it was authorized under an entire misapprehension of modern war-
fare it has been decided to abandon it and substitute for it a harness for the draft animaU
of the medical wagons which, by releasing the tugs and slipping a numnah beneath the
small saddle and applying a light metal pack frame with hooks to receive the loops of the
' These units have been provided for at the rate of one per field army. Each will have a capacity for at least 5,000
ambulatory patients. They will be known as convalescent hospitals. See Tables of Organization, 285-W.— £d.
A medical wagon of this type has been adopted. It is designated as the animal-drawn ambulance, new pattern.
It is capable of carrying the field medical set of the battalion and at the same time, if necessary, of transporting patient
thus serving in the dual capacity of a cargo and passenger vehicle.— £d.
APPENDIX
837
medical panniers which are secured by a surcingle, leaves the animal standing in a simple
modified pack harness. The medical wagons will also carry wheel litters which will not
only be available for transport of combat equipment forward when animals can not be used,
but also will be of great service at battalion aid stations. One of these wagons added to
the regimental transportation will serve as solution of the vexing question of transporting
the regimental dental equipment and will insure its being at the desired point.
The camp infirmary, and reserve, have been abandoned as useless adjuncts to medical
equipment, for the reason of their adoption — the preservation of combat equipment intact-
no longer obtains with the changed system of medical supply in the field, and these units
make needless draft upon transportation not compensated for by their small use.
Experience soon demonstrated the imperfections of the intradivisional evacuation
system as given in manuals and tables of organization. Permanent cadre of the sanitary
train of the division must be organized basically upon needs of troops upon the march, with
a flexible auxiliary organization of reserve transport units with the corps or army to care
for combat problems. This will permit the corps surgeon to supply these transport sections
to such divisions of the corps as are most in need. It may later be advisable to extend this
system to the hospital section of the train as well.
Separation of our division ambulance companies into a transport and a bearer section also
has not proven satisfactory, for the bearer section has seldom been used in its normal func-
tion of littering wounded from the battalion and regimental aid station to the dressing
station, and never from the front line to the aid station, which would have been the point
of greatest usefulness. In addition, dressing stations were seldom established, as they soon
were found to be of little use.
While we were not wedded to any particular system, we have found by much experience
that the French system of an ambulance service for transport only, and a litter bearer bat-
talion (brancardiers) which could be applied anywhere as needed, gives the most effective
service, and to that end we have abandoned the present ambulance company and have
formulated the ambulance service (just described) whose elasticity is enormous, and have
formed bearer sections into a battalion of litter bearers under control of the division surgeon
who may apply them, as a whole or as a part, to the line when needed, thereby not only
overcoming the difficulties which formerly obtained under the old system, but minimizing
the demand upon combatant troops for this necessary service. There have, however, been
retained two dressing station equipments for each division, which will be of service, in a
flat terrain, this equipment being carried in two 3 to 4 ton trucks attached to the litter
bearer battalion.*
The medical chests as now authorized contain many medicines and appHances that
may be eliminated under modern conditions of supply, and the chests being unnecessarily
heavy and of small capacity for dressings known to be useful, the development of a light,
canvas-covered wicker pannier for all units must be considered.
The medical belt and Medical Department pack for enlisted men have proven a source
of much dissatisfaction both as to contents and methods of packing, etc. The contents of
the pockets of the belt have been found more or less useless in modern warfare and we have
agreed upon the Infantry pack with a belt to maintain it in place. The hatchet has been
found of less use than might have been expected and if retained must be modified and
strengthened. An infantryman's shovel is considered a far more useful article to the sani-
tary soldier on the front. Front dressings, a rubber tourniquet, shears, adhesive plaster,
iodine swabs, etc., must be carried in a bag similar to the haversack or musette bag, slung
• The sanitary train has been supplanted by the medical regiment, of which 1 is authorized for each Infantry division,
1 for each army corps, and 4 for each field army. In general the recommendations of the board have been embodied in
the new organization. The medical regiment, includes a collecting battalion, which provides a collection station (dress-
ing station) and the litter bearers. The ambulance battalion has two motorized companies and one animal-drawn com-
pany and is exclusively a transport unit. The hospital battalion consists of three hospital companies (field hospitals),
and in view of the adoption of the surgical hospital (an army unit) is now freed of the necessity of caring for nontrans-
portable wounded. There is also included in the medical regiment a veterinary company, and a service company, con-
taining a laboratory section and a supply section. In the Cavalry division a corresponding type of organization has been
provided, which is known as the medical squadron. See Tables of Organization 81-W and 489-W.—
838
ab:ministrati()X, A:\rERK-AX expeditionary forces
from tlic shoulder.'' Thp medical officer's belt is useful with coml)at troops, but its equip-
inent must be modified to include, among other things, the assorted Greely units.
The use of mounts for medical and dental officers must be minimized, since motor trans-
portation has so largely superseded other forms when a column is en route. Motor-cycle
side cars must be assigned in numbers sufficient to cover this need.
The laundry ciuestion for front-line troops has proven a stumbling block in all armies,
and, as a division in line may not be accompanied by such impedimenta, it is reconnnended
that large laundries, to be conducted bv the Quartermaster Corps, be cstablislied in rest
areas for the benefit of divisions relieved from the line, and that delousing and bathing
plants with a supply of clothing be established at the same location, all these plants to be
under control of the Quartermaster Corps and provision made for their early functioning.
I
ORGANIZATION OF THE MEDICAL DEPARTMENT FOR FIELD SERVICE IN
CAMPAIGN
The enormous and sudden expansion of the I'nited States Army for service against the
Central Powers demanded reorganization of all branches of the Military Establishment
along new lines. The great changes in military tactics and the marvelous development of
lethal weapons necessitated a complete change in ])reconceived plans for the medical service.
A study of the operation of the medical departments of the British and French Armies
threw but little light upon the problem, inasmuch as the equipment of American units and
the organization of the units themselves differed so materially from both in the services of
the British and the French.
The first employment of American troops in corps formations during the Marnc offensive
in July, 1918, disposed of many preconceived ideas to which the Medical Department of
the United States Army had long adhered and served to outline a medical organization which
would be effective in either mobile or trench warfare.
It is feared that too much attention was given to the study of phases of trench warfare
to the exclusion of the phases of mobile warfare, for the former is an undesirable and unfor-
tunate condition forced upon a commander who has lost the power of offense, and which,
if continued, soon develops special routine to the great detriment of the force should mobile
warfare suddenly supervene.
In the long and indecisive period of trench warfare special hospitals for the care and
treatment of head, chest, abdominal, fracture, and gas cases soon grew up behind the lines,
and great importance was attached to these institutions by medical observers and writers
who failed to note that immobility — the greatest error in sanitary or military tactics — had
insidiously developed, and few foresaw what would occur shovdd the enemy suddenly give
over defensive tactics and assume the offensive.
Fortunately, the few who realized what did actually occur when the enemy advanced
in March, 1918. when our allies lost their special immobile hospitals, took steps so to organ-
ize the field and evacuation hospitals of the American Army that they would function
alike in either trench or mobile warfare and still retain that mobility which is the sine qua
non of any field unit.
No time was wasted in instructing the personnel of these units in such subjects as visi-
bility problems, for the advent of the aerial observer disposed for all time of the question
of visibility for sanitary units and imbued sanitary commanders with an intense desire to
obtain the most conspicuous Red Cross emblem available, as observations taken by the
aerial observers made accurate indirect fire possible both day and night, and only common
sense was necessary to avoid direct fire.
Function and speed in establishing, in demounting, and in moving were instilled thor-
oughly, and the results amply justified this radical departure from established custom. The
increase in sanitary units to meet the requirements of such a large force as was finally nomi-
nated an army demanded the assignment of competent officers to duties never before con-
templated, and while other assignments did not bear the approval of Tables of Organization,
they did receive the approval of competent authority, and the results amply justified the
assignments.
f The individual professional kits of all officers and enlisted men of the Medical Department now embody the bag
principle recommended by the board. For example, a medical officer carries on his person, slung from the shoulder, an
officer's medical kit. A medical private carries a private's medical kit, etc.— Ed.
APPENDIX
839
MEDICAL DEPARTMENT SANITARY SERVICE
THEATER OF OPERATIONS, EXPEDITIONARY FORCES
The office organization and duties of the chief surgeon of an expeditionary force liave
l)een touched upon under another heading (q. v.), but the relations of his office to general
head(iuarters, to his deputies, and to his representatives and subordinates in the zone of
the armies must be amplified to gain a comprehensive understanding of the otherwise intri-
cate chain of liaison and delegation of duties given in the accompanying chart.
In the accepted scheme of organization the chief surgeon is a member of the administra-
tive staff of the commander in chief, but the complex duties required of him in modern
warfare demand that the burden of detail be removed from his shoulders and placed upon
those of his assistants to afford him time and opportunity to deal with larger questions of
l)olicy and to become familiar through personal observation with all the activities of his
(lci)artment.
The chief surgeon, though not his office force, will be located at general headquarters,
which places him in close touch with the chief of staff of the forces and with the chief sur-
geon of the group of armies. In this position he still maintains his liaison with his deputy
ui)on the staff of the commanding general, the services of supply, from whose office medical
activities in the territory of the services of supply are controlled.
While frequent visits to, and even temporary location at the headquarters services of
sui)ply, will be necessary, there must be a deputy chief surgeon at those headquarters to
assume responsibility required in this situation. So also must there be a deputy chief surgeon
within the general headquarters group. This officer, however, will deal only with the larger
questions of policy and coordination, but in the absence of his chief will act for him in all
questions arising in connection with Medical Department activities within the zone of the
armies or the general headquarters group. Furthermore, he must exert technical supervi-
sion and control over the medical officers detailed to represent the chief surgeon vipon the
various general staff sections, although these latter officers are assistants to the assistant
cliief of staff of the sections to which attached.
As a member of the administrative staff of the commander in chief, the chief surgeon
must spend much of his time away from the two administrative headquarters, for only in
this way can he keep himself well informed as to the status of the Medical Department with
the armies and the activities of his department throughout the larger zone of the services
of supply. It therefore becomes necessary for him to maintain a temporary office, so to
si)eak, within the office of each of the two deputies.
The deputy at general headquarters will maintain an office and office force wherever
such facilities are available. In practice, excellent results have been obtained by making
this office a part of the coordination section of the general staff, with the deputy actually
a member of that section and in charge of a subgroup of the section (the medical section,
G-4-B). This has been true largely because this general staff section coordinates with the
greater i)art of Medical Department activities. It is quite possible, however, that it was
true somewhat because of the personalities of the individuals concerned. No machine,
however perfectly organized, can be expected to function just as efficiently with the personal
c(|uation eliminated, but the organization adopted for the Medical Department must be so
flexible as to permit the elimination or utilization of this equation when such elimination or
utilization would obviously work to better ends. Arbitrarily to say, therefore, that the
office of the deputy must be located with the medical officer representatives with the coordi-
nation section would be a mistake, since it might be found that better results might be
obtained if the medical section "grew up" as a part of, we will say, the operations section.
For this reason, also, although medical officers detailed to the sections should be detailed
general staff officers, it would seem better that the deputy at general headquarters as well
as the deputy as services of supply headquarters remain a member of the ^Medical Corps.
At general headciuarters and the services of supply headfiuarters a medical officer must
be detailed to each general staff section. These officers must truly represent the chief sur-
geon and must possess the confidence of their immediate general staff chiefs as well, else
such details are useless to both. Medical Department questions arising within all sections
840
ADMINISTEATIOX, AZMERICAN EXPEDITIONARY FORCES
should come before these officers for comment before being finally decided. So much of all
plans for the future as affect the Medical Department must, in confidence, be given these
officers in order that the chief surgeon and liis staff may be kept informed along lines where
the commander in chief will expect him to obtain results. Only officers known to be trust-
worthy will be selected for such positions, and if not acceptable to both parties they should
neither l)e detailed nor continued in office. But so long as they are acceptable they must
be not only with the section but also a part of it and admitted to daily conferences.
It is understood therefore that such officers are detailed for the purpose of giving and
receiving technical information with reference to the Medical Department and for the pur-
pose of coordinating efforts thereof with the efforts of other departments and those of their
own section. The mere fact, however, of the existence of such a detail must not be considered
as precluding in any way the direct official intercourse which the situation demands between
the chief surgeon, or, in his absence, his deputies, or his representatives within the armies or
services of supply sections, and the respective chief of staff concerned.
The deputy chief surgeon at services of supply headquarters is a part of the office of the
chief surgeon. In the absence of the chief surgeon, he directly controls that office and
exercises technical control over the medical officers detailed as medical representatives with
the general staff sections at those headquarters. When the chief surgeon is present the
deputy acts as his chief executive in all matters pertaining to the management of the office
or the supervision of Medical Department activities within services of supply sections, the
latter function being exercised, of course, through the chief surgeons of the sections therein.
Relationships between the chief surgeons or surgeons, as the case may be, of groups of
armies, armies, corps, or divisions, their medical representation with the general staffs of
these units and the respective chiefs of staff, are exactly as has been indicated for the general
headquarters and services of supply groups.
In the cases of army groups and armies, medical officers should be det.aled to all sections
of the general staff which are present at the headquarters of such units. With corps and
divisions a representative with the administrative and supply section should suffice, and
allowance for all such details should be made upon tables of organization of the unit concerned.
Below the army group, these officers should be assigned to the general staff section concerned
but should remain officers of the Medical Corps and not be detailed general staff officers.
Attention is invited to the linking up of the division surgeon and the commanding officer
of the sanitary train and the division surgeon and the regimental surgeon. In the case of
the former a hazy relationship has existed heretofore wherein the commander of divisional
trains was in a position to exercise technical control over the sanitary train even when trains
were not merely on the march and together as a unit. When on the march and acting as a
unit the need of such road control is conceded, but all other technical and tactical control of
the sanitary train must revert to the division surgeon when contact with the enemy is im-
minent. The commanding officer of the sanitary train is therefore one of the important
assistants of the division surgeon, and the direct official intercourse so necessary to the
proper functioning of the intradivisional evacuation system must be made possible and
considered essential." Relationship of army, corps, or division chief surgeons or surgeons
to the respective sanitary inspector deserves careful consideration. A status has slowly
developed within certain larger combatant units wherein the sanitary inspector has been
considered essentially a staff officer of the unit commander, with more or less independence
of the chief surgeon or surgeon. The opinion is held that such assumption is erroneous and
that this officer is an important assistant to the Medical Department head in question who,
furthermore, must carefully supervise and control his activities in groups of armies, armies,
corps, or divisions.
In the case of the regimental surgeon the status is quite different. The surgeon of a
regiment must be a staff officer of the regimental commander, and as such he is his technical
adviser on all matters medical or sanitary. He is therefore tactically and in all other ways
directly under the regimental commander through his adjutant. This may be taken for
» In the present organization the commanding officer of the medical regiment (sanitary train) also serves as division
surgeon. The medical inspector (sanitary inspector) serves as his assistant.— £d.
APPENDIX
841
granted, and the linking up of these officers with the division surgeon is merely to indicate
the technical supervision which must be exercised by the division surgeon over these juniors
who are, morally at least, his assistants.
A carefully organized liaison must be maintained between the medical department of
an expeditionary force and similar groups of allied armies with which our troops may be
operating. Through such an organization a multitude of details will be handled. Officers
of rank, experience and tact, speaking ths language of the foreign office] concerned, must be
assigned these important details. It is highly important that these offices be so orgnaized
as readily to permit direct communication between them and the offices of the chief surgeon
or his deputies. In the zone of the armies a similar status must exist. The direct communi-
cation referred to must be liinited, or course, to technical subjects and matters of approved
policy not requiring further reference to American or allied staffs.
The organization as presented above, therefore, is considered essential to the success
of the sanitary service with an expeditionary force. Acceptance of such an organization
will only duplicate, for combat units and their staffs, that which was in actual existence at
general headquarters in France for more than a year, and will largely counteract the loss of
efficiency developing for the Medical Department from the separation of the larger combat,
headquarters into echelons and placing of the chief surgeon of an army, for instance, back
with the second or third echelon.
By such a chain the chief surgeon, his deputies, and representatives with the fighting
troops — in all of which positions the necessity for prompt information is great — may be kept
informed regarding the expected activities, shortages, unusual occurrences, or the like.
This information is essential not only that those interested may be duly advised, but also
to preclude the loss of time which the usual channels of communication entail, such loss
resulting only in useless suffering and a sacrifice of human lives.
In this plan of organization the army service zone has been incorporated, since it is believed
certain that such an element will replace the advance section, services of supply, in any or-
ganization scheme adopted for an expeditionary force of any magnitude. This geographical
division places the advance section within the zone of the armies and therefore under army
control.
For the Medical Department the objective is to provide the means for relieving the
group chief surgeon of the multitudinous duties attendant upon the supply, equipment,
sanitation, discipline and training of the large numbers of Medical Department units and
personnel making up the group command. The larger the force the greater the necessity
for perfect liaison. Information and orders alike travel slowly in huge, dispersed commands.
The medical service, by reason of its large establishments and the mass of impedimenta and
transportation, requires time to be in a position of readiness. It must be apparent, there-
fore, that tardy information of any activity will eventuate in calamity and will detract from
the success of the venture if not entirely nullify it.
II
OFFICE OF THE CHIEF SURGEON, EXPEDITIONARY FORCES
The chief surgeon of an expeditionary force, with the rank of major general, is a member
of the administrative staff of the commander in chief, and his activities, in common with
those of all other chiefs of services, are coordinated through the coordination section of the
general staff, at general headquarters.
The office of the chief surgeon will be located at general headquarters, or at the head-
quarters of the services of supply, such location depending upon facilities and administrative
convenience.
Should conditions prescribe the location of the office at headquarters of the services of
supplv, the chief surgeon assumes the dual function of chief surgeon of the forces and of the
services of supplv, and his activities are coordinated through the commanding general,
services of supply and his general staff, but should he be located at an intermediate point
he must have a deputy to perform the duties of chief surgeon of the services of supply.
Even should his office be located at general headquarters, he must have a deputy at this
point. The deputy at general headquarters is in perfect liaison with the chief surgeon's office
842 ADiyilNISTRATIOX. AMERICAN KXPEDITION AHY P\:)RCES
and with the chief surgeons of combat organizations, and while normally he advises the chief
surgeon of policies jiromulgated by the general staff relating to the Medical Dej^artment and
transmitted to him by the A. C. of >S., coordinating section, he must be empowered to act
in emergency for the chief surgeon, particularly in those cases in which the element of time
is the determining factor, advising the chief surgeon promptly of the action taken.
The deputy at general headquarters must have assistants and a clerical force com-
mensurate with the volume of work devolving upon him; and the chief surgeon, whether
located at general headquarters or elsewhere, must have one or more representatives with
clerical assistants on each section of the general staff in conformity with existing regulations,
to the end that there may l)e effective coordination between the sections in their relation to
the Medical Department.
The deputy at general headquarters is in a peculiarly favorable position for liaison with
the armies of the expeditionary forces, and the location of the chief surgeon at an intermedi-
ate point, with a deputy at both general headquarters and the services of supply, places
him in a most advantageous position, as this disposition leaves him free from the mass of
routine in which he would be involved in another situation and affords him time for study
of problems confronting the Medical Department and opportunity for personal investiga-
tion of the adequacy of measures both at the front and the rear.
Experience has developed the office and determined its division into sections and sub-
sections as follows, a brief resume of the scope of each being given:
1. Chief surgeon. — General control of Medical Dei)artment and policies deaUng with
the department at home and aV)road.
2. Deputy chief surgeon. — Coordinating control of divisions of office, and acts for chief
surgeon in the latter's absence.
3. Deputy chief surgeon: General headquarters; duties outlined in text.
' (a) Medical officer attached to administrative section: Concerned with tonnage,
forecasts and priority of tonnage, priority shipment schedules, organization
and equipment and tables of organization, and authorized aid societies
affecting the Medical Department and not under other sections.
(6) Medical officer attached to intelligence section: Concerned with intelligence of
value to the Medical Department.
Medical officer attached to operations section: Concerned with oi^erations and
in close liaison with deputy chief surgeon,
^(d) Medical officer attached to coordination section: Concerned with hospitaliza-
tion, transportation, evacuation, supply, troop movement, veterinary
service, and in close liaison with deputy chief surgeon, general headquarters.
(e) Medical officer attached to training section: Concerned with training of medical
personnel and inspection of same, and conduct of sanitary schools.
(Note. — These officers, except the deputy, must be members of the general staff and
be regularly assigned.)
Close liaison between these officers assigned to staff sections facilitates the coordinating
function of the deputy chief surgeon and accelerates the work of the chief surgeon and also
that of deputy at the headquarters of the services of supply, thereby insuring promptitude
in movement of personnel, transportation, and materiel to meet the requirements of military
operations.
The division into sections and subsections of the chief surgeon's office, with duties
assigned each, are as follows:
1. Sanitation. — A medical officer of the rank of colonel, with the proper number of
commissioned and enlisted assistants, conducts this division, which is subdivided into the
following sections:
(«) Sick and wounded: Deals with inspection, auditing, correction, and compila-
tion of all statistical data relating to the sick and wounded and correspond-
ence pertaining thereto.
(b) Sanitation, lal)oratories, and communicable diseases: Deals with general and
special sanitary administration, laboratories, inspections, epidemiology, and
sanitary reports, sanitary publications and reference library, and venereal
disease control.
APPENDIX
843
2. Hotipitnlizntion. — This largo and iiui)ortant division would normally be under control
;)f a brigadier general of the Medical Corps, with the proper number of commissioned and
enlisted assistants, and subdivided into the following sections:
(a) Procurement and construction: Deals with hospital projects, transfer of
hospitals and property to the Medical Department and vice versa, offers
of lands and buildings for hospital purposes, leasing of lands and buildings
and the inventories and lease papers of same, hospital plans and construc-
tion in liaison with the chief engineer or with civil contractors, repairs
to hospitals, sanitary appliances for hospitals, procurement and distribu-
tion of tentage, coordination with rents, requisitions, and claims bureau
and Quartermaster Corps, reference maps and graphic charts of projects
completed, under construction and proposed, and inspection and reports
relating to above items.
(b) Administration and policy: Deals with hospitals, boards, inspections, instruc-
tion, personnel requirements, regulations, war diary hospitalization section,
coordination of administration with other divisions and sections,
(f) Statistical and liaison: Deals with daily bed report of base hospitals and con-
valescent camps, weekly reports of all hospitals, monthly bed reports
and authorization reports of all hospitals, statistical tables, liaison with
chief quartermaster, office reference, care and location of Medical Depart-
ment units arriving from the United States, installation of new hospitals
transportation for new hospitals, instruction and assembly park for
hospitals for nontransportable wounded, and assemljly and shipment
of same.
{(I) Evacuation and transportation: Deals with primary, secondary, and special
evacuation of sick and wounded, collection of evacuables of class
D, transportation and assembly of special classes of patients, estimates
for basis of procurement of motor ambulances, hospital trains, motor
cycles, etc., for Motor Transport Corps, liaison with Navy, troop move-
ment bureau, armies, and general headquarters, records and statistics
of evacuation, hospital train assignment, motor ambulance transportation,
services of light railways and waterways, and liaison with railway transport
service.
3. Personnel. — A medical officer of the rank of colonel, with the proper number of com-
missioned and enlisted assistants, conducts this division, which is of the first importance in
that the function of all units of the expeditionary force depends upon its conduct. It is
subdivided into the following sections:
(a) Army Nurse Corps: A nurse of recognized executive aljility is assigned as
supervisor, for upon her depend the administration, policy, assignment,
discipline, and replacements of the nursing personnel (female) and aides,
if any, for the entire medical establishment.
(b) Medical Corps, Sanitary Corps, civilian clerical force, and enlisted men of the
Medical Department: The medical officer in charge of this section must
Ijossess an accurate file of all personnel of the Medical Department and
civilian attaches, and his office concerns itself with assignments, orders,
transfers, returns, personal reports, files, location, organization, and
commissions.
(c) Promotions: This section deals with correspondence relating to promotions,
records of recommendation and subsequent promotion, and notification
of promotion, and the officer in charge must be ever upon the qui vive to
obviate injustice being done deserving officers.
4. Professional services.— This division must be in charge of a medical officer of the
regular estal)lishment with the rank of colonel, to insure an accurate knowledge of adminis-
trative routine, and he must also possess a wide knowledge of the professional qualifications
of the large number of civilian practitioners in the United States who form the conunissioned
medical reserve in time of war, that assignment to duty with the greatest efficiency in per-
formance may be made.
844
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Tliis office is in direct ]iaisoii with the personnel and administrative divisions, and should
be empowered to issue orders involving the travel of medical officers, nurses, and enlisted
men of the Medical Department selected to form surgical and medical teams to the end that
these teams may be transported with the utmost dispatch to points where their services are
indicated.
The officer in charge also is in direct liaison with the division of supplies to the end that
eciuipment is supplied in proper amount for effective performance of function by the teams
and surgical and medical staffs of hospitals, and is assigned a proper number of assistants
and clerical help. He maintains a file and record system that enables prompt action to be
aken at all times.
To insure efficiency he must l^e empowered to make personal inspections in all units
of the expeditionary force.
This division is subdivided into two subdivisions:
(a) Surgical.
(6) Medical.
The surgical subdivision, under charge of a medical officer of the highest surgical attain-
ments, is subdivided into the following sections:
(a) General surgery. (/) Neurological.
(6) Research. (g) Ophthalmology.
(c) Urological. (h) Maxillofacial.
(d) Orthopedics. (i) Otolaryngology.
(e) X-ray.
The medical subdivision, under a medical officer of high professional attainments, is
subdivided into the following sections:
(a) General medicine.
(6) Psychiatry.
It is imperative that each subdivision and section thereof be in charge of officers who are
preeminent in that particular branch and who at the same time possess administrative
ability. In addition to routine duty, these officers prepare the bulletins issued from time to
time, announcing the latest approved methods of technique, for the information of medical
officers of the expeditionary force, and give stated lectures on the same subject to each class
of medical officers at the sanitarj^ schools.
5. Dental. — An officer of the Dental Corps with the rank of colonel and with the proper
number of commissioned and enlisted assistants conducts this division, which is in part admin-
istrative and in part technical, the former dealing with current reports and returns, records,
statistics, equipment, personnel, schools, and supplies, and the latter with the teaching,
apparatus and supplies of the complex branches of prosthetic and maxillofacial dentistry.
6. Administration. — This division is in charge of an officer of field rank, and he, with a
proper number of assistants, conducts the office, which, for convenience, is directly in liaison
with all divisions:
(a) Records, deahng with numbering and fihng of permanent records, receipt, and
dispatch of official mail.
(b) Administration, dealing with general supervision of entire force of chief surgeon's
office, information, courier service, chauffeurs, orderlies, printing, and
stenographic work.
(c) Detachment, deaUng with entire detachment on duty in chief surgeon's office,
its records and reports, discipline, instruction and equipment, censoring
of mail, office property, mess, and quarters.
7. Supplies.— This division is in charge of an officer of the Medical Corps with the rank
of colonel who is accomplished in all branches of supply work and who with a proper number
of assistants conducts the procurement, statistics, and distribution of supplies, and main-
tains a careful liaison with the medical officers detailed to the general staff sections deaUng
with tonnage and supplies at the various headquarters.
APPENDIX
845
The office is divided into the following sections:
(a) Procurement, dealing with foreign purchase, United States automatic, requisi-
tions, and Red Cross medical supply activities.
(b) Statistics, deahng with graphics showing locations and functions of depots,
cables relating to supplies, records, personnel, and car movements.
(c) Distribution, dealing with medical supply depots, inspections, controlled
storage depots.
8. Finance and accounting. — This division is under charge of an officer of the Sanitarv
Corps, for he must be expert in all forms of auditing and accounting, subjects entirely
foreign to the professional education of a medical officer.
With a proper number of assistants, and provided with the most approved time and
labor saving mechanical devices for the work, the office is subdivided into the following
sections:
(a) Finance, dealing with disbursing, examination of money vouchers, examination
of hospital funds, liaison, and final clearance, billing, financial reports.
(6) Property, dealing with examination of property vouchers and returns,
(c) Legal, dealing with legal reference and recommendations based thereon.
9. Veterinary. — This division will be under the charge of an officer of the Veterinary
Corps of field rank. With a proper number of assistants, he conducts the office which deals
with administration, personnel, supply, organization, statistics, construction, inspection,
liaison, appointments, assignments, promotions, veterinary hospitals, and instruction.
10. Organization and equipment. — This is a new division, the necessity for creation of
which has been manifested constantly throughout the late war and the lack of which has made
it necessary for officers already engrossed to the fullest to put aside temporarily most impor-
tant duties to perform this labor.
It is the duty of this division to study the equipment and organization of the Medical
Department with a view to constant improvement, and this is based upon reports and observa-
tions concerning every unit of the medical service, new offices being recommended to meet
conditions not contemplated and the abolition of others found to be excessive and of little
importance, and modifications, increase or decrease in equipment to enhance efficiency.
Officers detailed to this division should be permanently assigned as long as they possess
creative faculties and demonstrate ability, and promptly relieved upon evidence of failure in
either. The division is subdivided into three sections, as follows:
Shipment schedules and tables of organization: This section prepares the priority ship-
ment schedules with reference to units of personnel, keeps the schedules up to date and
furnishes extracts thereof to the personnel and supply divisions in advance of their realization
in order that the former division may be fully acquainted with expectations in personnel and
units and that the supplv division may prepare its tonnage forecasts, prepares recommenda-
tions for changes deemed necessarj', and keeps up to date the existing Tables of Organization.
Maps, charts, graphics, and manuals: This section prepares and maintains the correctness
of all maps showing the location of all Medical Department units, all charts and graphics
dealing with the duties of personnel or the layout of an}^ unit, and circulars announcing
changes, revocations, or additions to the Manual of the Medical Department or other Medical
Department service publications.
Hospital and combat equipment: This section studies the equipment of the medical
service from all angles and makes comparison with that of foreign services, recommending such
changes in any part of the equipment as will reduce weight or volume, increases efficiency,
mobility and durability, and facilitate standardization. It must be provided with drafts-
men, mechanics, etc., as the w^ork is of a technical nature, particularly in the combat section.
All modifications effected and accepted by the chief surgeon must be checked over to the
hospitalization and supply divisions in order that these offices may keep their projects and
schedules up to date. ^
* An organization and equipment division under the title of planning and training division has been in operation in the
oflice of The Surgeon General since 1919, and a corresponding division will be maintained in the oflBce of the chief surgeon
of any expeditionary force. — Ed.
846
ADMINISTRATION, AMEHICAN EXPEDITIONARY FORCES
ATTEXDIXO SURGEON'S OFFICE.'
Attending surgeons will be detailed for all large military Iicadqiiarters w itliin an expedi-
tionary force. Officers so assigned will be field officers of the Medical (Jorj)s and nni.st
possess tact, administrative ability, and be well versed in the [^ranches of their profession.
A competent complement of commissioned and enlisted assistants, including dental surgeons,
will be assigned to the attending surgeon's office.
The function of this office is to provide medical and dental attendance for the coni-
mi.ssioned, enlisted, and civilian personnel forming the command of which the office is a
part. Attending surgeons are members of the staff of post or headquarters commandant.s
and as such will make necessary recommendations with reference to sanitation and schedules
for the authorized sick calls and physical and medical inspections.
Boards of officers will be convened from time to time at the various headquarters for the
purpose of conducting investigations which may be of the utmost importance. It is fre-
(luently necessary to have medical officers detailed to these boards for the purpose of conduct-
ing required physical examinations, and attending surgeons must be prepared to sit as members
of such boards.
Sick calls will be held ordinarily twice a day for enlisted and civilian personnel. For
officers, a morning hour sick call will be held daily. At other times officers will be permitted
to consult the attending surgeon, or his assistants, as needed. One medical officer will be
detailed for night duty at the office of the attending surgeon. He will be constantly on duty
for emergency calls during the hours between 7 p. m. and 7 a. m. A well-organized eye, ear,
nose, and throat clinic will be a pressing need in such an organization, and suitable personnel
will be assigned this work.
Sanitary supervision of messes and disposal facilities connected therewith is a functioii
of an attending surgeon. He recommends sites for the estal)lishment of bathing facilities
for officers and enlisted men, and subsequently keeps in close touch with the sanitation of
these establishments.
Although the closest attention being paid to laundry and bathing facilities offers the
best means of maintaining a command free from louse infestation, such infestations are
certain to occur, and a power-driven, high-pressure disinfestor, adequately manned, should
be part of the regular quartermaster equipment of a large headquarters.
A regular course of lectures covering prophylaxis against and the danger of venereal
disease, personnel hygiene, and sanitation will be arranged for all enlisted personnel of the
command.
The establishment and supervision of adequate facilities for venereal prophylaxis
within the environs of a military headquarters is an important duty of this office. These
stations must be maintained within easy and natural reach of the men and will be distributed
throughout the city in which headquarters are located, in number sufficient to meet the
need adequately. One such station will be established near the entrance of each camp
associated with a headquarters. Supervision of these stations, if delegated, will be delegated
to a commissioned officer only, and their operation intrusted to the highest type of enlisted
personnel. These men must be impressed with the great responsibility they bear in helping
to keep their comrades free from venereal diseases.
It is frequently impossible for personnel connected with administrative and tactical
staffs to avail themselves of opportunity for proper exercise, rest, and recreation. These
men can rarely take advantage of leaves, and then only at long intervals and for short periods.
Work within offices at a headquarters is intensive and often continued without regard to
hours, and a tendency will exist for individuals to continue at such duties without due regard
to health. A grave responsibility in this respect therefore rests upon the attending surgeon.
He must use all known means to reduce to a minimum the effects of wear and tear, during
work at high tension, upon officers and men of his command. He will find of material
assistance in this work a small corps of trained masseurs who have been recruited and trained
from among the enlisted personnel at large. These men should be attached to the attending
surgeon's oflBce for duty.
• The organization formerly alluded to as the "attending surgeon's office" is now known as the dispensary The
standardized unit of this type is the general dispensary. See Tables of Organization, 677-W.—
APPENDIX
847
III
ORGANIZATION OF THE SANITARY SERVICE OF ARMY GROUPS, ARMIES, CORPS
DIVISIONS, ETC.
ARMY GROUP
The chief surgeon of an army group is the adviser of the group commander upon all
sanitary matters arising within the territory occupied by the armies and auxiliary forces
comprising the group command, relating to both the military and civil population, his duties
being largely administrative and, upon occasion, tactical.
He coordinates all sanitary administrative measures between the armies and grand
headquarters; through his assistant, the chief surgeon, army service area, he sees to the suf-
ficiency of sanitary personnel, hospitalization, supplies, and transportation within the group
zone; he advises the surgeon of the zone in his immediate rear of the imminence of battle,
that the latter may clear his hospitals of evacuables, and, through the coordinating section
of the group command, causes a sufficiency of hospital trains to be garaged as near the front
as conditions warrant. He announces to the chief surgeons of the armies and of the army
service area policies authorized for the sanitary service by both the group and group com-
mand.
The chief surgeon, army group, forwards important communications n\)on sanitarv
subjects from the chief surgeons of the armies to the chief surgeon of the forces, but, beyond
this infrequent usage does not conduct an office of transmittal. He maintains no office of
record beyond keeping a loose-leaf file of communications of immediate interest and tele-
grams, but should examine and note requisitions and inventories of all lands, buildings,
and materiel acquired from allied or civil sources and should forward them to the rents,
requisitions, and claims bureau through the chief surgeon of the forces, that adjustment
may be promptly effected when the use is terminated. He examines and forwards, after
approval, to the chief surgeon's office all vouchers for purchases or personal service arising
in the sanitary units under his immediate control.
He keeps informed of morbidity within the zone for ijoth military and civil population,
and when an epidemic arises beyond the power of subordinate chief surgeons to control,
under the authority of the group commander, assumes charge and takes the necessary steps
for its suppression. From time to time lie makes personal inspections to assure himself of
the correct performance of duties assigned army chief surgeons and other surgeons in charge
of various sanitary details in both the military and civil establishments. He sees to the
ade(|uacy of medical attention and hospitalization for personnel attached to group head-
quarters.
When the group command assumes control of the armies for a tactical movement he
prepares a sanitary paragraph of the battle order upon which the battle order of the indi-
vidual armies is based; he controls activities of the auxiliary societies attached and all vol-
untarv aid.
THE ARMY
The chief surgeon of an army is the adviser of the army commander upon all matters
relating to the sanitary service within the zone of the army, his duties being both adminis-
trative and tactical.
Under the authority of the army commander he commands the evacuation and army
field hospital, the medical parks and depots, and the army ambulance service through
assistants assigned to direct these units; through consultants attached to this office during
military activity, he directs the surgical and medical services of army units, corps, and
divisions; he maintains liaison with adjoining armies through the medium of an officer of
tact and judgment detailed for that duty.' He coordinates sanitary activities of all elements
' Normally each army surgeon will have under his immediate jurisdiction 15 evacuation hospitals. 12 surgical hos-
pitals, 1 convalescent hospital, 1 army medical supply depot, 1 army medical laboratory. 4 medical regiments, and in
addition re(|uisite veterinary units for the care and evacuation of animal casualties— £d.
13901—27 54
848
ad:ministeation, ameeican expeditionary forces
of the command; he sees to the sufficiency of personnel, transport, supply, and hospitalizat.cn
within the zone of the army. He supervises the sanitation of the command and of the ci. ..
population within the zone of the army, personally assuming charge in any epidemic that
subordinates fail to control, acting in such case with authority of the army commander.
He directs estabUshment of evacuation and army field hospitals at carefully selected loca-
tions, and through his assistant, the director of the army ambulance service, applies ambu-
lance sections and individual ambulances where needed.
He keeps in constant touch with the operations section of the army general staff in
order that he may at all times be cognizant of contemplated movements, and, possessed of
this knowledge, he prepares the sanitary paragraphs of battle orders issued from time to
time in which it is clearly stated what evacuation hospitals are to receive severely and
slightly wounded, medical, gassed, and neuropsychiatric cases, and the location of medical
supply parks. He advises the chief surgeon of the group command of the imminence of
battle, that hospitals to the rear may be freed of evacuables and hospital trains garaged as
near the front as conditions warrant.
When the army is acting independently of the group command he advises the surgeon
of the army service zone that he may clear his hospitals. He clears his evacuation hospitals
of evacuables in a steady flow at all times, and especially when battle is imminent.
His operations are coordinated through the coordination section of the army in all
matters requiring the sanction of the general staff of the army that are not routine in character.
He promulgates the sanitary code of the army, reconciling it with any orders from higher
authority. He maintains no office of record beyond a loose-leaf file and diary for current
use, and index of commissioned personnel of evacuation and army field hospitals, the army
ambulance service, the medical supply depot and parks, the corps and divisional medical
staff, and the surgeons of army units. He transmits important communications from division,
corps, and army unit surgeons going to higher authority relating to sanitary subjects, indi-
cating his approval or disapproval. He does not transmit routine reports of divisions and
corps, but does transmit sanitary reports from army units.
He approves or disapproves vouchers for authorized purchases or payments for per-
sonal services arising in army units, forwarding the approved vouchers to the office designated
by the chief surgeon of the forces. He approves or modifies the maximum stock allowances
of the medical supply depots of the army, forwarding a copy of the first one to the chief
surgeon of the forces for his information. In any emergency he uses the telegraph freely,
and, acting under authority of the army commander, takes steps to meet the emergency,
and makes report of his action to proper authority. He sees to the adequacy of medical
attendance and hospitalization for personnel attached to army headquarters. He controls
the conduct of the army convalescent camp, through the senior officer on duty thereat.
He controls activities of the auxiliary societies attached, and all voluntary aid.
The sanitary inspector must be an officer of experience in field sanitation and must be
possessed of broad views, that he may separate theoretical from practical sanitation, as the
former has no place in an army engaged in combat. He should make prearranged plans with
the coordination section of the army for the employment of labor battalions or Engineer
regiments in the prompt burial of human and animal dead, in the proportion of one or more
battalions to each corps sector. While regulations and sentiment direct the burial of human
dead by their comrades in arms, it is rarely possible for combatant troops to be so employed,
and in spite of sentiment surrounding the dead fallen on the field of honor, there is no more
depressing duty imposed upon combatant troops than paying the last tribute to their dead
compatriots, nor one which tends to lower their morale to a greater degree. Human dead
should be promptly interred in the vicinity of the place wdiere death came, and the location
and number of bodies, with names reported to an officer of the graves registration service.
Men engaged in combat in modern warfare have not the same sense of nicety in the dis-
posal of excreta and waste, obtaining in back areas and in peace-time camps, and it is folly
to expect troops in combat to even make a pretense of digging straddle trenches for the
disposal of their excreta or to bury kitchen and other w^aste material. This being an irre-
futable fact, it behooves the sanitary inspector not only to make provision for labor battalions
to follow the corps and bury human and animal dead and to thoroughly police the ground
APPENDIX
849
over which troops have passed but also to so instruct the corps and division sanitary inspectors
that they may not make futile attempts to have combatant troops perform duties which
military exigencies preclude and from which they should be relieved in the interest of the
first consideration; i. e., defeat of the enemy.
The sanitary inspector should concern himself intimately with the sanitation of army
units and troops not in combat and which should be held strictly to the standard of sanita-
tion. He controls sanitary squads and locates them at points selected for the most efficient
service, these locations of necessity being in rear of the divisional line in open combat, though
nearer to the front in stable or trench warfare. Beginning in the training area, he should
maintain constant search for "carriers," and all cooks and kitchen helpers must be subjected
to thorough examination to discover typhoid or paratyphoid sources. He must see to the
chlorination of all water for drinking purposes and have the water tested for chlorination
sufficiently. In the presence of infectious diseases within the army zone he should see to
the prompt disposal of the infected and to observance of the rules governing contacts and
disinfection, and, in diseases disseminated by the mouth and nasal secretions see that patients
are masked immediately under all conditions of transport and hospitalization. In case of
friction or inefficiency arising in the sanitary service he should investigate and report his
findings to the proper authority for adjustment.
Under instructions of the administrative section of the army, he makes stated sanitary
inspections of the command, and under the training section of the army inspections of Medical
Department organizations and units, his routine duties being under the army chief surgeon.
Inspection of either line or sanitary troops conform to custom and the Manual of the Medical
Department, and report is made upon the prescribed form.
Should his duties prove too onerous or too much time be required for their performance,
he should request, through the army chief surgeon, the assistance of corps or division inspec-
tors, or both, the work being divided in accordance with its importance. In the inspection
of combat troops, great attention should be paid to the sufficiency of food for the front line
and the means to insure its reaching there hot; to the measures for drying clothing and
shoes, and to facilities near the front for bathing and disinfecting, the latter manifestly being
impossible during open combat, with a constantly shifting line. All complaints of inadequate
treatment in sanitary formations should receive prompt investigation, as also should shortage
of necessities.
Procurement and distribution of medical supplies, management of army supply depots,
and the functioning of the supply service within the zone of the armies is fully covered under
the heading "Medical Department supply service."
The director of hospitals, under the supervison of the arm};- chief surgeon, controls
activities of the hospitals and makes tentative selection of location for future establishment
for the approval of the army chief surgeon, having in mind protection from direct fire,
accessibility to rail and wagon roads, water and suitability of terrain. He notifies the army
chief surgeon when a hospital is prepared to function, or to close prior to change of location,
so that the latter may notify the operation section of the general staff of the fact, which is
immediately published to the command served by this particular hospital. He should
charge himself with prompt establishment of telephonic communication between the hospitals
and the main trunks, giving timely notification to the army chief signal officer. By constant
supervision, and instruction if necessary, he should assure himself that evacuating officers
thoroughly understand the prescribed method of evacuation by hospital train and the prep-
aration of reports of evacuables for the coordinating section of the army and for the regulat-
ing officer.
Marked attention should be paid to the work of registrars in the preparation of statistical
reports and the prompt completion and forwarding of case records with evacuated patients and
of those dying in hospital. This office keeps a file of daily admissions for all hospitals, by
class, officers and men separately; deaths, return to duty, and evacuations, which should be
compared frequently with the daily report made by all corps and division surgeons and hospi-
tal evacuating officers to the evacuation officer in G-4 of the general staff, and also with a
weekly report of train evacuations which should be made by the regulating officer. Data
contained in this file serve as a basis for the final report of the army chief surgeon upon
conclusion of a campaign.
850 ADMIXISTRATIOX, Ar^IERK'AX EXPEniTIOX AHV FORCES
Tlic director of tlie armv ambulance service controls the army ambulance park and
the companies which make up the service/" together with the repair unit, under supervision
of the armv chief surgeon. It is essential that the officer selected for this duty be familiar
with moto; ambulances and truck technic in order that he may supervise intelligently this
very necessary part of the service. He should maintain a card record of every motor ambu-
lance and truck in the service (the United States and motor numbers, and make), together
with a card record of the personnel, both chauffeurs and mechanics, noting m brief their
qualifications. Upon receipt of advice from the army chief surgeon the director of the army
ambulance service assigns as many companies as are deemed necessary to divisions, corps,
armv troops, and evacuation service, making note of the length of time each company serves,
as a guide to relief for rest and repair, the length of service to be contingent upon military
conditions and not made for any stated period. During times of military stress this officer
should maintain close liaison with the army chief surgeon and corps surgeons m order that
he may, under authority of the army chief surgeon, increase the number of companies at
points where the greatest number of casualties are occurring.
The director of army ambulance service maintains the sanitary courier service between
sanitary units of the army and the army chief surgeon's office, using for this purpose the
motor cycles of companies in rest, and upon request of the officer in charge of medical supply
parks, he furnishes transportation fop medical supplies or for emergency articles for the front.
Location of the park is left to his discretion, subject to the approval of the army chief surgeon,
and the vicinity of the central medical supply park should have preference. At all times he
should instill into company commanders, and through them into drivers and mechanics, the
vital necessity for esprit de corps so that the whole command may work for the common
end — the rapid and careful transportation of the sick and wounded. In order to make this
possible, vehicles should be kept in thorough repair and their cleanliness and immediate
availability be insisted upon.
The adjutant of the service supervises the routine reports and returns demanded by
existing regulations from the commanding officer of each company attached to the park and
evacuation service, those serving with corps, divisions, and army troops making and forward-
ing theirs through the command to which they are attached. Each company commander
should keep a record of the number of trips, the number of miles run, the number of sick
persons, both sick and well, transported, making to the next higher commander prompt report
of any abuse of ambulances, turning in to the ambulance service director this record upon
completion of his detail. In case of abuse of an ambulance not meeting with swift action on the
part of the next higher commander, the company commander should be authorized to make
report of the occurrence direct to the director of army ambulance service, stating nature of the
occurrence, date and time, with the names of witnesses, that the matter may be reported to
the army inspector for investigation and action. The quartermaster makes requisition for
rations for all personnel at the park and for clothing for the entire enlisted personnel of the
service, and for spare parts, gasoline, and oil for every motor vehicle employed in the service,
forwarding such requisitions through prescribed channels.
The assistants necessary for maintenance of the park should be officers of the Sanitary
Corps selected for their knowledge of motor vehicles and who, with the mechanics for the
repair of machines, are assigned by the chief surgeon of the forces, upon request made through
the army chief surgeon. (See section on Army ambulance service.)
The officer in charge of correspondence and records performs routine duties prescribed by
higher authority in orders from time to time, keeps the service records of the enlisted personnel
attached to the office, prepares the daily statistical report for the adjutant general's office,
and also transmits to him all statistical reports from army units received in the army chief
surgeon's office.
The chief consultants assigned the army chief surgeon's office are ordinarily attached dur-
ing campaign only, each coordinating the particular service to which assigned, down through
the divisions and, under authority of the army chief surgeon derived from the army com-
mander, directs the services, especial attention being given to perfection of technic and in-
' The army ambulance service comprises an ambulance battalion from each of the four army medical regiments, and
ambulance troops pertaining to medical squadrons of cavalry divisions belonging to the army.—
APPENDIX
851
struetion. These officers maintain no records beyond those necessary for a report of the
services upon the completion of a campaign, for incorporation in the report of the army chief
surgeon. They merely make recommendation where error is discovered, reporting the facts
to the army chief surgeon for correction if subordinate surgeons fail to take action.
The furnishings and supplies of an army chief surgeon's office should be as meager as
will be consistent with proper functioning and should be devoid of any materiel which would
preclude complete removal in two 3-ton trucks upon a half-hour's notice.
THE ARMY CONVALESCENT CAMP '
(Numbered from 1 up)
When military operations are decided upon, the first duty of the group chief surgeon or
the army chief surgeon, if the army is operating independently of a group command, is the
selection of a site for the concentration of sick and slightly wounded of each army, to be located
at the rear of the army combat zone in proximity to the replacement camp, and its prompt
establishment, though independent of it. These convalescent camps should have a capacity
of 10,000 for each army, the men to be housed in huts, buildings, or under canvas, and should
receive sick and slightly wounded patients evacuated from army hospitals who are incapaci-
tated for duty for a period of two weeks or less. They should also receive all venereal cases
in the infective period.
These camps should be under medical control and the patients given such graded exer-
cises as will improve their physical condition, healthful amusement being added in abundance
to preclude depression. Venereal patients should be segregated within wire enclosures,
partly for the protection of other occupants of the camp and of civilian population and partly
for punitive purposes, their presence in 90 out of 100 cases denoting a breach of discipline.
The medical staff of a rest camp should be composed of men of mature judgment and
great tact, as their knowledge of the young soldier and of his shortcomings is invaluable in
the conduct of the camp and in the prompt selection of cases to be returned to duty through
the replacement camp. Auxiliary associations will find in these camps a field for their
activities and should be encouraged in all legitimate endeavors to promote the welfare and
recreation of the men, all possible facilities being given them.
Attention to the perfection of kitchen and bathhouses is necessary, for both are important
in recuperation. The men should not spend their time in idleness, and after finishing camp
police dutj', physical drills should be given under the guidance of an officer selected for his
knowledge of these exercises. Drills being finished, as many men as possible should be bathed,
these several activities occupying the morning hours. In the afternoon out-of-door games
should be indulged in, under direction of a ({ualified officer, the men who were unable to get a
bath in the morning being given opportunity to bathe after games are over.
For men not yet able to indulge in physical drills or sports, and for all in inclement
weather, recreation and reading rooms should be provided. Disinfecting and laundry plants
must be provided to render the men free from vermin upon admission, and not only to keep
them clean but also to incline them to the desire for cleanliness. Drills savoring of military
movements or of the Manual of Arms should not be introduced, the object being to promote
physical and mental well-being and to take the men's minds from their disabilities and the
environment at the time of disablement. This, of course, applies to the sick and wounded
and not to venereal cases. Men suffering from venereal diseases are disabled through their
own misconduct and not as a result of military activity, though they too should be given
exercise and indoor recreation when off duty.
The venereal section should be a part of the camp and necessary guards furnished from
permanent camp personnel. The section should house a thousand men, should be con-
ducted by an urological unit and supplied with all facilities for the care of venereal cases.
The location of these camps as regards distance from the army is of little importance if only
a railroad is near. When a man from either the venereal or the convalescent camp is pro-
nounced by an examining board as of class A, he is transferred to the near-by replacement
camp for equipment, after which he is returned to his unit through the regulating station.
' The army convalescent camp is now known as a convalescent hospital, with a minimum capacity of at least 5,000 pa-
tients. See Tables of Organization, 285-W.—
852
ADIMINISTRATION, AMERICAN EXPEDITIONARY FORCES
ARMY AMBULANCE SERVICE
(Companies numbered from 1 up)
Experience demonstrated that the system so long in vogue of assigning to divisions, corps,
and evacuation hospitals, ambulance companies of 12 machines each, while excellent in theorj'
was wrong in principle and in fact, in that one company might have too great a burden to
bear while another had too little and no opportunity was afforded either for rest or repairs.
The system of pooling all ambulances into an ambulance service with 20 machines to a com-
pany, all under control of an army director of ambulance service who, in turn, was assistant
to the army chief surgeon, gave the most effective service in that it made possible the assign-
ment of ambulance companies to divisions, corps, and evacuation hospitals in sufficient
numbers and also afforded opportunity for relief of the personnel and the repair of machines
which other sj'stems precluded."*
The assistant director, army ambulance service, in charge of personnel, should be an
expert in driving motor vehicles and should impart this knowledge to the ambulance company
personnel to the end that every man may be made proficient. One man should drive while
his partner is resting or doing orderly duty, so that the driver will at all times have unimpaired
faculties. In the course of instruction — which should begin the day that a company arrives
at an ambulance park — the rules of the road should be carefully taught, particularh^ observ-
ance of rules of circulation governing transit in the combat zone, and the correct methods of
traction by truck or tractor when road conditions preclude progress alone.
The assistant director army ambulance service (in charge of equipment, transporta-
tion and repair) conducts the function of the repair unit and also instructs members of the
company at rest in the use and care of the gas motor, methods of detecting loss of function
in a part, and in the methods of making quick temporary repairs to engines and running
gear while en route, company mechanics assisting in the overhaul and repair of all cars in
their companies.
Motor ambulance companies for all requirements of the theater of operations should
be supplied at the rate of eight companies per division from front to rear. Of these eight
companies, three should be equipped with machines of the light type, all others heavy, and
all companies should have 20 motors each, whichever the type.™ A maximum of 10 per
cent of ambulances will be needed as reserve. This estimate therefore requires 176 motor
ambulances to be shipped per division to an expeditionary force, and the basis is not confined
to combat divisions. Of the eight ambulance companies per division, seven companies per
combat division will be required for the zone of the armies, including the army service zone,
and one company per division will be required by the services of supply for base ports, hos-
pital centers, base hospitals, etc. This number should be increased by the additional eight
companies per division shipped for replacement or depot division which must accrue to the
credit of the Services of Supply.
Ambulance companies attached to divisions normally transport the wounded from for-
ward aid stations to the divisional triage or sorting station or to the other divisional hos-
pitals. These companies function under direction of the director of ambulance companies
of the division, and he in turn under control of the commander of the divisional sanitary
train.
The corps surgeons should each be assigned four companies of heavy ambulances, three
operating at a time while the fourth is resting and repairing, the companies being under
control of the corps director of ambulance companies, the latter's activities being directed
by the corps sanitary train commander. The function of these ambulance companies is
the transport of the wounded from "triage" to the mobile surgical hospital (corps), in which
duty in times of stress they are assisted by the companies assigned to evacuation hospitals,
and from the mobile surgical hospital (corps) to the designated evacuation hospitals.
Twenty ambulances are now authorized for each ambulance company or ambulance troop.— £d.
» Two types of field ambulances have been devised. The heavy provides a capacity for six patients Ijing, and the
light for four patients lying. — Ed,
APPENDIX
853
The machines assigned army troops are eight companies in number, of heavj^ type,
permitting service with Engineers, Artillery, labor, salvage, and pioneer troops and the
transport of the sick and wounded of these organizations to evacuation hospitals, and also
rest and repair.
To an army of four corps of four combat divisions each the above assignment, which
is the minimum for proper service, would give :
16 combat divisions (light cars, 48; heavy, 16) 64
4 corps (heavy cars) , 16
Army troops (heavy cars) 8
Evacuation hospitals (heavy cars) 16
In reserve 8
Total 112
For the army just given, which totals approximately 675,000 troops, there should be
112 companies in the army zone. In addition to the eight companies in reserve there should
be held at the ambulance parks a just proportion of the 10 per cent reserve of ambulances.
These companies and extra ambulances will be necessary to insure prompt and easy transport
and to preclude recourse to motor trucks to the detriment alike of the wounded and of troops
remaining in the line.
Each machine should have a large white cross painted on its top and a red cross on the
sides, the color of the ambulance being khaki, against which background the red and the
white crosses are emphasized. The white cross on top is necessary for protection against
enemy aircraft. All ambulances should he equipped with disk type of demountable wheels,
with one spare wheel, complete with casing and tube, ready for use, as part of their equip-
ment each. Running and head lights should have the red cross painted on the glass to
insure free passage of the circulating route and to gain assistance of the military police in
case of a road block.
A study of the various uses of the gasoline exhaust for the purpose of heating the interior
of ambulance warrants the rejection of them all, and the simple thermosiphon was recom-
mended. This thermosiphon requires only a small pipe leading from near the top of the
radiator on one side back beneath the floor of the ambulance, where it is connected with a
small coil, the return pipe running from the lower strand of the coil to near the bottom of
the radiator on the side opposite the one on which the lead began. The coil should be located
beneath a perforated disk, with a hinged cover to exclude heat when not desired. This
simple appliance is really a small hot-water heating system acting under the double effect
of expansion of water by heat and of gravity, and it requires but little mechanical ingenuity
to install at small expense in any car. It affords an even heat, which is felt after a few
minutes' running of the engine. In cold weather the car may be warmed quickly by filling
the radiator with hot water or by running the engine a short time before patients are placed
on board.
Each ambulance will carry four litters upon each side in racks, and in the top should
be slung arm and leg Thomas splints, two each, to automatically replace those worn by a
patient, the same kind of splint being returned to the hospital from which patient was
received. This simple system insures a steady supply of splints to the front. Eight blan-
kets and four hot-water bags or metal cans should be carried on each ambulance for
replacements.
Experience on sandy roads of the Mexican border warranted the rejection of ambulance
trailers, but these vehicles, identical with the ambulance itself minus the machine and steer-
ing gear, would have been of great value on the hardpan roads of France. Their further
development must be considered.
In very muddy soil an ambulance may, on occasion, be stuck, and in such a predica-
ment the services of a heavy truck, of a tractor, or even a tank must be solicited by the
ambulance company commander, and with this possibility in view all ambulances, whatever
their type, should be provided with a short towrope, with hooks borne on swivel joints at
each end.
854
ad:ministration, American expeditionary forces
In addition to its repair truck, each ambulance company should have assigned to it
one 2-ton or 3-ton truck for carrying supplies and the personal effects of the personnel, one
trailmobile kitchen, and one w ater cart, the two last named to have roller-bearing axles to
prevent the burning out of the running gear.
As ambulance companies usually camp in the vicinity of other sanitary units, their
medical attendance can be provided by the nearest hospital; but every ambulance company
should have a pannier filled with dressing packets, bandages, adhesive tajjc, iodine swabs,
etc., for use in case of emergency.
The commanding officer supervises the preparation and forwarding of current reports
and returns. He keeps a record of the number of patients or persons transported, miles
traveled, the amount of gasoline and lubricating oil used, all in a small book, the data serv-
ing as a basis for his report to the chief surgeon of the army, through the director of ambu-
lance service, upon conclusion of service period or of a campaign.
THE EVACUATION HOSPITAL
(Numbered from 1 up)
The evacuation hospital is the keystone of the sick and wounded system of a field army,
and these units should be organized in the proportion of one for each division, this ratio
being sufficient for the needs of army troops, it being recognized that at no time, except
under the most unusual conditions, are all the divisions of an army in the line at the same
time.
Evacuation hospitals must of necessity be movable units, capable of functioning in such
buildings as exist in the zone of the armies or under their own tentage. They should be
self-contained in the fullest sense, with a standardized equipment, and should have a cai)acity
of 500 cots and 250 litters over and above the space occupied by permanent and temporarily
assigned personnel, and are under the control of the army chief surgeon, through his
assistant, the director of hospitals.
The assignment of evacuation hospitals to the care and treatment of special types of
surgical and medical cases exclusively is unwise and even in fixed warfare is wasteful of
personnel and transportation.
If terrain permits, these hospitals should be placed in pairs, each retaining independence
of the other. This arrangement permits one to fill and close, the other one opening when the
first closes, thus enabling the first one to deal with its quota and free itself of evacuables.
If rail facilities offer, evacuation hospitals should be located as near as possible to a siding, for
without this means of establishing a constant flow of sick and wounded to the rear they
quickly fill and cause a reflex congestion in divisional hospitals; a condition which should never
be permitted to arise. The sole departure which should be allowed from this rule would be
the possession by the sanitary service of an adequate number of motor ambulances, motor
trucks, and busses, in which evacuables could be transported to a second line or echelon of
evacuation hospitals or to advanced base hospitals.
With the consent of military authorities (coordinating section, general staff, army)
advantage should be taken of every railroad siding in the battle area to which the regulating
ofl3cer can dispatch a hospital train without undue interference with supply trains, and no
location should be definitely decided upon by the army chief surgeon without specific agree-
ment with the coordinating section, as above, and the regulating oflicer, as to the availability
of a sidmg for containing a hospital train for a specified loading schedule, and the number of
trains allowed on this siding in a period of 24 hours .
In selecting sites for establishing evacuation hospitals the armv chief surgeon should
make a personal reconnoissance beforehand, or have a competent assistant do it, to deter-
mme the existing facilities as to railways, buildings, wood, water, ground space for the
erection of tents, and safety from enemy fire, either direct or indirect. Having made a selec-
tion which receives the approval of the coordinating section, armv, if the unit to occupv the
site IS on a railway and transportation is available, a request in memorandum form to the
operations section, army, will produce the necessary order, which is accomplished by the
troop movement bureau of the coordinating section, army; if bevond the limits of armv
APPENDIX
855
control, request made by the army commander upon general headciuarters by wire will produce
the desired result. Once within the army zone the transport of these units is usually made on
trucks from place to place, as but small dependence can be placed upon available trains.
The average number of trucks of 3-ton capacity to transport an evacuation hospital is 50
for a single trip, so unless a long move is to be made it is economy to use not more than 20 at
a time. This enables one portion to be made ready to function at the new location while the
remainder is being transported. When the new establishment is prepared to receive personnel
all the commissioned officers, except the adjutant and one or more assistants to superintend
the loading, and the female nurses, should be transported in ambulances to the new location.
A sufficient number of enlisted personnel with all but two cooks will have already proceeded
there on the first trucks.
On assignment to a unit each commanding officer should immediately prepare a truck-
loading schedule in such a manner that the equipment and tentage necessary for commissioned
persoimel and nurses, the cooks, surgical department, and lighting and heating units will
arrive first at the new location. It is incumbent upon each commanding officer to familiarize
himself with the amount of space necessary to contain the hospital when tentage is erected and
to prepare a diagram to scale for each tent employed, whatever the make, and also of the
application of tentage to buildings. Every officer and enlisted man of the permanent per-
sonnel should be drilled in this demounting and erection by schedule and diagram until that
proficiency so essential in time of activity is acquired. The new location may not lend itself
exactly to the prearranged plan, but in no instance is more than slight alteration necessary,
and that in the wards. The receiving ward or triage should always be located at the opposite
side from the evacuating section, and the surgical and bathing sections should be near the
triage. By remembering this simple rule, novices will avoid much confusion.
Every hospital should be provided with a cross of white canvas, each arm 9}^ feet in
length and 6 feet wide, to be pinned firmly to the earth, preferably on green grass — before any
other detail is given attention. If no grass plot is available, black cinders or rock should be
placed in the quadrants to make the white cross conspicuous. Investigation has proven that
a white cross on a green or black background is far more conspicuous than red when viewed
from the air, and gives perfect definition in pictures taken from airplanes. The adoption of
this expedient saved many hospitals from enemy fire. The importance of placing this white
cross before any part of the unit is erected lies in the fact that aerial oV)servers take photo-
graphs in the daytime and bombing planes discharge their missiles by night upon any point
indicated in the picture, unless this cross is observed, and as red does not show up in a picture
the usual distinguishing mark for a hospital is useless for this purpose.
Upon assuming connnand, the commanding officer should prepare a loading schedule for
rail transportation based upon the known weight of the hospital equipment in tons and also
the cubic space occupied. This schedule should be that of the maximum equipment, which
should never be exceeded, and also the space necessary for 3,000 rations to be taken by every
evacuation hospital, as cars for personnel, including temporary teams, box cars, and flat cars,
must be accurately determined and made a matter of quick reference. It is essential that
a car be included in the string with end doors opening upon the personnel cars, for the installa-
tion of a range so that cooks can perform their duties en route and the train continue without
stop for feeding the persoimel.
An evacuation hospital should have the following departments:
1. Receiving, triage, or sorting.
2. Operating, for severe and slight cases requiring operation.
3. Dressing, for slightly wounded, not requiring operation.
4. X-ray.
5. Pharmacy, laboratorj', and dental.
6. Mess: Patients, officers, nurses, enlisted personnel.
7. Office: Commanding officer, adjutant, registrar, quartermaster.
8. Supplies: Medical, quartermaster, and laundry.
9. Hospitalization: Medical, gassed, surgical.
10. Morgue.
11. Evacuating.
856
ADMINISTEATIOX, AMERICAN EXPEDITIONARY FORCES
In times of activity the personnel should be increased by the addition of 12 operating and
2 gas teams, each operating team being composed of 2 surgeons, 2 nurses (1 anesthetist),
and 1 orderly, and gas teams being each composed of 1 officer and 2 orderlies."
Every unit should have 4 operating teams among its permanent personnel, so that with
the addition of 12 temporary teams 8 would be available for intensive operations during
a "push," the 2 sections relieving each other every 8 hours— which is the longest period that
a team can operate with justice to the wounded. Two dressing teams for shghtly wounded
dressing and operating rooms are organized within the unit, these also relieving each other
every 8 hours.
Two medical teams for shock work, each team composed of 1 officer, 2 nurses, and 2
orderlies, all trained in approved measures for combating shock, are indispensable during
battle. Their personnel should be especially trained in transfusion.
Two splint teams, organized from the permanent personnel, are indispensable. Each
team should have 1 specially trained medical officer and 2 privates, for the correct application
of splints, 1 team for day and 1 for night duty. By splinting a fracture or an orthopedic case
these groups relieve the operating team and save time that otherwise would be consumed in
changing operating gloves and gowns.
At least two surgeons with the permanent or temporary operating teams should be
proficient in surgery of the brain and eye, so that patients in each of these two classes may
receive prompt and correct attention.
A medical officer of recognized abiUty, member of the permanent personnel, should be
assigned as chief of the medical service and should so supervise the service that it will be
prepared at all times to give correct treatment both to toxic gas cases and medical cases of all
classes. He is also the assistant to the chief triage officer, the two working alternately and
assisted by others detailed for this duty as required.
Two medical officers thoroughly versed in radiologic, fluoroscopic, and screen technic,
one for day and the other for night service, with one or more assistants for each, and all
members of the permanent personnel, should be assigned for X-ray work. Young men are
preferred for this service on account of the long hours necessary during times of stress and
also on account of the necessity for keeping X-ray records ahead of operating teams in order
that no delay may ensue and throw a surgical team behind its schedule.
A medical officer proficient in wound bacteriology and in pathology should be assigned
from the permanent personnel. His duties should consist primarily in routine bacteriological
procedure, in making Dakin solution, in preparing smears from wounds to insure their con-
trol, and in performing post-mortem examinations in cases of peculiar interest, preserving
such anatomical specimens as are deemed worthy of forwarding to the Surgeon General's
office.
An officer of the Quartermaster Corps, preferably one with experience, should be per-
manently assigned to the unit, for a multiplicity of most important duties devolve upon
this officer, who of necessity must be familiar with existing regulations concerning subsis-
tence, clothing, transportation, heating, lighting, and equipment. He must also be bonded,
so that he can assume the duties of disbursing quartermaster of the unit.
The registrar should be an officer of the medical administrative service, thoroughly
familiar with the intricacies of the sick and wounded report and the necessity for correct and
prompt preparation of statistical reports (A. G. O.), the notification required by the chief
surgeon's office upon the origin of infectious epidemic diseases, the collection and forward-
ing of individual medical cards. X-ray plates and records, and histories of all cases evacuated,
and the prompt forwarding of all records in case of death. He should report the status of
the hospital every day as of 6 a. m. to the evacuation officer attached to the coordinating
section, army, giving admissions, the number of surgical, medical and gassed patients,
officers and men separately, the number evacuated and dead, and the number remaining as
classified above, this report being made by telephone or courier. He should also keep a
thoroughly posted diary giving data upon all movements of the unit, with orders, the number
' These teams have been provided for in an organization known as the auxiliary surgical group, which is assigned to
general headquarters reserve, normally at the rate of one group for each field army. See Tables of Organization, 689-W.—
APPENDIX
857
of cases admitted, designating them as surgical (the class being given bj^ the nature and
degree of injury); medical, the number and class being given; gassed, the number, specifying
the kind of gas used, if known; the number of operations by classes; the number of evacua-
tions, both sitting and lying, medical, surgical and gassed; the number remaining, by classes;
and the number of dead, with name, cause, time, place of burial and grave number, the last
being obtained from a member of the graves registration service, who should be attached
to the registrar's office.
A mess officer, member of the medical administrative service and permanently assigned,
assisted by three noncommissioned officers, is in charge of the various messes, keeps the
records, and makes provision with the railhead officer for supplies.
On the successful service of the receiving ward or triage depends the successful function
of the unit, and for this reason officers selected for this duty need to possess a knowledge of
both medicine and surgery and the ability to make quick decisions based upon good judg-
ment and diagnostic powers.
The clerical force should be gifted with quick perception and be capable of recording
quickly the data notied upon diagnosis tags and field medical cards, such data being the
basis of important statistical reports (A. G. O.). One member of this force needs to be a
man of known probity whose sole duty should be the collection of valuables from uncon-
scious patients, those in extremis or those who desire it, valuables being placed in small bags
provided for the purpose and retained in the custody of the receiving officer. The patient
should be given an itemized receipt which is placed in the field envelope, a duphcate of this
receipt being attached or affixed to the bag of valuables. Care in this procedure will pre-
clude the loss of valuables and unpleasant investigation and explanations, this system
enabling each ward surgeon to secure and return to patients prior to evacuation the valuables
receipted for. It also secures for the receipting officer the original receipt, which, with the
duplicate, should be retained as part of the records as long as the unit functions and then
transferred to the chief surgeon's office with other historical records.
Two evacuating officers should be detailed, one for day duty (the detachment com-
mander) and one for night duty (a detailed assistant), each with a number of htter bearers
from the personnel, the strongest being selected for this very exhausting duty, to the number
of 40, all trained in the correct procedure in loading and unloading ambulances, trucks, and
hospital trains.
Having received notice of the imminent arrival of a hospital train, these officers should
ascertain the number and names of patients to be evacuated, medical, surgical and gassed,
recumbent and sitting, officers and men separately, and should prepare the entraining list
for the train commander, a duplicate of this list being sent to the registrar.
When evacuation by train is desired, these officers notify the coordinating section, army,
of the fact, furnishing the information noted in the preceding paragraph, which the coordi-
nating section transmits to the regulating officer, and the latter, having a daily report of the
entire hospital bed status is in a position to know to which hospital in the rear a loaded train
should be dispatched.
Evacuating officers of each unit should infoi-m the regulating officer by telephone or
wire twice daily of the the number of evacuables, officers and men separately, sitting and
lying, of surgical, medical, and gassed.
When evacuation by ambulance convoy is desired, the evacuating officer ascertains
the vacant bed status of the other evacuations or base hospitals in the immediate rear, and
dispatches the convoy to the one mutually agreed upon, a list of cases by name and class
being furnished. This information, with the name of the hospital receiving the cases, is
transmitted both to the coordinating section, army, and to the regulating officer.
The chief nurse controls the activities of nurses and nurses' aides, assigns those with
operating room training to the operating section, and others to ward service and diet kitchens.
She keeps the nurses' records, preparing for the commanding officer's approval and forward-
ing the required reports.
A chaplain is indispensable, and selection should be made without regard to denomina-
tion. The duties are onerous and divided between religious ministrations and conduct of
amusement features of the unit, the latter being very necessary for the relief of the dreadful
monotony and sadness that soon pervade an active evacuation hospital during hostilities.
858
ADMINISTRATION, AIMERICAN EXPEDTTIONAHV KOHCES
The cuisine of an evacuation hospital is second only in importance to the operating sec-
tion, for the importance of diet in the treatment of wounded and gassed should not be under-
estimated. Two of the sixteen cooks assigned to an evacuation hospital should be competent
diet cooks who, with the assistance of the diet nurses, prepare food for patients with capri-
cious appetites and for those placed on liquid and light diets. Two rolling kitchens and five
ranges, gasoline or No. 5, Army, should be supplied each unit, field ranges not proving a success
in these units.
A laundry is absolutely essential to the proper functioning of a hosi)ital, and particularly
so in the case of an evacuation hospital as it is always situated in a region away from civil
population. Experience demonstrated that a portable gasoline motor-driven laundry gives
the best service for small, fiat work, the main laundry of demimobile type with a linen ex-
change being established at the army medical supply depot. A laundry capable of washing
1,200 pieces of flat work per day needs the services of two enlisted men of the permanent
personnel. A drying chamber can be easily extemporized.
Five mechanics, assigned permanently, should be attached to an evacuation hospital;
one tinsmith, two carpenters, one plumber and one electrician. These are indispensable,
for the amount of work required of them is enormous, and often a unit is unable to function
properly for lack of them.
The remainder of the enlisted personnel should be assigned the usual police, mess hall,
orderly, barber, tailor, telephone, quartermaster, record office duties, etc., but all should be
trained in litter-bearer service.
The commanding officer should detail his assistant as fire marshal and the adjutant
as assistant fire marshal, with the entire male personnel divided into (a) rescue squads,
(b) fire-fighting squads, (c) salvage squads, all being drilled in their duties daily until pro-
ficient, and thereafter drilled once a week. In fighting fire in wooden huts or tents it should
be remembered that blankets soaked in water and applied to the roofs and exposed sides of
adjacent huts and tents is the surest method of isolating fire and preserving near-by
structures. Every hut or tent should be provided with two fire extinguishers equivalent to
Pyrene, and tubs, barrels, or buckets should be filled with water and kept close to each hut
or tent.
The establishment of a post exchange at an evacuation hospital is unnecessary, as
auxiliary societies perform the functions which pertain to this, and also establish recreation
rooms or tents.
The receiving triage or sorting department should be one or more large rooms, if build-
ings are occupied, or a small hangar or several ward tents, if tentage is used. Capacity
should be at least 60 litters, and rooms or tents should be warm. The receiving or triage
officer, with the clerks, is located here, and upon admission of a patient the decision is made
whether operative procedure is necessary or not, whether further antigas treatment is indi-
cated, if assignment is to be made to a medical ward, to the shock ward, if the case can be
evacuated, or returned to duty.
The patient's name, number, organization, diagnosis, and all the data necessary for a
record are obtained here from personal interrogation and from the diagnosis tag and field
medical card, or from the latter and questioning of those who accompany the patient if he
is unconscious. Valuables are placed in a small bag, a receipt for them signed by the triage
officer, and they are placed in a field envelope, duplicate receipt being affixed to the bag,
the contents of which have been listed on both original and duplicate. All conscious patients
should be informed that the hospital can not be held responsible for valuables left in the
possession of a patient who refuses to take advantage of the facilities offered for their care.
If examination shows that operative measures are necessary, the patient is now trans-
ferred by litter, via the bath if conditions warrant, to the preoperative room, where his
injury is reexamined and the case assigned to a team unless shock treatment is indicated,
when the case is taken in charge by the shock team. If the triage officer decides that
operation is unnecessary, the patient is sent to the dressing room for the slightly wounded,
by way of the bathing and washing room, and after dressing and the administration of anti-
tetanic serum, if not previously given, the patient is sent to the evacuation section, whether
considered as suitable for evacuate or for a return to dutv.
APPENDIX
859
A case (losigiiated as gassed is sent to the bathing room and bathed with alkahne soap
and solution as indicated, the clothing entirely removed, and in a fresh suit of pajamas
assigned to a ward, if not to be evacuated; or if evacuable or to be returned to dut\^ sent to
the evacuation section. Medical cases are disposed of similarly, and if an infectious disease
is diagnosed the case is removed immediately to a ward set apart for such. In the event of
epidemic respiratory diseases occurring in the Army area, the receiving officer should see
that every case admitted is masked, to minimize infection.
One of the auxiliary societies may establish a light refreshment counter at the triage
for the benefit of patients who may take light food and also for ambulance drivers and
orderlies.
A large supply of litters and blankets and a smaller supply of splints should be kept,
both day and night, near the entrance to the triage, under charge of a noncommissioned
officer, whose duty it is to see that a blanket or litter or splint is returned to the ambulances
for every one brought in with a patient. This is most important, insuring the automatic
supply of these articles to front divisions. A sign should be conspicuoush' placed bearing
the legend " Litter, Blanket, and Splint Exchange." The triage or receiving ward should also
be conspicuously indicated, both day and night, as should all roads within a radius of 4
miles toward the front. This marking of roads leading to evacuation hospitals is the duty
of each hospital, and for obvious reasons it should never be neglected. Road markers
should be of metal, black bodied, with directions in luminous letters preferably, for the
guidance of ambulances by night. All signs belonging to a unit should be collected when it
moves to a new location.
The bath hut or tent should be floored with "duck boards," should have a drain either
open or piped, as resources permit, and two so-called instantaneous heaters of the jacketed
type, with 50-gallon tanks supported on iron tripods, each heater supplying eight shower
heads, with a cut-off and the necessary pipe. There should be two heaters, one on each side
of the middle, with two partitions of either board or canvas, one section being for the use
of officers and nurses, the other side for enlisted men. Nurses should have exclusive use of
the allotted section from 8 to 10 a. m., and officers from 10 to 12, as the wounded arrive in
large numbers between noon and midnight. The importance of these bath units can not be
overestimated. Thej' are a necessity, not a luxury.
The dressing station for slightly wounded not requiring operation should be located
in a tent or hut near the triage, and requires only simple provision: An operating table, a
few benches, a small table for dressings — prepared and sterilized in the main surgical section —
and the usual instruments and utensils found in dressing rooms. This section is under the
charge of two officers with surgical experience, assisted by two men. If a wounded man is
found not to have received a prophylactic dose of tetanus antitoxin previous to admission,
it should be administered here and proper notation made on his field medical card.
The main surgical department should be divided into an operating, an X ray, and a
preoperating section, the latter having shock beds adjacent. The preoperative section is
either a portion of a hut or a tent fitted with litter racks upon which litter-borne patients
may rest previous to operation. This tent or hut requires no furniture nor fittings except
litter racks, but it should have a good heating stove. The adjacent shock ward should be
heated at high temperature by a suitable number of stoves, even in warm weather, and
litters containing patients should be placed on racks, a cradle of half-barrel hoops placed
over each patient, a blanket beneath and over him, and heat from a small lamp or a can of
solidified alcohol or a small stove conducted beneath the blanket by means of an elbow
pipe. It is here that highly trained personnel thoroughly familiar with the treatment of
shocked cases find their work, for patients' lives are always in the balance and it is essential
that shock teams be prepared to administer Cannon's gum-salt solution or to transfuse, or
both, as the case demands. After operative procedure it is often necessary to place a patient
in this ward until it is safe for him to be transferred to a general ward.
The X-ray room or tent siiould be connected with the preoperative ward, and it is
necessary to make provision in advance for darkening the interior either with black cloth
or paper. The chief of the surgical service directs which cases are to have fluoroscopic or
screen examination, for plates are used only in cases of peculiar interest or where accurate
860
ADMINISTKATION, AMERICAN EXPEDITIONAEY FORCES
localization is desired, it being essential that the X-ray operator make the quickest possible
examination and record of findings, so that he may always be several cases ahead of operating
teams and thus avoid any delay. It is a waste of time to examine clean perforating machine-
gun and rifle wounds and it is only when the projectile has passed close to a bone or joint
that X-ray examination is called for. Shell wounds, on the contrary, demand examination
in every case, for in this class of wounds it is impossible to determine by visual examination
the presence or absence of shell fragments in the deeper tissues. Cranial injuries also require
plate record for the purpose of avoiding possible error at the time of operation and also to
furnish a permanent record for those to whose care patients will subsequently pass. What-
ever the method of examination employed, the operator makes a simple slip of his findings,
this being affixed to the field medical card or diagnosis tag for the information of the operating
team assigned to the case, a dupUcate being retained for hospital records.
The main operating hut or tent should have at least eight operating tables down the
center, a row of double shelves running the entire length of one side. These shelves should
be smooth planks resting on folding horses, the upper shelves for holding sterile dressings,
utensils, etc., and basins for lavage of the hands of those required to be sterile; the lower
shelves for nonsterile dressings, utensils, etc. This row should be on the side next the head
of operating tables, leaving the space between the foot of the tables and the side of the room
or tent free for the passage of litter bearers. The use of the long shelves does away with the
need for a multiplicity of small tables and increases available space. When a building with
small rooms is occupied, the shelves being sectional are easily adapted to the space afforded.
Every operating table should have a brilliant electric light suspended over it, and these
lights should be provided with a cone shade to i)revent the dispersion of rays, particularly
upward. As the major part of operating is done after nightfall, it is imperative that a black
lining be applied to the entire interior of a tent, with hinged window flaps; or if a building
is used, the windows must be made light proof, as otherwise an inviting target is offered to
enemy airplanes. As stated under duties of personnel, each hospital should have 16 operat-
ing, 2 shock, 2 gas, 2 dressing, and 2 splint teams, of which 12 operating and 2 gas teams
are supplied at the time of the unit's engagement in activity, by the director of professional
services, upon antecedent request of the army chief surgeon. This arrangement affords 8
operating teams, 1 shock, 1 gas, 1 dressing, and 1 splint team for duty every eight hours,
the longest period that a team may work on battle casualties with justice to the patient.
There needs to be among the operating personnel at least one surgeon proficient in cranial
surgery and one in ophthalmic surgery, in order that cases requiring special technic may
receive the best treatment.
When an operating team has completed its work upon a wound of the extremities involv-
ing fracture or a joint, instead of wasting time and effort in applying a spUnt, the case is taken
charge of by the splint team. They apply the additional external dressings and the splint
on a table or a htter placed on rack in a corner of the room or tent, leaving the operating
team free to proceed with another case. The dressing team is for service in the dressing room
for slightly wounded.
Adjacent to the operating hut or tent should be the hut or tent containing the sterihzing
apparatus. This should be simple in construction and adequate to the requirements of
perfect sterihzation of dressings, instruments, utensils, and water. Three autoclaves of
24-inch diameter and three stock pots, 26-gallon, with faucets, each with an iron foot base
9 inches high, a number of drums for dressings, and instrument boilers, all heated by gaso-
line burners of the Bunsen type, have been found adequate to all demands. With the assist-
ance of 3 enhsted men, 2 nurses are sufficient for conducting sterihzation. On account of
the danger from fire the sterilization hut or tent should be separated from other units, but
it should be connected with the operating section by a corridor covered with canvas and
easily pulled down.
The supplies department, both medical and quartermaster, must be in charge of the
quartermaster, who also manages the laundry and linen room. At least 3 noncommissioned
oflicers and 14 privates or privates, first class, are needed to conduct this department, 2 of
the men operating the laundry. This laundry should be run by a gas motor, the set consist-
ing of washer, extractor, and tumbler, and it should be easily transportable.
APPENDIX
861
Laboratory, pharmacy, and dental offices should be located together for convenience,
and these require no special comment.
The hospitalization section, surgical, medical, and gas, should be as simply equipped
as possible, cots with thin mattresses being used, each cot in the infectious wards being
separated from those on each side by means of a triangularly folded sheet suspended, to
preclude cross infection. Wards should be supphed with the necessary amount of beddings,
towels, urinals, close stools, etc., and the nurse should have a small room or a corner screened
off where a small stove can be installed for heating water, food, and for other purposes. For
each bed there should be a head net, as flies in enormous numbers always appear in a battle
area during the greater portion of the year and annoy patients exceedingly.
The morgue may be a hut or tent and should be furnished with light,"^ four litter racks,
washing facilities, and several galvanized-iron cans. The carpenter shop and lighting unit
are also located in a corner of this tent or hut.
The evacuating section may be in huts or tents and should have racks for litters to the
number of 250, and the simple furnishings of a ward. A few nurses and ward masters are
sufficient for its conduct, as the majority of patients are capable of helping themselves to
some extent.
Notice of psychiatric cases should be sent to the train commander in order that they
be afforded such segregation on the train as possible, and infectious cases should be placed
in the compartment set aside for such patients. Weapons of every sort must be taken
from all patients who are to be evacuated and turned over to the salvage officer, the owners
being informed of the fact. This procedure is most important if regrettable incidents are to
be avoided. The entraining area should be placed under police control to prevent unauthor-
ized persons from boarding trains and to regulate road traffic during the period of entrain-
ment.
The salvage officer and his assistants find an enormous accumulation of Government
property at the triage, bath and operating sections daily, and he has this listed according
to service and taken to the nearest salvage dump or depot.
Next to litter bearing, the preparation of graves is the hardest duty which an evacua-
tion hospital has to perform; and as the personnel is barely sufficient to meet strictly pro-
fessional demands during a "push," it is incumbent upon the commanding officer to soHcit
aid from near-by labor troops, or enemy prison camps if the hospital is 25 km. behind the
line, or in any other way to secure the personnel necessary to dig the number of graves esti-
mated. For esthetic reasons as well as for the sake of morale it is necessary that the dead
be buried promptly.
Evacuation hospitals should be permanently equipped with interphone systems. In
every case the chief signal officer (army) must be advised of the location in advance and
request for trunk connection made, as it is imperative that the hospital be in communication
promptly.
Experience demonstrated the impossibility of an evacuation hospital functioning to the
standard necessary unless equipped with a portable electric generator in duplicate for both
lighting and the activation of the X-ray." The acetylene flame is not the equal of ordinary
illuminating oil, for its ceases to be of use after four hours, and the atmospheric jar of a field
gun or bursting shell invariably extinguishes it. The triage, operating department, and
offices at least should be electrically lighted, as the greater part of the work in these hospitals
is performed at night.
Every evacuation hospital should be equipped with heavy painted canvas ground sheets
on a basis of three to a tent, as it often i s necessary to hurriedh' erect tentage on wet or dust-
covered ground, and timber for floors is seldom obtainable.
When a commanding officer receives orders to move to a new location it is his duty to
ascertain as promptly as possible from the coordinating section (army) the railhead at which
he will draw rations at the new location.
"A special electric generator and lighting unit for an evacuation hospital has been provided.— £d.
862 ADMIXISTRATIOX, A:MERICAX EXPEDITIONAHV FORCES
THE ARMY MOBILE LABOKATORV
(Numl)ered from 1 up)
The brief stav of the wounded in evacuation hospitals rendered laboratory eciuipnient
at first supplied these units very excessive, and for this reason the question of utility has
been considered, with the result that marked curtailment of laboratory equipment has been
effected, as explained above, under " Evacuation hospitals." The consensus of opinion was
in favor of one large, well-equipped mobile laboratory in the proportion of one to an army,
to be located in the vicinity of the army ambulance park and the army medical supply depot,
for facility in supplv and transportation. "
Equipment should be elaborate enough for all requirements of field laljoratory work and
vet capable, even with a special ward tent, of being transported upon two trucks. As free-
dom from dust and dampness are important, advantage should be taken of existing buildings,
tentage being used onlv in case of necessity, and personnel should be billeted. Messenger
service for the collection of specimens should be furnished by the army ambulance park,
use being made of ambulances and motor cycles of companies in rest.
THE SANITARY SQUAD
A sanitary squad is a small services of supply unit required in the proportion of two and
one-half per division for the maintenace of sanitary apparatus and instruction in its correct
usage, its members being familiarized with the routine of sanitary inspection in relation to
the care of latrines, water supply, preparation of food, suitability of billets for occupation, the
disposal of wastes, including horse droppings, diseases among the civil population, especially
those of a communicable nature. Every member of the squad should be required to keep a
thoroughly posted notebook with all the necessary information for the unit commander to
make a report to the officer responsible for defects, with recommendations for remedy, and
to sanitary inspectors if responsible commanders fail to take action.
In practice it is found that units within the zone of the armies function best under the
chief surgeon advance section area. If these units are assigned to combat areas their activi-
ties may best be controlled by the army sanitary inspector. If such assignments are found
necessary, one squad to each division gives a force sufficiently large to meet the requirements
of the sector occupied. For administrative convenience the area should be divided into
sections by vertical and horizontal lines, each section being assigned to a squad, which is
held responsible for maintenance of sanitation within its particular section and also for the
equipment installed.
The major portion of these units will be required in the services of supply at hospital
centers, base ports, etc. It must be made plain to all that the duties of a sanitary squad do
not contemplate the performance of police duty, as this is part of the routine work of troops
occupying the area, and that the members of this squad are really inspectors and instructors.
The sanitary scjuad is, however, responsible for maintenance of sanitary apparatus and to
that end should possess the necessary tools and a suitable place in which to make or repair
the simple appliances used in the field.
Upon detection of a sanitary defect that is remediable, the unit commander should
inform the responsible officer, recommending the remedy, and onlj' in the event of the failure
of this officer to make correction should report be made to the sanitary inspector.
The commander of the unit should be both resourceful and tactful and should keep him-
self thoroughly posted upon all matters of sanitary and local interest, in order that he may
be in a position to give full information to the commanding officers of newly arrived commands.
*******
"An army medic-.il labniatiry of a mobile type is assigned to each field army. See Tables of Organization
m-Vf.—Ed.
APPENDIX
863
IV
BASE SECTION CHIEF SURGEON'S OFFICE
A medical officer with the rank of colonel will be recommended by the chief surgeon of
the forces for the duty of chief surgeon of each base section. Officers so detailed should have
had long administrative experience and should possess a thorough knowledge of sanitation
and epidemiology. Selection for these positions should be made from among those of known
organizing ability.
The size and importance of base sections vary with the port facilities which they contain
and the rapidity with which the expeditionary force is reinforced. Development of facilities
within base sections is dependent upon the distance from them to the fighting hne. EstabHsh-
ment of a port within a base section may in itself constitute a combat problem, in which case
the service of the rear will develop only as fast as is permitted by advancement of the combat
forces. Unless a base section, and port facilities therefor, be taken over complete from an
ally, it is reasonable to assume that these projects will develop gradually.
Base sections should be under command of a line officer, usually of the rank of brigadier
general. Each base section should be organized along the lines of the services of supply
group in general. The staff, therefore, of a base section commander consists of a chief of
staff, a general staff, and administrative and technical assistants. The administrative,
intelligence and coordination sections are the only sections of the general staff represented
at the headquarters of base sections. The base section chief surgeon is a member of the
administrative and technical staff of the section commander, and as such is his adviser upon
all questions connected with the sanitary service of the section. TJie chief surgeon should be
represented in the general staff sections by a medical officer detailed to the administrative
and coordination sections. Officers so detailed should be possessed of tact and ability and
familiar in all details with the organization of the sanitary service of the section and the stage
of completion of the various projects connected therewith. These officers must be acceptable
to the chief surgeon and to the chief of the general staff section to which detailed if they are
to be of value to the staff and at the same time really represent the chief surgeon of the
section. These officers are detailed for the purpose of giving and receiving technical informa-
tion with reference to the Medical Department and under direction of the chief of the section
they coordinate the work of their own departments with that of others. The officers should
be members of the Medical Corps and not detailed to the general staff.
Just as the section in general is organized along lines similar to the services of supply,
so the chief surgeon's office of a base section is organized in a manner similar to that of the
office of the chief surgeon of the forces (q. v.). The chief surgeon of a base section should so
organize his office as to be free to circulate, within the section, among his various and well
dispersed activities. Not only is he responsible for the correct functioning of his office
proper, but he exercises supervisory control over various Medical Department activities
such as hospital centers, camp hospitals, the attending surgeon's office attached to head-
quarters, the embarkation-debarkation camps or centers, ambulance companies, sanitary
squads, medical supply depots and storage stations, medical laboratories, veterinar\^ units,
leave areas, and the Medical Department detachments attached to the various services of
supply battalions or regiments.
In the absence of the chief surgeon he is to be ably represented by his first assistant,
who is in all respects his understudy. This officer will have been selected for the position
by the chief surgeon from amongst officers of his own organization and preferably will be one
who has had experience in several of the important divisions of that office. He should
have the rank of lieutenant colonel and should be a member of the Medical Corps.
The administrative section of the office should be headed by a field officer of the medical
executive service, assisted by the necessary noncommissioned officers and enlisted men.
He assumes the responsibihties of detachment commander for the Medical Department
enlisted men on duty in the office of the chief surgeon and should have entire charge of all
transportation assigned to the office from the local pool. He estabUshes a complete office
13901—27 55
864
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
of record, with all necessary blank forms, equipment and files. A mimeograph and an adding
machine are essential items in this equipment. Within the record office there should be
maintained a pool of stenographic and typist help for general use throughout the office.
Reports, correspondence, etc., going to or coming from the various divisions of the office
are transmitted through and coordinated by the administrative division of the office.
In addition to the administrative division the staff of the section chief surgeon consists
of professional or technical assistants and those whose duties are largely administrative.
Those of the former class are as follows: Foreign Uaison; general surgery; general medicine;
orthopedic surgery; supervisory dental surgeon; naval liaison.
The divisions of the administrative class are as follows: Personnel; evacuation; sanita-
tion; hospitalization; property and finance.
Administrative divisions of the office are further divided into sections, the most important
of these being the embarkation-debarkation service section of the sanitation division. Activi-
ties of this section will be covered, with personnel and organization thereof, under a separate
heading.
TECHNICAL AND PROFESSIONAL GROUP
FOREIGN LIAISON
Should a base section be established upon allied territory, thereby making use of foreign
ports, it becomes necessary to establish immediately a reciprocal liaison with the various
groups of allied forces present. Through the central liaison office the chief surgeon of the
forces should request the assignment of the requisite number of medical officers from the
alhed army concerned, detaihng upon request of these forces officers from his own office to
represent him whenever necessary with the allied forces in question.
The foreign officer detailed to assist the base section chief surgeon should be familiar
with the details involved in a large embarkation-debarkation problem and with the organiza-
tion and personnel of the local governing powers. All divisions of the office coming in contact
with aUied local miUtary or civil functionaries should maintain close and tactful haison with
the foreign representative detailed to the office of the chief surgeon of the section. This
applies particularly to the evacuation service and the sick and wounded and epidemiological
sections in their relations with local boards of health with reference to the movement of
communicable disease curves.
GENERAL SURGERY
An officer of the Medical Corps experienced in general surgical procedure should be
detailed from the consultant body by the director of professional services, chief surgeon's
office. It is the duty of this officer to standardize and supervise the work of general surgeons
throughout the sanitary service of the base section. He is the adviser of the section chief
surgeon upon all questions relating to general surgery. He is empowered to investigate the
sufficiency of surgical personnel and materiel throughout hospitals of the base section, making
necessary reports and recommendations to his chief upon completion of an inspection tour.
In this work all consultants are expected to correct minor defects upon the spot, without
recourse to correspondence. The granting of such authority, however, requires that only
officers with mature judgment and tact be assigned the duties in connection therewith.
Consultants should observe the results of triage in the forward hospitalization echelons by
noting the percentages of cases arriving within base sections that properly should have
remained within the zone of the armies. This procedure, with the necessary reports, will
materially assist in the efficient administration of the sanitary service in forward areas.
GENERAL MEDICINE
The duties, jurisdiction, etc., of this office and that of general surgery are analogously
constituted, differing only in the different nature of the professional work involved. It is
the duty of the officer detailed to this work to carefully supervise the after-treatment of
toxic gas cases. Should the number of cases warrant, assistants who are experts in psy-
chiatry and diseases of the lungs should be assigned.
APPENDIX
865
ORTHOPEDIC SURGERY
What has been said upon the duties, etc., of consultants in general medicine and surgery
aptly applies to such a detail for the division of orthopedic surgery. Like all consultants
on duty in base sections, the officer detailed to this work concerns himself with supervising
the selection of cases for evacuation to home territory and to the rapid elimination of the
unfit in incoming drafts prior to the necessity of hospitalizing such within the zone of the
armies with attendant embarrassment of the bed situation in that zone. The consultant in
orthopedic surgery carefully supervises and standardizes the methods of application of all
orthopedic splints and appliances. He should observe and report upon all evident failures
in this respect in areas outside of his section as indicated by the condition of such cases
arriving upon hospital trains from the front, following active engagement of combat forces.
SUPERVISING DENTAL SURGEON
This division of the office should be under a lieutenant colonel of the Dental Corps
empowered to act for the chief surgeon of the section in all matters relative to the maintenance
of an efficient dental service throughout the base section and the hospitalization units con-
tained therein. He investigates the sufficiency of personnel, supplies, and equipment and
passes upon requests for replacements of both personnel and materiel checked over to him
from the personnel or materiel divisions. He supervises the activities of the dental surgeons
of outlying and detached organizations, insisting upon their proper performance of the re-
quired inspection of teeth of the members of incoming drafts. Base sections should have
assigned to them an adequate number of dental surgeons to properly complete necessary
reparative dental work on troops intended for forward areas, thus precluding, as far as possi-
ble, the necessity for other than emergency dental work with combat units at the front.
The major part of this work should be done in the camps or centers of the embarkation-
debarkation service, and equipment should be sufficiently elaborate to cover the need fully.
NAVAL LIAISON
A naval medical officer, a member of the staff of the naval port officer, should be detailed
to act in liaison with the office of the chief surgeon of the section. This officer must be fully
cognizant of the general situation at the ports and familiar with the needs of the Army and
with the facilities which the naval authorities have to offer. It should be his duty to trans-
mit information relative to the suitability and capacity, for patients, of all ships operating
under naval control and having such facilities. Such data will clearly indicate numbers of
the various classes of cases which can be transported.
When a board of officers is appointed to determine questions relative to suitability and
capacity which may have become controversial, the naval liaison medical officers, with
proper representatives of the chief surgeon's office, should be detailed to such boards. These
officers should transmit to the proper office all details relative to the arrival, departure,
destination, change in plans, etc., with reference to all patient-carrying transports. As it
is manifestly impossible for naval authorities to maintain Medical Department personnel
and materiel in sufficient amounts to care for all the sick on board ship, it is the duty of the
naval liaison medical officer to transmit requests to the personnel and supply divisions of
the office for additional medical officers, nurses, and enlisted men and for such supplies and
equipment as may be needed to meet all conditions.
THE ADMINISTRATIVE DIVISIONS
PERSONNEL
The personnel division of the office should be under the direction of a field officer of the
Medical Corps, assisted by one officer of the medical administrative service and by a member
of the Army Nurse Corps acting as supervisor of the nursing service of the section. This
force should be augmented by the requisite number of noncommissioned officers and men
for the numerous administrative and clerical duties connected with the office. The division
should be subdivided into sections dealing with orders and assignments, qualifications and
classification, and records and reports.
866
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Thft subsection dealing with orders is concerned mainly with drafting orders necessary
properly to shift Medical Department personnel amongst the various activities of the base
section. Chief among these assignments are those to naval transports above described.
Should it be found necessary and possible to establish a Medical Department casual camp
as a personnel pool, this unit will be administered and supervised by the section chief surgeon
through subsections of the personnel division. Assignments and requisitions for replace-
ments of personnel should be passed upon by the orders and assignments subsection, which
will be assisted in that work by the detailed data relative to the classification, qualifications,
etc., of the individuals concerned, compiled in the section devoted to this work. Routine
reports, special reports, records, etc., relative to Medical Department persomiel are prepared,
filed, forwarded, or transmitted, as the case may be, by the office force of the records and
reports subsection.
The supervising nurse maintains close touch with the entire nursing service of the sec-
tion, including the facilities provided for the shelter, subsistence, amusement, and recreation
of the members of the Army Nurse Corps. It is important that the nurse assigned to this
important position be well equipped in tact and possessed of broad vision and knowledge of
human nature if she is to succeed in a position fraught with so many difficulties and delicate
situations. Every possible assistance should be afforded the various aid societies in their
efforts to increase the comfort, and thereby the contentment, of the nursing personnel.
EVACUATION
This division of the office is responsible for the organization, maintenance, and super-
vision of the entire evacuation system within a base section. The chief of this division
should be an officer of exceptional qualifications if he is to succeed in organizing and admin-
istering a service of this magnitude, and he should be a field officer of the Medical Corps.
He should be assisted by two officers of the medical administrative service and the necessary
number of noncommissioned officers and enlisted men of the Medical Department. In no
other division of the chief surgeon's office is it so necessary to maintain careful coordination
of the work with that of all other divisions as in the evacuation division. The work of this
office is intimately associated with that of practically every other activity, and the develop-
ment of a smoothly working machine requires the establishment of excellent liaison affect-
ing particularly the professional and technical divisions and those of hospitalization, personnel,
and sanitation (embarkation-debarkation service). The work of this office will be divided
amongst the subsections of transportation, records, reports and statistics, and schedules.
The transportation subsection controls all Medical Department transport units such as
ambulance companies, hospital trains, barges, etc., available and in use in the evacuation
system. It makes all assignments of ambulances and motor-cycle side cars in accordance
with Tables of Organization or equipment manuals, due consideration being given to availa-
ble reserves upon these items of equipment. In cooperation with the records, reports, and
statistics section, accurate card records should be maintained, covering transport units
available. These records indicate the personnel assigned, United States numbers of vehicles
or trains, location, periods of service, state of repairs, consumption of fuel, etc., and should
be constantly kept up to date. All reports required by higher authority, and requisitions
for replacement relative to transportation should be prepared in this office.
The statistical office consolidates information received in reports from the various
offices of the base section relative to the subject of evacuation. Such reports are sent to
it by hospitals and hospital centers and by the superintendents of the Army Transport
Service and railway transportation office. After consolidation of this data the schedules
section is in possession of information regarding cases for evacuation and concerning facili-
ties available for accompUshing the movement. Necessary schedules are prepared and
needed instructions for filling requisitions sen*- to the hospitaUzation unit affected. AH
transportation units concerned and railway or shipping offices should be notified at the same
time concerning details of intended evacuations, train schedules, loading and unloading
points, time of arrival or departure, and time and place of arrival and departure of the ship
which it is intended to have used.
APPENDIX
867
Where an ambulance service between hospital and ship or train is required, the nec-
essary instructions should be issued by the transportation section following conference with
the schedules section. Arrangements should be made within the evacuation division to
organize and supervise the checking out of patients baggage, records, and valuables. If this
be well systematized and carefully supervised embarrassing complaints will be minimized.
After final disposition of evacuables, detailed reports relative to evacuations should
be made to the chief surgeon of the forces through the administrative section of the general
staff of the base section. This data is used as the basis of cable reports to embarkation
authorities in home territory.
Should there be patients requiring special treatment or consideration upon shipboard,
such details should be taken up with the naval liaison medical officer for adjustment and
the patients not evacuated until proper arrangements have been completed.
SANITATION
This division should be under the direction of an officer of the Medical Corps with the
rank of lieutenant colonel, with organizing ability and trained in epidemiology and practical
field sanitation. He will succeed largely through his ability to meet and get along with
other officers not members of his own corps, and through his ability to handle men. He
must, therefore, have tact and force and also possess vision and imagination. Officers who
lack the elements of compromise should be detailed to such position only when their manifest
advantages outweigh this serious shortcoming.
The officer in charge of the division of sanitation needs in his work the assistance of
three district sanitary inspectors of the rank of majors, and the officers in charge of the
various subsections of his office. The total personnel allowed this important division can
be seen at a glance by consulting the organization chart for the section chief surgeon's office,
and that for the embarkation-debarkation service section of the sanitation division.
The district sanitary inspectors are field officers of the Medical Corps. Actual organi-
zation of sanitary inspection work, including the districting of the section, supervision of
sanitary squads, etc., is decentralized to these officers. They must completely cover the
area to which assigned, carefully investigating water and food supplies, kitchens and mess
facilities, ventilation and heating within shelter, bathing, laundry and disinfesting facilities,
and, in general, the environs of all inhabited areas, civil or mihtary, in a searching quest
for cither public nuisance or sanitary menace. Once discovered, the hygienic defect should
be followed up with recommendations and repeated inspections until corrected. In this
work sanitary squads are the assistants to district inspectors.
The subsections of the division are as follows: Food and nutrition; epidemiology;
embarkation-debarkation service; urology; laboratory service.
The embarkation-debarkation service is covered by separate text under appropriate
heading.
FOOD AND NUTRITION
This office is controlled by a field officer of the Medical Corps or the medical admin-
istrative service (allied science branch). He is assisted by an officer of the administrative
branch and by the necessary enlisted stenographers. The officer in charge of the section
should be a trained practical food expert, and his activities confined to organizations within
the base section and to ships plying between home territory and the ports of the section.
He should direct his efforts toward the practical improvement of all food and messing facili-
ties and the conservation of foodstuffs, developing to the utmost the salvage of waste. His
activities should not be confined to casual investigations and inspections, but he should give
practical demonstrations and instruction in the kitchens of the various commands. Food
and nutrition experts should be prepared at all times to decide questions arising in connec-
tion with the sufficienc}' of the army ration.
EPIDEMIOLOGY
This office is concerned with statistical records of epidemic diseases, the standization
and supervision of methods of control thereof, and those details relative to sick and wounded
reports which it will be necessary for the chief surgeon's office to handle.
868
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Through the office of the foreign liaison officer this office maintains liaison with the
local health authorities, each reciprocating with necessary information relative to outbreaks
of communicable disease and progress made toward the elimination thereof.
Charts and graphs showing prevalence, case incidence, location, noneffective rates
and similar information with reference to sickness and injury of troops within the section
are to be maintained in this office.
UROLOfiY
An officer of the Medical Corps with known ability in the prevention and care of skin
and genitourinary diseases should be in charge of this section. The detail wall ordinarily
be made by the director of professional services, chief surgeon's office, and the officer so
detailed becomes the section consultant in urology, but he functions directly under the
sanitation division, since his problems are so intimately connected with those of sanitation
and hygiene. He standardizes the methods of prevention and treatment of all diseases
under his specialty. He investigates fully all sources of infection and makes the necessary
recommendations toward eradication of such sources whenever discoverable. He should
maintain "spot maps" indicating cases and sources, and should be prepared to take the
most energetic steps when unusual percentages appear in connection with any locality or
command.
The section urologist should personally investigate the sufficiency and adequacy of
both personnel and materiel for the prevention and treatment of skin and venereal dis-
eases. Where shortage exists in materiel or there is inefficiency in personnel charged with
this work, he should make report of the same to the chief of his division, recommending
the necessary action. He should devote a considerable part of his time to the development
and execution of a plan for liberal instruction of the members of the command with refer-
ence to the social evil and its connection with noneffective rates. Dealing as he does with
a disease that walks by night, and confronted as he is at every turn by obstacles seemingly
thrown in the path by Mother Nature herself, he needs to be fearless and bold if he would
reap even a measure of success in his truly philanthropic task.
LABORATORV SERVICE
A trained laboratory expert who has had administrative experience should be detailed
to the charge of this section of the sanitation division. He should be a field officer of the
Medical Corps, assisted by one Medical Department sergeant. The base section Medical
Department laboratory (stationary unit) should be attached to the office of the section
chief surgeon, and the activities of this unit, its personnel, function, etc., supervised and
coordinated through the division of sanitation. The laboratory service sub section acts as
liaison between the director of laboratories of the office of the chief surgeon of the forces
and the entire laboratory service within the base section.
All laboratory methods and technic should be standardized and supervised by this
office, with the advice and assistance of the officer in charge of the section laboratory. The
two should work in close cooperation with the other subsections of the sanitary division.
Laboratory work connected with special sanitary investigations or of a routine character
for all commands, other than hospital centers and base hospitals, are to be performed by the
section laboratory. Units having laboratory facilities should complete their own examin-
ations. Exception to this rule will be made, in the interests of uniformity in result, in the
case of Wassermann reactions or of such other examinations requiring specialized apparatus
or technic. This work should be carried on within the section laboratory.
From such data as it may possess the laboratory service should assist other divisions or
sections of the office in the preparation of graphic charts dealing with epidemic diseases, etc.
Routine reports, etc., required by the chief surgeon of the forces and higher authority will be
prepared in this office.
BASE SECTION EMBARKATION-DEBARKATION SERVICE
Medical Department personnel attached to the embarkation-debarkation service at
base sections is controlled through the division of sanitation. The service usually consists
of one or more large concentration camps or centers conveniently located as regards the base
4
APPENDIX
869
port. Each camp or center should be under the command of a hne officer, he to have as a
member of his staff a medical officer as the camp or center surgeon. The surgeon of an em-
barkation-debarkation camp bears the same relation to the commanding officer of the camp
as a surgeon to the commanding officer of a garrison, with other duties imposed bv the arrival
or departure of troops and casuals. His duties are manifold and he must be both energetic
and resourceful and should so organize his office as to be free from a mass of routine, and
should employ his time in a supervisory capacity over pohce and sanitary activities of his
camp. His office is organized with the following divisions:
ADMINISTRATION
This important division coordinates the duties of all office divisions, checks communi-
cations coming into or leaving the office, prepares all papers for the surgeon's approval and
signature, and receives, distributes, and censors all mail. The administrative division is
subdivided into two sections: Detachment, deahng with the enlisted personnel on duty in
the office and the records pertaining thereto; mess, deahng with conduct of the messes for
Medical Department personnel, enlisted personnel and, if conditions warrant, for officers as
well.
DISPENSARY
This division conducts the pharmacy (which should be well stocked), maintains a place
for holding sick call, the attendance upon which will be large by reason of the large number
of troops arriving and departing (and in this connection a medical officer with the necessary
attendants must be on duty at all hours), and is the location for the prophylactic station,
which must be adequate and open day and night.
Space should be allotted within the dispensary for dental sick calls and treatment room.
Dental officers should be provided in these locations without regard to rate per thousand.
All possible emergency and reparative work must be completed here prior to troops leaving
for the front or for home territory.
PHYSICAL EXAMINATION
This important division should be under an officer qualified in physical examination, the
conduct of disinfestation and bathing establishments, and the detection of venereal or other
communicable skin diseases. His office is subdivided into the following sections:
Examining teams. — The duties of this section are of great responsibilitj' in that it is the
point at which the separation of the fit from the unfit is inaugurated and diseases that would
be a menace to the forces in the advance detected, at the same time being the proper place
for examining home-bound troops, to sort out venereals and those having other diseases
which would be a menace to the homeland.
Bath teams, which conduct the bathing and disinfestation establishments through
which all troops bound for home must pass, and on occasion those arriving from the home-
land, as vermin in wartime are found in abundance on all mihtary routes of travel. This per-
sonnel also supervises the laundry establishment of the camp or center.
Train teams, which are concerned with meeting every train filled with the sick and
wounded to be embarked, to examine all cases which give evidence of unfitness for further
travel, and to render any medical assistance needed in case of sudden sickness or injury
among arriving or departing troops. The personnel of these teams also accompany troop
trains for the purpose of medical attendance.
Dock teams, which are primarily for detection of the unfit among arriving troops, and
secondarily to render medical assistance to all at the piers, including crews of vessels if
desired. In evacuations this personnel makes the last inspection of sick and wounded prior
to their embarkation for home territory.
Venereal teams, which examine all incoming and outgoing troops for the detection of
venereal and contagious skin diseases, and provides for the treatment of such cases as are
detained, and for the immediate transfer of others to the designated hospital.
870
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
SANITATION
This division is concerned with the sanitation of the entire camp and its environment,
pohcing being given special attention, since the last place observed leaves a lasting memory
with those departing for home or for the front. Barracks, billets, huts, or tents must be main-
tained in a state of scrupulous cleanliness, marked attention being given to latrines, ventila-
tion, and heating. Kitchens and mess halls should be inspected daily and sanitary defects
corrected on the spot, under authority of the camp commander. Food handlers should be
examined frequently for detection of possible "carriers." The disposal of garbage and waste
should be perfect in every detail, as well as the disposal of manure, not only to prevent fly
breeding but also to afford an object lesson in sanitary poUcing. Drinking water supplies
must be well protected, and if chlorination is required, daily tests must be made for its
sufficiency. Water and food containers must be perfectly cleaned daily. If the location is
malarial or mosquito breeding, steps should be taken to eliminate the cause, if humanly
possible.
HOSPITALIZATION
This division of the office of the base section chief surgeon should be under the control
of an officer of the Medical Corps, with the rank of lieutenant colonel. He should be as-
sisted by two other field officers of the Medical Corps and one officer of the medical adminis-
trative service. The officer in charge of hospitalization should be a man trained in hospital
work in all its details, including those of the administrative and constructive branches as
well as those of a professional nature.
In large expeditionary forces (two or more armies) it will be necessary to decentralize
hospital control, except that of hospital centers, to the office of section chief surgeons, thereby
relieving the chief surgeon of the forces of an infinite amount of details. At the same time this
decentralized control should be exercised only in carrying out the policies of the chief surgeon
of the forces, which will be, for the section concerned, part of a grand scale hospitalization
plan. This office must therefore remain at all times in close touch with the mother group
in the office of the chief surgeon of the forces. The division is organized into the subsections
of inspection, construction, and retrenchment.
The inspection section is concerned with investigation of the administration, internal
economy, discipline, efficiency, and supply of the hospital units within the base section.
In so far as hospital centers are concerned, their control by the base section surgeon's office
is confined to the supervision of their sanitation and to fire protection. In cooperating with
the evacuation division this section investigates the efficiency of the evacuation system as
developed by the individual units in an effort to further standardize all such activities.
New sites for hospitals will be inspected and passed upon by the section prior to their
being recommended for acceptance, and in cooperation with the construction section fre-
quent inspections and reports thereon will be made as construction upon these sites pro-
gresses toward completion.
The construction section is directly concerned with the completion of hospitalization
projects authorized for this section. Plans prepared in the office of the chief surgeon of the
forces and turned over to the constructing service for completion will be followed as closely
as possible, but varying conditions in localities may demand that modification be made in
these accepted plans. All such approved modifications will be reported to all offices con-
cerned, and thereafter contractors or builders will be held to the new specifications.
Authorized repairs or additions to completed projects should be carefully supervised by
the construction section and retained files of plans brought up to date in conformity with
the change effected.
The retrenchment section prepares, in advance of need therefor, a systematic plan for
the gradual reduction of hospital facilities within the section. This is of great importance
when buildings and sites have been utilized within the territory of a foreign country, for
upon conclusion of hostilities demands for such shelter are sure to be made, and for reasons
of international comity, at least, these must be diplomatically received and considered.
When active retrenchment begins, this section takes over the function of transferring
again to civil control, foreign or otherwise and in accordance with the prearranged plan,
hospitals, buildings, sites, etc., as they can be spared and vacated.
APPENDIX
871
In the case of transfer of buildings, equipment, etc., from military to civil control, the
process must be formal and complete and will be accomplished in cooperation with the in-
spection section and the rents, requisition, and claims department of the services of supply.
PROPERTY AND FINANCE
A field officer of the Medical Corps, assisted by an officer of the medical administrative
service and the necessary noncommissioned officers and enlisted men of the Medical Depart-
ment, controls this division of the office of the base section chief surgeon. This force receives
and visas all requisitions for equipment and supplies from Medical Department units or
attached organizations within the base section.
Every base section should have at least one full stock issuing medical supply depot,
under control of the section chief surgeon's office and established to cover local distribution
needs. Upon the 15th and last days of every month these depots should render a complete
stock-balance report to the property division. It should also be required that for its infor-
mation a duplicate of all similar reports made to the central control office by base storage
station be made to the section chief surgeon's office. Requests for initial equipment or
other requests involving carload lot shipments of the heavier or bulkier items will be, when-
ever this is possible, visaed and relayed to "controlled stores," chief surgeon's office.
Requisitions from issue depots of the section must be passed upon in the supply division
before being forwarded to the central control office in the office of the chief surgeon of the
forces. Such requests may be filled either wholly or in part by diverting the necessary
materiel, in original packages, from the stream of materiel flowing into base or interior
storage stations. This contingency is provided for by blanket authority for such action to
base section chief surgeons.
For the information of the central control office, the supply division will carefully
supervise the management and stocking of ba.se storage stations and the activities of Medical
Department dock representatives, although for administrative purposes such organizations
are directly under control of the supply division of the office of the chief surgeon of the
forces. All correspondence, however, from this higher control to the storage stations,
should, in the interests of good coordination, pass through the office of the section chief
surgeon.
Under blanket authority this ofl^ice should be permitted to approve emergency purchases
of medical supplies or equipment up to a definite and fixed limit (usually $250). This
granting of authority presupposes due consideration being given stocks in depots, outside
the section, before issuance of a request for the authority to purchase as "emergency."
Such information is available by use of the ordinary means of communication.
With reference to finance, this office maintains liaison with the finance and accounting
division of the office of the chief surgeon of the forces and should audit accounts referred to
above imder emergency purchases. Hospital fund statements should be examined, corrected
and approved, and proper final disposition made thereof in this office. Should a medical
disbursing officer be found necessary, he should be located and operate under the division
of property and finance.
THE CORPS SURGEON
The corps surgeon is the adviser of the corps commander in all matters of sanitary interest
arising within the corps, and controls under the authority of the corps commander the sanitary
units assigned the corps through the commander of the sanitary train,'' his duties being
both administrative and tactical; he prepares the sanitary paragraph of the corps battle order
based upon the army battle order when the corps is operating under army control, and inde-
pendently when the corps is operating alone.
The corps surgeon supervises the location of the mobile surgical hospital (corps) , these
locations having been previously tentatively selected by the director of field hospitals, due
regard being given safety from direct fire, roads to front and rear, relation to divisions of
' Each corps surgeon has under his immediate control 1 medical regiment belonging to the corps troops. See Tables
of Organization 81-W. — Ed.
872
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the corps in line of battle, water and fuel; he announces to the army chief surgeon and to the
division surgeons the location of these mobile surgical hospitals (corps), and sees that the roads
leading to them are conspicuously marked by signs both to the front and rear for the direction
of ambulance drivers.
He transmits important sanitary communications from the divisions and corps troops
to the army chief surgeon, or directh' to the next higher medical authority in the absence of
army command; he supervises the work of the division surgeons and sees that divisional units
are correctly located for the most effective service; he concerns himself with the sufficiency
of sanitary supplies, equipment, personnel, and transportation within both the corps and
divisions; he maintains close liaison with the division surgeons operating under the corps on
the one hand and with the army chief surgeon on the other.
He assumes charge of any epidemic within the corps area, under the authority of the
corps commander, either among the military or civil population, and also within the divisional
areas when the division surgeons fail in control, himself calling upon the army chief surgeon
for assistance in the event of his resources being overtaxed; he directs the activities of the
consultants assigned his office, and especially through the director of field hospitals, the activ-
ities of the mobile surgical hospital (corps) where the consultants find their greatest field
of usefulness. He maintains no office of record beyond a loose-leaf file, and diary (data for
his final report), and a card index of commissioned medical personnel within the corps or
divisions of his corps; his office must of necessity be mobile and the furnishings so simple that
all can be moved upon one 3-ton truck upon short notice.
The director of field hospitals and ambulance companies perform the same duties out-
lined for the divisions (q. v.), the director of field hospitals being mainly concerned with the
conduct of the hospitals for nontransportable wounded in which duty he is assisted by the
consultants.
The duties of the remainder of the office force are similar to those in the office of the army
chief surgeon and need no comment.
MOBILE SURGICAL HOSPITAL (CORPS) »
(Numbered from 1 up)
In order to provide for the class of battle casualties known as nontransportable wounded
it is necessary to provide a well-equipped, standardized surgical hospital that is easily trans-
portable, and can be brought forward close to the division field hospital used as a triage,
to provide prompt surgical care for these cases and obviate a long ambulance haul to larger
hospitals placed of necessity further to the rear. The addition of a complete operating equip-
ment to any division field hospital, besides being diflScult of transport with a division, offers
the further objection that once the hospital receives severely wounded it becomes immobilized.
In order to properly function and to keep contact with the division the field hospitals must
not lose their mobility.
There has been provided, therefore, for the nontransportable wounded, one modified
field hospital, with standardized X-ray, electric lighting, sterilizing, and surgical equipment
in the proportion of one of these surgical hospitals for each combat division in the corps.
Experience has effectually disposed of the fetich born of the long period of indecisive
trench warfare to the effect that a wounded man must be immediately operated upon.
Adherence to this idea can only result in the unnecessary death of many, since the shock of
operation will be superimposed upon that of trauma. The question of how far a wounded
man may be transported with safety is an open one, but if rest and shock treatment be given
before the journey is begun the man will bear transportation to the mobile surgical hospital
(corps) where facilities obtain for further shock treatment if necessary, and the majority
of cases will arrive in condition for early operation.
To each corps there is assigned a medical officer of the rank of major as a director of the
mobile surgical hospital (corps). He will be under the direct orders of the corps sanitary
train commander, or, in his absence, the corps surgeon.
• Surgical hospitals are army units placed at the disposition of the corps surgeon for the purpose outlined under this
heading. See Tables of Organization 284-W.—
APPENDIX
873
Each mobile surgical hospital (corps) is commanded by a medical officer of the rank of
major who functions under the immediate orders of the director of the mobile surgical hospital
(corps) or, in his absence, under the orders of the corps surgeon.
These mobile hospitals are sent to the army area to be under the control of corps surgeons.
They will be provided in the proportion of one to every combat division in the corps.
These hospitals are placed in the corps or division area according to the orders of the
corps sanitary train commander to the director of corps field hospitals, to be located where
they can provide immediate care for the divisional nontransportable wounded. They will
be placed as close to the division triage as possible. They must not be placed too far for-
ward when there is a possibility of a sudden retreat, and care must also be exercised that they
are not placed in direct range of enemy artillery.
The evacuable operated wounded are transported to the evacuation hospitals from the
mobile surgical hospital (corps) by ambulance companies under orders of the corps surgeon,
assisted by the army ambulance service assigned to evacuation duty when requested.
The surgical consultant assigned to the corps is responsible for the proper performance
of the surgical work in these hospitals.
If the departure of divisions from the corps area leaves an excess of mobile surgical
hospitals (corps), the fact will be reported by the corps surgeon to the chief surgeon of the
army, who will issue orders for the proper reassignment of the hospitals.
These hospitals, being designated in the battle order for the reception of nontransportable
wounded, are expected to receive only that class of casualties. Should poor triage in the
divisions result in sending transportable wounded to this hospital, report will be made at
once to the corps surgeon for its correction.
A mobile surgical hospital (corps) should have the following departments: (1) Receiv-
ing, triage or sorting; (2) shock ward; (3) X-ray department; (4) operating room; (5) phar-
macy, laboratory, dental ; (6) mess (patients, officers, nurses, enlisted personnel) ; (7) evacuat-
ing; (8) office (commanding officer, adjutant, quartermaster); (9) morgue.
For the general functioning of the hospital see the part on the evacuation hospital, the
organization and work of the surgical department there being similar. The mobile surgical
hospital (corps) , under canvas, will occupy 22 tents and will have a capacity of 250 patients.
VI
THE DIVISION SANITARY SERVICE
DIVISION SURGEON
The surgeon of the Infantry or Cavalry division must have the rank of colonel, and the
officer selected for this duty must not only be energetic and zealous but possessed of tact
and a broad knowledge of sanitary tactics and administrative duties.
He is the adviser of the division commander upon all questions of sanitary interest, and
in his administrative capacity controls the sanitary activities of the organizations and units
composing the division and the activities of the voluntary aid associations attached.
He inaugurates and maintains a schedule of training for the entire sanitary personnel
of the division, and this schedule should be begun when the division is formed and continued
to the time of entry into combat.
He maintains no office of record beyond a loose-leaf file, diary, and card index of the
sanitary personnel of the division.
All official communications relating to the sanitary service, whether to or from the
organizations and units of the division, are referred to him for action. He is responsible for
the prompt and accurate preparation of casualty reports and the inspections of the divisional
organizations and units to insure preparedness for combat and compliance with sanitary
regulations; he systematizes and maintains the entire sanitary service for such medical and
surgical care as the divisional facilities afford the sick and wounded and provides for the
necessary transportation to insure the prompt evacuation of all cases in a condition to bear
transportation; if suitable buildings exist, he will assign such equipment and personnel as
are necessary to convert the buildings to hospital use, in this manner conserving his tentage;
he makes provision for the disposition of the sick and wounded of the division oit the march,
874
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
in training, and in combat, making use of all facilities to free the command of noneffectives
and maintains the entire sanitary service in the highest degree of mobility; he is responsible
for the timely rendition of requests for replacement of personnel and requisitions for materiel,
which includes those for transportation.
To be in perfect liaison with the general staff of the division the division surgeon must
have a medical officer detailed who will be attached to the administration section where he
will be in a position to gain accurate information of all matters relating to the sanitary
service and transmit this information promptly to the division surgeon, whose engrossing
duties do not permit him to remain in an office during combat.
The sanitary paragraph of the battle order is prepared by the division surgeon and based
upon the corps battle order unless the division is operating independently, and submitted to
the division commander for approval and incorporation in the divisional battle order. This
memorandum will show the location of the aid stations, the triage, the field hospitals, the
ambulance companies, the litter bearer battalion., and the medical supply dump, the plan
and routes of evacuation to the aid stations, triage and field hospitals, and the disposition
of cases as sick, wounded, or gassed. If time affords, a road sketch showing the above data
should be prepared and submitted to the division commander and the corps surgeon, though
the latter must always be given the location of the divisional aid stations and sanitary units
in either a formal or informal manner to insure coordination with the sanitary service of the
corps.
During combat all changes in location of the divisional sanitary units must be promptly
notified to the corps surgeon, as must al-so preparations for an advance or retreat, and this
information must be sent by a trusted officer who is personally known to the corps surgeon
and who must be prepared for this service at all times.
The division surgeon must see to the enforcement of orders to the effect that all ambu-
lances carry a sufficient number of blankets, litters, splints, hot-water bags, etc., to replace
those taken from the aid stations with the sick and wounded, and that the triage and field
hospitals maintain a supply of similar articles to replace those turned over by the ambulances
to the hospitals with the patients, in this manner insuring automatic replacement.
In campaign there are assigned to duty with the division by the director of professional
services, medical officers of the consultant body who will be known as division consultants.
The services represented are psychiatry, orthopedics, toxic gas, and urology, the first three
finding their greatest field of usefulness in combat at the triage to which they are assigned by
the division surgeon; the last concerning himself with the prevention and treatment of venereal
and skin diseases in the entire command.
During the training period these officers give instruction to the medical personnel of
the division; the psychiatrist making examinations to detect mental or neurotic cases with a
view to prompt ehmination, and during combat, while on duty at the triage, he differentiates
the genuine war neuroses from the false, and in proportion to his ability and zeal conserves
to the combatant troops many men who are malingerers, hysterical or extremely fatigued,
and who may be returned to the line after a few hours of rest; the orthopedist institutes
measures to prevent "trench foot," makes the examinations for the detecting of and prescribes
treatment for genuine flat feet, trains the sanitary personnel in the application of splints,
and during combat while on duty at the triage superintends the readjustment of application
of splints; the toxic-gas officer instructs the entire personnel of the division in the effects
of toxic gas, in the proper use of the mask and in the preparation of a dugout to exclude the
gas, and the sanitary personnel in the means of combating the effects of gas, particular
instruction being given the personnel of the field hospital set apart for the treatment of toxic-
gas cases; at the triage during combat he differentiates real from false cases irrespective of
previous diagnosis before reception, and recommends the disposition. The commanding
officer of the field hospital, acting as a triage, must be possessed of great diagnostic ability,
for upon him and the consultants assigned to the triage during combat rests a great respon-
sibility, the triage being the sorting place where the real sick and gassed cases are separated
from the false, and the wounded are classified for disposition. Faulty triage will inevitably
cause overwhelming of the evacuation system and a reflex congestion at the triage and field
hospitals besides greatly affecting the morale of the division.
APPENDIX
875
Upon receipt of a movement order, whether by train, truck, or marching, the division
surgeon prepares a schedule for submission to the division commander in which is detailed
the position of the sanitary units on the march or by train or truck and the provisions for
hospitalization of the sick and wounded to remain or be transported, these latter details being
also transmitted to the corps surgeon or in his absence to the army surgeon.
DIVISION SANITARY INSPECTOR
To each division is assigned a medical officer of the rank of major who is concerned with
the sanitation of the division, and the officer selected for this duty must possess tact,
experience in field sanitation, and be well versed in epidemiology.
He makes the sanitary inspections of the entire division, whether in training area, on
the march, or in combat, and also, when so directed, makes the required inspections of
sanitary troops attached to regiments and smaller units and the sanitary train to determine
the discipline, instruction, and sufficiency of supphes, equipment, personnel and transporta-
tion, reporting his findings upon appointed forms to the division surgeon; he instructs the
entire sanitary personnel in sanitation and assists in every way to maintain sanitary perfec-
tion; he concerns himself intimately with the preparation of food, the cleanliness of kitchens
and appliances, mess halls, handhng food, which he has had examined by the bacteriologists
for the detection of "carriers"; he investigates the quality, sufficiency, and variety of food
and makes recommendations for modification or improvement; he investigates the availability
of bathing and clothes-washing facilities at approved locations if none obtain in the area,
making suggestions for improvisation if standard types are not available; he investigates the
question of disinfection and disinfestation, and drying of clothing, recommending such
number of disinfectors or disinfestors and dryers as may be required, and if unobtainable
suggests improvisations; he investigates and reports to the division surgeon the incidence of
any infectious or communicable diseases and the means taken to prevent their spread.
He investigates and makes report upon the venereal status of the command and makes
recommendations for the prevention, care, treatment, and disposition of these diseases; he
makes constant inspection of the prophylactic stations and investigates their conduct and
the frequency of use in relation to the prescribed physical inspections and prevention of
venereal diseases; he investigates the type, adequacy and management of methods for the
disposal of liquid and solid garbage and manure, and makes recommendations for modifica-
tions or improvements; he conerns himself intimately with the disposal of liquid and solid
human excreta and makes recommendations for a standard system in the training area, on
the march, and in combat; if the command is to be billeted, he makes arrangements with the
civil authorities for sanitation during the period of occupancy, and concerns himself with
the adequacy and potability of the water supply; he has all sources of drinking water placarded
as potable or unsafe as the case may be, and investigates the use of Lyster bags, the clean-
liness of water containers and whether the water is chlorinated, frequently submitting samples
for testing for the sufficiency or excess of chlorination; he investigates the sufficiency and
adequacy of clothing and the proper fitting and preparation of shoes, the facilities for drying
clothing and shoes, and the care of the feet.
The sanitary inspector investigates police adequacy, and the suitability of houses,
barracks, or tents for occupancy, pays particular attention to heating and ventilation, and
makes recommendations for repair or improvement; he searches for fly or mosquito breeding
places and takes steps for their elimination; he precedes the command whenever possible to
a new location to familiarize himself with all conditions relative to sanitation, and prepares
his recommendations for any improvements indicated; in combat he concerns himself with the
supply of hot food for the troops and the cleanliness of containers, policing of the battle
ground, and the interment of the human and animal dead.
THE DIVISION DENTAL SURGEON
The division dental surgeon acts in a supervisory capacity over the dental surgeons of
the division, all reports of dental work being consolidated by him for transmittal; he sees to
the sufficiency of dental supplies and equipment; he requires that periodic dental examina-
tions of the command be made and records kept of the necessary dental work to be performed,
876
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
and the immediate dental examination of and reparative work to be performed upon any
recruit joining the division; he makes provision for dental treatment of the personnel attached
to division headquarters, and, upon notification, for the personnel of the division supply
train. The mobile hospital receiving the nontransportable wounded of the division will be
provided with dental attendance by the division dental surgeon or one of his assistants.
THE DIVISION SANITARY TRAIN
The sanitary train of a division is composed of four motor ambulance companies (three
light and one heavy), four motorized field hospitals, one litter bearer battalion, one medical
supply unit, and one laboratory unit, the train being under the command of a medical officer
with the rank of lieutenant colonel, who must be experienced in Medical Department
administrative and tactical duties.'
The sanitary train of a division is technically an integral part of the divisional trains,
which are under the control of the division commander of trains. This control, in so far as
the sanitary train is concerned, extends only to march and road control while the trains are
together and marching or camping as a unit. When combat is imminent or when the sanitary
train is detached from the other trains, all control, either technical, tactical, or administrative,
reverts to the division surgeon through the medical officer in command of the sanitary train.
All communications concerning the units of the train pass through the office of the
sanitary train commander. The train commander by frequent inspection insures the pre-
paredness of the units for combat duties; he directs the movements of the train in compliance
with orders, and in combat exercises assumes direct command over the units and coordinates
their functions in relation to the battle order; when possible he precedes the train to a new
location and makes a reconnaissance, reporting his observations to the division surgeon, if
time permits before the entrance of the division into battle, he, in company with the director
of ambulance companies, makes a study of the battle terrain, and reports his recommendations
to the division surgeon concerning the availability of locations for the establishment of the
triage and field hospitals, due regard being given to existing houses, fuel, water, and roads
both to front and rear; he consolidates the supply of the train and provides for the necessary
transportation from the divisional railhead to the units; he maintains perfect liaison with
the regimental surgeons and the division surgeon during combat; all requisitions for supplies,
spare parts, etc., for the units are transmitted by him to the division surgeon, and all requests
for replacements in personnel and transportation; he provides the transportation for the litter
bearer battalion when the exigencies of service demand quick transportation to a given point.
THE TRIAGE OR SORTING STATION
It is the duty of the Medical Department to retain effectives at the front by preventing
those who do not require more than slight medical or surgical care from going to the rear, and
to promptly evacuate the noneffectives without interference with military operations.
Triage or sorting begins at the front and continues through the entire chain of sanitary
formations. Improper triage causes a loss in effectives through permitting men with slight
or no disability to leave their units, and not only causes congestion of the evacuating system,
but lowers the morale of the troops.
Correct triage insures the proper and prompt disposition of the sick and wounded in the
hospitals designated for their reception and treatment, and a constant uninterrupted flow
of evacuables to the rear.
It is poor policy to retain in the divisional and corps areas cases requiring more than
a very brief hospitalization, for this practice immobilizes the hospitals and increases the
supplies and materiel which can only be transported by an unwarranted tax upon the supply
train.
The triage, which is in reality the receiving ward of a field hospital, is located as near
the front as conditions permit, due regard being given accessibility both to the front and
rear, and to this point all the sick and wounded are transported from the aid stations by the
' Each Infantry division now has a medical regiment in lieu of the old sanitary train. See Tables of Oreani;
tion, Sl-^y.— Ed.
APPENDIX
877
litter bearer battalion or by ambulances as dictated by the military and topographical con-
ditions. The director of field hospitals, under the orders of the sanitary train commander is
charged with the location and establishment of this important formation, which is the keysto'ne
of the divisional evacuating system, and which is conducted by the commanding officer of the
field hospital assigned this duty, who with one of the medical officers of the hospital three
noncommissioned officers and six privates, and assisted by the consultants in psychiatry
orthopedics, and toxic gas, receives and sorts the cases, designating those for transfer to the
division field hospitals, mobile hospital for nontransportable wounded, evacuation hospital
and those to be returned to duty. '
In a command untried in battle it is well to have a sufficient number of military police
assigned to assume charge of those returned to duty, to insure their reporting to their
respective units.
A blanket, litter, hot-water bag, and splint exchange must be established under the
charge of a noncommissioned officer whose duty is to see that for every one received one of
each kind is returned to the aid station from which the sick or wounded man came, in this
manner providing automatic replacement.
No attempt is made to provide medical or surgical care at this station beyond checking
hemorrhage, readjusting a splint, or reenforcing a bandage, but antitetanic serum should
be administered if previously omitted; the assistant of the triage officer with two privates
makes the necessary additions or corrections to the diagnosis tags and prepares the field
cards and envelopes of the cases examined by the triage officer and the consultants; one
noncommissioned officer with two privates disposes of the cases as received in such a man-
ner that they will not be confused' with those already examined; the remaining noncommis-
sioned officers with two privates superintends the evacuation of those examined and
assigned to hospitals, and turns over those pronounced fit for duty to the military police,
if doubt is entertained of their wilUngness to return to their units voluntarily.
Surgical cases are divided into the following classes: (a) Those able to perform duty
in three days; (6) transportable requiring hospitalization longer than three days; (c) non-
transportable.
The nontransportable cases are divided into four classes: (a) Sucking chest; (b) per-
forating abdominal; (c) severe hemorrhage; (d) shock.
Sucking chest and perforating abdominal cases not requiring immediate shock treat-
ment are transported to the near-by mobile surgical hospital. Severe hemorrhage and
shock cases are removed to wards assigned to such cases within the field hospital conduct-
ing the triage. Cranial injuries bear transportation well before operating and not at all
afterwards, so these cases must be voluminously dressed, and, if not in shock, transported
to an evacuation hospital designated for severely wounded, for the necessary surgical
interference.
Medical cases are divided into two classes: (a) Those able to perform duty after hos-
pitahzation for three days; (b) those requiring hospitalizaton longer than three days.
The battle order designates the field hospitals for the care of sick and gassed cases
and the evacuation hospitals to receive the severe and slightly wounded of the division as
well as the location of the mobile surgical hospital sent forward for the reception of the non-
transportable wounded. The corps ambulance companies, reinforced if necessary by the
ambulance companies assigned to evacuation duty, evacuate all cases of the transportable
classes to the hospitals designated by the triage officer, the transportables being divided into
two classes, sitting and prone.
While partially equipped for surgical work no operative procedures beyond those neces-
sary to save life will be attempted in a field hospital. The personnel of the field hospital
assigned triage duty, as well as that of the field hospital in reserve, which may be advanced
and become the triage, must be especially instructed in triage duty, for the work is exhaust-
ing under battle conditions and the triage party must be relieved from time to time .
878
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
THE DIRECTOR OF FIELD HOSPITALS
To each division is assigned a medical officer of the rank of major as director of field
hospitals and who is under the immediate control of the sanitary train commander." The
duties of this officer are tactical and not administrative, and he maintains no office of record.
When the division is assigned a sector in the line he must make personal reconnaissance
and study of the map, become familiar with the terrain, and submit recommendations to the
division surgeon covering sites selected by him for the estabhshment of the field hospitals;
he designates the field hospital for triage duty, the one for gassed cases, the one for sick,
and the one to be in reserve; this designation and the location of each being incorporated
in the division battle order in the sanitary paragraph.
He supervises the inspection of the personnel of the field hospitals and observes their
performance of duty, making such recommendations to the division surgeon as he deems
best to improve the service; he sees that each hospital is adequately supplied with medi-
cines, dressings, foods, and heating facilities at all times.
During combat he takes station at the triage and supervises the evacuation, informing
the division surgeon from time to time of the number of cases received and hospitalized
in the divisional units and the necessity for an increase in evacuation.
Should the division be compelled to change location, and the triage and gas hospital
contain nontransportable cases, he designates the number of personnel and the equipment
to remain for their care, and reports the facts to the division surgeon.
On the march he accompanies the field hospital designated to care for the sick or
wounded en route; he sees that the sick are disposed of as directed by the division surgeon
and makes arrangements for the keeping of proper records pertaining to those left behind;
he makes the necessary agreement for such reception in writing and transmits the docu-
ment to the division surgeon.
THE FIELD HOSPITAL
(Numbered from 1 up)
The commanding officer of a field hospital is a medical officer with the rank of major
and is under the direct orders of the director of field hospitals or the division surgeon.
The function of the field hospital is to provide food and temporary shelter, medical,
and surgical care for the sick or injured divisional troops in combat or on the march, and
in the absence of a camp hospital in the training area. A field hospital is a standard unit,
designed with a view to mobiUty, and additional equipment will not be permitted.
The locations of field hospitals for combat service are defined in the battle order of the
division, and care must be exercised to avoid crossroads, which are targets for enemy
artillery, and the vicinity of ammunition dumps or aerodromes, or the vicinity of railheads,
factories, or conspicuous buildings that are on ground recently vacated by the enemy.
Should the line stabilize, advantage should be taken of existing buildings which do not
offer a target. All selected sites will be conspicuously marked with a large white cross upon
the ground upon a dark background to preclude damage by indirect fire following aerial
observation.
The roads leading to a field hospital must be plainly marked to direct ambulance
drivers, and the signs are the property of the hospital, to be recovered when the hospital
moves to a new location for further use. The designation of these hospitals for the care
and treatment of certain cases is detailed under the article on triage, but no hospital except
the triage should be opened for the reception of sick and wounded until its use is indicated,
and then only in sections, unless it is definitely known from the nature of intended combat
that all will be required.
Every effort must be made to maintain one hospital in reserve for use in an advance
or retreat, and a hospital once established will not be closed except by order of the director.
A field hospital is divided into the following sections for administrative convenience:
Reception and triage, surgical dressing, hospitalization, evacuation, record, mess, and
» In the medical regiment organization an officer of the rank of major commands the hospital battalion. See Tables
of Organization 85-W. — Ed.
APPENDIX
879
mortuary. Each hospital will be provided with facilities for combating shock, and as heat
is the most effective agent for this purpose, small stoves will form part of the equipment.
Only those cases requiring hospitalization for not more than three days will be retained,
and this class must be kept at the minimum to insure mobility. If the military situation
demands a change in location, all cases will be, upon order of the director, transferred to an
evacuation hospital without delay.
Being both an administrative and tactical unit, a field hospital maintains a full record
system, employing the forms prescribed from time to time. The diagnosis tags, field medi-
cal cards, and envelopes of cases admitted are prepared for those not recorded in other units,
alterations and corrections are made where required, and all completed cases are reported
on sick and wounded cards. The record system includes loose-leaf files, a diary, and a card
index of personnel.
THE DIRECTOR OF AMBULANCE COMPANIES
To each division is assigned a medical officer with the rank of major who performs the
duties of director of ambulance companies under the direction of the commander of the
sanitary train. "
He maintains no office of record, but transmits all communications arising in or referred
to the ambulance companies; through constant inspection he insures the adequacy of per-
sonnel, equipment, and transportation, reporting deficiencies to the sanitary train com-
mander; he concerns himself with the instruction of the companies, such instruction com-
mencing upon the reporting of each company for duty with the division. This instruction
must be given without regard to the length of service directed, since ambulance companies
assigned to front-line work must be kept in a condition for immediate and effective service
at all times; on the march he accompanies one of the companies and carries out the orders
of the sanitary train commander concerning the distribution and service of the units under
his command during the march; in the training area he maintains the ambulance service for
the evacuation of the sick and wounded from their respective camps to the camp hospital
or field hospital acting as such.
If time affords before the division enters combat, he, in company with the sanitary train
commander and the director of field hospitals, will make a reconnaissance of the terrain and
prepare a road sketch, in rough, showing the most suitable routes for ambulances and the
locations of the ambulance companies, and submit it with his reasons for the approval of
the division surgeon; his tentative recommendations having been approved, he furnishes a
sketch to each ambulance company commander who in turn instructs the drivers in the
location of all aid stations, triage, field, and corps mobile hospitals; during combat he
alternates between the aid stations and field hospitals assisting in the evacuation from the
combat line in every way to insure a steady, uninterrupted flow, and when a road block
occurs he invokes the aid of the military police to give the ambulances from the aid stations
the right of way; when an unusual number of casualties occurs at a point of the line he
arranges with the commander of the litter bearer battalion for the rapid transport of so much
of his battalion as is deemed necessary to the point, employing ambulances and trucks for
the purpose. Should the number of casualties overwhelm the ambulance service he requests
more transportation of the commander of the sanitary train and calls upon the commander
of the supply train for the authority to use trucks returning empty from the front.
In boggy terrain or densely wooded areas with soft roads he is empowered by the divi-
sion commander through the division surgeon to employ the regimental combat wagons
which are admirably adapted for this service over short distances. He insures the automatic
replacement of litters, blankets, splints, and hot-water baths to the aid stations, and employs
such empty ambulances going to the front as are necessary to transport medical suppUes;
he makes immediate report to the commander of the sanitary train of unauthorized use
or abuse of Medical Department transportation.
• In the medical regiment organization an oflBcer of the rank of major commands the ambulance battalion. See
Tables of Organization, SA-Vt'—Ed.
13901—27 56
880
ADMINISTKATION, AMERICAN EXPEDITIONARY FORCES
THE AMBULANCE COMPANY
(Numbered from 1 up)
Motorized ambulance companies are provided in the proportion of four to each division
and assigned from the army ambulance service. Each company is commanded by an
officer of the medical service corps, as the service is one of transport only, and the company
commander is under the control of the director of ambulance companies. The light and heavy
companies assigned a combat division x\all be in the proportion of three of the former to one
of the latter."
The function of the ambulance company is the transportation of the sick and injured
from the aid stations to the triage and field hospitals; to replace materiel removed from the
aid stations with the sick and wounded, and transport needed medical supplies from the
division supply unit to the aid stations; to transport sanitary personnel either to or from the
front; and to provide ambulance service in camp, in the training area, and on the march.
The company commander is responsible for the discipline, instruction, efficiency of
the personnel, and responsible for the property, transportation, and equipment of the unit.
During combat he directs the work of his company in every part of the sector assigned
through the director of ambulance companies by the division surgeon. He instructs his
drivers by means of a road sketch or map in the location of the aid stations, the routes to be
followed to the front and rear in conformity to the orders governing circulation issued by
the administrative section of the division general staff, and the location of the triage and
field hospitals. He estabUshes an ambulance relay station, as nearly as possible midway
between the aid station of the sector served and the triage to provide for an ambulance
returning from the front being replaced immediately; should his company become over-
whelmed he advises the director and requests assistance; he maintains close liaison with
the battahon and regimental surgeons and the commanding officers of the litter bearer
companies.
An ambulance company, being an administrative and tactical unit, the records must
conform to prescribed orders, and a loose-leaf file, a diary, and a card index of personnel and
transportation will be kept, the latter containing all data necessary for the prompt furnishing
of information required with reference to any vehicle. This date must include the details
concerning number of individuals or wounded transported; the quantity of gasoline, oil, and
grease used; the number of miles traveled; the details of the abuse of transportation; the
damages sustained and the repairs or replacements indicated; and the spare parts required.
This data is a basis for the report required by the director of the army ambulance service
upon the completion of a service period.
THE DIVISIONAL LITTER BEARER BATTALION
To each combat Infantry division in war is assigned a litter bearer battalion which is
under the control of the sanitary train commander, and companies of which or parts thereof
will be applied by him to any part of the combat line to supplement the bearers of the regi-
ments of separate battalions.^
The normal duty of the four companies of this battalion is the littering of wounded
from the front line to aid stations and from the latter to the point attained by the ambulances
if conditions preclude the ambulances approaching the aid stations.
In this last situation it may be necessary to direct the bearer companies to establish
dressing stations, the equipment for which remains at the camp of the battalion until needed.
The establishment of these stations, however, in modern warfare will be infrequent, and
then only while operating on a flat terrain. The battalion is commanded by a medical
officer with the rank of major, the nature of the duty requiring experience in field work and
disciplinary powers beyond the ordinary. He maintains no office of record, but presents a
Ambulance companies now form a part of the ambulance battalion of the medical regiment.—
* In the medical regiment organization litter bearers are found in the collecting companies, of which three constitute
the collecting battalion. (See Tables of Organization, 83-W.) In action these companies establish a collecting station
and send forward litter bearer sections for the purpose of evacuating the aid stations on their front. — Ed.
APPENDIX
881
numerical report of the cases carried upon the conclusion of combat. Close liaison with
the regimental and battalion surgeons and the ambulance company commanders must be
maintained.
The companies ordinarily proceed to the scene of activity by marching, and must be in a
position of readiness at the front before the co,mmencement of combat, since a sudden increase
in casualties beyond the capacity of the battalion bearers in a particular sector of the line
may demand their quick transport to that point. In such cases application is made to the
director of ambulance to furnish the necessary transportation. Upon the conclusion of com-
bat duties the entire battalion may be transported to the triage and field hospitals to assist
the evacuation.
The equipment of the dressing station is simple and the work is confined to dressing
wounds, readjusting splints, checking hemorrhages, administering liquid food, and heating
the shocked, the evacuation to the triage being conducted with promptness. Should the
establishment of the dressing station be decided upon after the commencement of combat,
the battalion commander notifies the sanitary train commander of the location and time of
opening. No records or reports are required from a dressing station. Use must be made
of_any shelter and if none exists application is made by the battalion or company commander
to the nearest field hospital for a tent. In inactive periods the battalion camps with sanitary
train headquarters and on the march follows the Infantry.
THE REGIMENTAL MEDICAL SERVICE
The regimental surgeon, as a member of the regimental staff, is the adviser of the regi-
mental commander upon all sanitary subjects, and under his authority controls the Medical
Department personnel attached to the regiment.
In his administrative capacity he inaugurates the instruction of the sanitary personnel
and maintains sanitary discipline on the march, in camp and in combat. He is his own
sanitary inspector and makes recommendations to the regimental commander for the
installation and use of all measures indicated for the disposal of liquid and solid wastes,
excreta, and manure. He has all sources of water supply investigated before permitting
anj^ to be placarded as potable, and sees that a sufficiency of water sterilizing bags are pro-
vided, and that the chlorination is efficiently performed.
The regimental surgeon cooperates with the police officer in the maintenance of thorough
police of the entire environment of the command, and pays marked attention to the prep-
aration, quality, sufficiency, and variety of food, and to the cleanliness of the kitchens and
appHances and the exclusion of "carriers" from those handling food; he investigates the
living quarters of the troops and determines the adequacy of floor and air space; he causes
all members of the command to be inoculated against smallpox, typhoid, and the para-
typhoids, and takes immediate steps for the isolation of every case of infectious and com-
municable disease and the segregation of contacts; he is responsible for the sufficiency of
medical supply and maintains the combat equipment at its maximum at all times, forwarding
requisitions as indicated from time to time; he is responsible for the inauguration and
maintenance of the venereal prophylaxis stations, and personally sees that they are operated
effectively, and that the stated physical inspections are made; in the training areas he gives
lectures upon sanitary subjects in relation to field work to the officers of the regiment.
He maintains no office of record beyond a loose-leaf file, a diary, and a card index of
the sanitary personnel, and prepares and forwards the prescribed reports; he institutes
measures for the drying of clothing and shoes, the disinfestation and bathing of the com-
mand, and with his assistant makes frequent examinations of the footwear of the entire
command and the care of the feet, prescribing the correct sizes of shoes and socks, and has
the ailments of the feet corrected; in cold or wet weather he must see that the feet are bathed
daily in cold water and dusted with foot powder containing camphor if obtainable, and that
the feet and lower legs are frequently given friction with tallow, salt-free lard, or whale oil;
should the regiment be ordered to change location by marching, he informs the division
surgeon of the time of departure and requests the necessary ambulance service for the
command.
882
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
His tactical duties are concerned with terrain exercises and combat, and being furnished
a map of the regimental area he selects the locations of the battalion aid stations and submits
a report to the regimental commander for approval and incorporation in the battle order
for the information of all, a copy being furnished the division surgeon. The map used must
be of the same date and scale as those used by the regimental and battalion commanders.
If time affords he makes a reconnaisance of the terrain and instructs his subordinates,
who will conduct the battalion-aid stations, as to the proper location and designates the
routes of evacuation from the front to these stations, and the water points, and informs
the division surgeon of his action. The regimental and battalion medical combat wagons,
when not a part of the divisional train, are under his control. The division surgeon coordi-
nates the regimental medical activities with other branches of the sanitary service of the
division.
Combat may be suddenly entered upon before selection of aid stations can be made
by the regimental surgeon and in this event each battalion surgeon locates his station and
informs the regimental surgeon, by means of a runner, of the exact location and the roads
to be used for evacuation, and this information is transmitted to the division surgeon and
regimental commander.
In modern combat every available cellar, dugout, or cave affording protection from
shell fire must be made use of, and if the terrain does not afford such shelter first aid must
be rendered in the open and the evacuation to a sheltered location by litter made as quickly
as possible. Wheeled litters should be used at every possible opportunity as their use obvi-
ates the exhaustion of the litter bearers and quickens the evacuation. When facilities offer
for the establishment of an aid station under proper conditions, every wounded man must
receive a prophylactic dose of antitetanic serum before he is evacuated.
Facilities will be provided for combating shock and splinting fractures in aid stations.
Shock cases must be heated and surrounded with hot-water bags and blankets, and all com-
pound fracture cases must be correctly and securely splinted, both classes being given an
opiate before they are evacuated. All fracture cases should be splinted as near the scene of
injury as possible, and the trench or snowshoe combination splint and litter is especially
indicated for all fractures of the lower extremity.
Cases of toxic gas will not be treated in a dugout, cave or room with the sick or wounded,
since the latter may be gassed, and the equipment so penetrated that others will be gassed
from it.
All gassed cases must be evacuated in ambulances carrying only that class of cases.
Should the command occupy trenches, the sanitation must of necessity be as perfect as
human ingenuity can devise. This subject has been considered under the article on sani-
tation. Upon relief from a trench sector the surgeon of the command to be reUeved must
conduct his successor over the entire area giving him full information on all points necessary
for conduct of an efficient sanitary service.
DIVISIONAL MEDICAL SUPPLY UNIT
The divisional medical supply unit is an integral part of the sanitary train." This
unit is the medium for the procurement and distribution of all Medical Department supplies
and equipment required for the sanitary service of the division. The function, personnel,
organization, and equipment of this unit are fully covered upon graphic charts and in text
under the separate heading "Supply Service." Attention, in this connection, is invited
to the table of organization, "Sanitary train— Infantry division." For march and road
control this organization is under the control of the commander of the sanitary train. In
all other respects the commanding officer of this unit is an assistant to the division surgeon,
and as the divisional medical supply officer advises him upon all questions relating to medical
materiel.
82- w.
V Th^medical supply section is now part of the service company of the medical regiment. See Tables of Organization,
APPENDIX
883
DIVISIONAL LABORATORY UNIT
To each division, whether combat or replacement, is assigned a mobile laborator„v, the
equipment of which is packed in chests and transported upon one truck, the unit being part
of the sanitary train. ^
In the training area the unit is located at the point of greatest use, and when the division
enters combat, at the camp of the sanitary train in conjunction with the medical supply
unit.
The equipment is sufficient for the routine bacteriological work of the front hospitals
and the testing of the sufficiency of chlorination in the water for drinking purposes. The
greatest use of the unit is in the training area, where time affords for the bacteriological work;
but during combat its use is of necessity curtailed, as the field hospitals do not retain cases
sufficiently long to warrant bacteriological technic, though upon occasion it may be called
upon to exercise bacterial control of cases in the mobile surgical hospitals, or to make patho-
logic examinations and prepare specimens of interest for transportation to the central
laboratory.
VII
THE REGULATING STATION
MEDICAL DEPARTMENT ACTIVITIES
Regulating stations for the military control of railway traffic are established in large
railroad centers within the zone of the armies. The number and distribution of those groups
will depend upon the size of the forces and upon the topographical distribution of the trans-
portation lines.
Each regulating station group will be under the command of a regulating officer who
will be a member of the general staff corps, and the coordination section thereof. Regulating
stations will ordinarily serve an army or group of armies but may be established for the
service of a detached army corps. The regulating officer will require a capable administra-
tive and technical staff to assist him in the many responsible duties associated with his posi-
tion of a military general manager of a railway center.
Regulating stations and regulating officers are under the direct control of general head-
quarters through the agency of the chief regulating officer, who is a member of the coordina-
tion section of the general staff at general headquarters. Regulating officers remain at all
times in close liaison with this control, this section of the general staff being responsible for
troop and train movements and supply within the threater of operations. General head-
quarters will keep regulating officers constantly advised upon actual or anticipated changes in
the military situation with reference to their front. Regulating officers will therefore be in a
position to decide all questions involving train movements upon their immediate sector.
All trains coming from the zone of supply are controlled by the troop movement bureaus,
which are under the control of the coordination sections of the general staff at the head-
quarters concerned. This control continues until trains enter the zone of the armies, when
they come under the direction of regulating officers. Conversely, all trains leaving the zone
over which the regulating officers exercise control are taken over by the troop movement
bureau of the coordination section concerned.
This system, wherein regulating officers and troop movement bureaus have been en-
dowed with powers beyond those delegated to the general managers of civil railway systems,
makes for efficiency, but requires the services of experts in railway technique, excellent liaison
and coordination, and the most perfect telephone and telegraph facilities obtainable.
The regulating officer is the commanding officer of the regulating station group. He is
in every sense a post commander. A medical officer therefore of experience and ability in
administrative and sanitary affairs must be detailed as an assistant to regulating officers.
This medical officer will bear the same relation to the commanding officer of the station
group as does a post surgeon to the commanding officer of a garrison, and as a member of the
staff of the regulating officer will be his adviser upon all questions relating to the conduct of
the sanitary service within the domain of the regulating station group.
» The medical laboratory section Is now part of the service company of the medical regiment. See Tables of Organiza-
tion, 82-W.—
884
ADMINISTRATION, AMEEICAN EXPEDITIONARY FORCES
Such additional officers of the medical department as may be required will be assigned
to regulating stations. Inasmuch as those groups are large and entail the handling of large
numbers of men, it will usually be necessary to station at such places a camp hospital. This
unit will, however, remain under the orders of the chief surgeon, army service area.
Should the actual management of hospital train dispatching require additional com-
missioned assistants, these may be detailed from among officers of the Medical Corps. These
officers will be concerned with the multitudinous duties attendant upon the dispatching,
supply, inspection, etc., of Medical Department trains.
The senior medical officer present, who as stated will be known as the surgeon, is re-
sponsible for the sanitation of the area occupied by the station group. In this respect only
he is responsible to the chief surgeon, army service areas. Medical and dental attendants
will be furnished the command by the personnel of the camp hospital, where permanent
hospitalization will be provided for the sick of the group.
The medical officer on the staff of the regulating officer not only controls the movements
of the hospital trains in the domain of the regulating station, but is responsible for the con-
duct and efficiency of the personnel, and for the equipment and supplies carried by the trains.
Commanding officers of hospital trains assigned to regulating stations will be under
orders of the surgeon of the regulating station group in matters pertaining to Medical
Department administration. This staff officer is responsible to the regulating officer that
trains are at all times ready to answer calls and kept properly stocked and provisioned.
He maintains a small storehouse for the medical supplies required by hospital trains.
This issue point will be under an officer who is thoroughly conversant with the requirements
of these units in medical supplies and equipment. The necessary rations for trains will be
drawn from the common source of such supplies.
Tables of organization of personnel will be kept on record for each train in service.
Should the chief surgeon, expeditionary forces, order changes in personnel of trains, the
regulating officer will see that such directions are carried out, and the personnel will be
regulated through the regulating station office. All changes in personnel of trains will be
kept on record at the regulating station concerned.
The number and composition of hospital trains, assigned to regulating officers by the
coordination section, general staff, general headquarters, will be kept on a classified list,
copies of which will be furnished the chief surgeon of the army, and the chief surgeon of the
forces.
This list, giving carrying capacity (in litter and sitting) of each train, is particularly
important in case foreign or other than regular hospital trains are placed at the disposal of the
regulating officer, since such trains will vary greatly in capacity. The list will be valuable for
the use of officers in charge of evacuations in preparing loads when trains are announced.
Changes in lists will be reported at once and all retained copies modified in consonance there-
with.
The surgeon of a regulating station group maintains an accurate record of all hospital
trains in all particulars, together with lists of modifications of schedules for trains going to
any part of the zone, and a list of evacuating points supplemented with maps giving the length
of sidings and loading facilities in the entire zone, and the number of trains permitted to
load at each siding during a period of 24 hours, and the length of stay allowed upon each
siding; he informs the chief surgeon, army group, army corps, or division, as the case may be, of
this data when it is desired to estabhsh an evacuation hospital or loading point at any siding;
he receives a report from each train commander of the number of cases carried, by classes,
and keeps a correct record based upon these reports which he reconciles with daily phone or
wire reports from the evacuating officers. (For the procedure to be followed in the use of
hospital trains at the front, see text of evacuation hospital.)
Hospital trains are Medical Department organizations and, as sanitary formations, are
under the direction of the chief surgeon, expeditionary forces. As railway units, and in
systems of evacuation within the zone of the armies, they are operated under the direction of
the regulating officer to whom they are assigned. They are repaired by the transportation
service.
APPENDIX
885
Assignments of hospital trains will be made by the coordinating section, general staflF,
general headquarters, to regulating officers, and to the troop movement bureau at head-
quarters, S. O. S. When the coordination section, general staff, directs a change in assign-
ment of a hospital train by telegram or otherwise from one regulating officer to another,
the former regulating officer notifies the following by telegram as soon as the train is ordered
to move: The commanding officer of train; troop movement bureau of area to which train
moves; regulating officer to whom train is assigned; coordination section, general staff,
general headquarters; chief surgeon, expeditionary forces.
Through the surgeon of the group there must be a constant liaison between the regu-
lating officer and the train commanders. The regulating officer being informed as to the
general and special situation at the front, is usually in a position to say when the next journey
by any particular train will be made. When trains are in one garage, Journeys will be assigned
consecutively and the first train in will be the first train out. All trains, however, must be
fully stocked and prepared at all times and held in a state of readiness for calls upon short
notice.
For the purpose for simplifying evacuation, hospitalization facilities will be districted
into zones. This is accomplished by the coordination section, general staff, in consultation
with the chief surgeon of the forces. Regulating officers will be advised of the zone into
which the chief surgeon will make his evacuations. After this division into zones becomes
effective, the commanding officers of hospital centers and base hospitals will telegraph daily
to their respective regulating officer the number of beds available for use of the army which
the regulating officer is serving. These messages will be sent direct and will state the beds
available as of 8 p. m. and that this number will be available for 24 hours. In these figures,
trains routed to the hospital in question, but not yet arrived, must have been considered.
For centers in base sections these telegrams will be relayed by the office of the chief surgeon.
In these reports beds will be classified as surgical, medical, contagious, and convalescent.
The arrival of a train at a center or detached hospital is announced by telegram from the
regulating officer, and the commanding officer of the train.
After all trains have been dispatched, regulating officers will daily inform the coordi-
nating section, general headquarters, and the office of the chief surgeon of the forces of the
number of hospital beds available. The evacuation officer, army chief surgeon's office, and
representing the coordination section of the army general staff, or the commanding officer of
each evacuation hospital group will advise the regulating officer of his area or army as of
8 a. m. and 6 p. m., each day as to the number of evacuable cases classified as follows: Wounded
preoperative. Utter and sitting; wounded, post-operative, litter and sitting; medical cases,
litter and sitting; gassed cases, Htter and sitting; officers, allies, and prisoners, litter and
sitting; contagious, litter and sitting.
The regulating officer with this data available will arrange for a sufficient number of
hospital trains to evacuate completely the evacuable cases reported; he will determine the
destination of each train according to the cases to be evacuated; i. e., medical cases to medi-
cal hospitals, and surgical cases to surgical hospitals, etc. The evacuation officers do not
request trains; they merely give the regulating officer the number of evacuable cases.
As soon as destination and schedule for trains are arranged with the railway technician,
the regulating officer will telephone to the evacuation officer concerned giving the exact load
of each train, the number and type of cases, and the time of arrival and departure of train at
loading point, and will direct the number of rations to be placed on the trains when rations
are necessary; in case other evacuations by same train are to be made further along the route,
each evacuation point or collecting station will be notified in the same manner.
The regulating officer will confirm telephone calls to the evacuation officer by telegram,
and in addition will send copies to the following: Coordinating section, hospital evacuation,
army; commanding officer of base hospital at destination; regulating officers through whose
areas train moves; troop movement bureau of area in which train moves; statistical depart-
ment, adjutant general's office, general headquarters; chief surgeon, expeditionary forces.
In each telegram to the evacuation officer he is instructed to give copy of telegram to the
commanding officer of train.
886
ADMINISTEATION, AMERICAN EXPEDITIONARY FORCES
The evacuation hospital will see that necessary steps are taken to load the train in the
allotted time, and only with the number and type of cases designated by the regulating offi-
cer. If the loading of the train is delayed the train will lose its schedule and will be subjected
to delays en route. Should the train be loaded with other than class of patients designated,
the base hospitals at destination may not be equipped to take care of them.
In time of calm, collecting of patients from two or more evacuation groups is possible,
but the total loading time from different evacuation centers should not exceed four hours,
including the time spent en route from one loading point to another. In intensive operations
full train loads only are sent from each evacuation group. Before loading a hospital train
evacuables must be most carefully classified into seriously and slightly wounded, and ordinary
and special sick. Such classification will permit of loading the patients by classes into dif-
ferent parts of train and will greatly facilitate their ultimate distribution at unloading points.
Further grouping according to destination will be resorted to whenever possible. The
evacuation officer will give the commanding officer of train the evacuation sheet, on which
appears nominal fists of all cases (classified) to be evacuated; the commanding officer of the
train in turn will prepare his train for this load.
Schedules given to hospital trains will depend upon the zone in which they may be
operating. Within the zone of the armies mifitary schedules only will be obtainable and
these are usually slow. While traversing the zone of supply schedules will be faster. In
cases of emergency trains may be dispatched on fast schedules for entire length of journey,
provided it does not interfere with the schedules of military trains which have priority. All
fast intercommunicating schedules will be arranged by the coordination section, general staflF.
Such arrangements are immediately made known to the regulating officer interested, to
permit train dispatching and the notification of proper railway authorities.
As armies advance or retreat the regulating officer will select new loading stations at
points most conveniently located to the proposed evacuation centers decided upon by the
army chief surgeon. Army chief surgeon will consult regulating officer on the location of
these evacuation points for loading hospital trains. Reconnaissance of loading points wiU
be made by the regulating officer, in conjunction with the evacuating officer of the army and
the railway technician, should an important movement of the army be contemplated.
Regulating officers must arrange with the railway technician to route hospital trains so
as to allow patients to reach their destination in shortest possible time. Long stops at sta-
tions will be permitted only where there are tracks which will permit loading or unloading
without blocking main tracks. In small stations where there are no such conveniences, the
unloading must be done in the short time allowed and such unloading points will be avoided
whenever possible. On branch lines a night service is not always organized, and advance
notice will be given should train be due to arrive during the night. Trains will not be split
except in certain large stations and then only when absolutely necessary.
MEDICAL DEPARTMENT HOSPITAL TRAINS
For the railway evacuation service of an expeditionary force hospital trains will be
provided. Each train will be capable of transporting 360 prone patients. The number of
trains required will depend upon the size of force, length of land fines of communications,
and the nature of the combat problem. In general terms it may be stated that with forces
of 20 combat divisions (one army) or less, two Medical Department hospital trains will be
required per division and with forces greater than one army (two or more armies) one train
per division will suffice.
Hospital trains must be constructed in time of peace in conformity to standard speci-
fications and garaged at convenient locations under the charge of caretakers, for when war is
declared the roUing stock of railways is too much in demand to permit the assignment of a
sufficient number of PuUman, tourist sleepers, or first-class passenger cars to the Medical
Department, and the alterations for the conversion of American cars of any type is time
consuming and expensive. Should it become necessary to convert coaches to hospital train
use the cardinal defect to be overcome in American cars is the absence of side doors on both
sides of every car to be used for ward purposes, as without side doors for loading it will be
next to impossible to introduce a loaded fitter without intervals between the cars to permit
a litter being passed into the vestibule.
APPENDIX
887
As locomotives are not always available in war for permanent attachment to a hospital
train to furnish steam for heating, a steam boiler of adequate capacity will be installed in the
brake van or baggage car to supply steam at all times, and a gas motor-driven dynamo to
supply the electric lighting power, both plants being under the charge of two mechanicians,
one relieving the other at stated periods. When the train is under traction the locomotive
will supply steam for the radiators, and the dynamos attached to the running gear of each
car the electric current, the excess going to accumulators; but as hospital trains often stand
idle for long periods it is in the interest of economy and utility to maintain separate heating
and lighting units, especially in cold weather when if in motion the locomotive requires its
steam for traction use with these heavy trains.
A field officer of the Medical Corps will be assigned to each hospital train as command-
ing officer. He will be assisted by medical officers, nurses, and enlisted men as indicated
below. The duties of a hospital train commander may be conveniently classified as adminis-
trative, and professional or technical.
As an administrative officer he controls his personnel and patients, being responsible for
their discipline, rationing, and comfort at all times. He is responsible that none are evacuated
except those appearing upon lists furnished him prior to the movement. The question of
triage, which is of the utmost importance in an evacuation system, is carefully considered by
the commanding officers of all trains, cases which should properly have remained in the zone
of the armies being reported by name and organization to the regulating officer.
Cases of death occurring en route will be reported with full particulars to the regulating
officer, who will transmit this information to the proper office. The commanding officer of
trains has authority to refuse cases which he deems unfit to travel. He will report his action
on such instances to the regulating officer. He maintains an office of records for the sick and
wounded under his care and for his detachment of Medical Department enlisted and members
of the Army Nurse Corps (female).
When the commanding officer of the train had carefully checked the data given him upon
an evacuation and verified same with patients on board the train, he will send a telegram to
the following:
The chief surgeon of the forces (or his deputy at headquarters. Services of Supply).
The commanding officer of the hospital center or hospital at destination.
The regulating officer concerned.
This telegram will contain data covering the foUowing, classified further into officers,
nurses, allies, and enemy prisoners :
Total load, litter and sitting.
Wounded, litter and sitting.
Sick, fitter and sitting.
Gassed, litter and sitting.
All cases for evacuation will be carefully inspected by the evacuation officer prior to
loading upon train. No patient will be evacuated unless properly clothed. All cases requir-
ing antitetanic serum must have received the proper injections. Equipment carried will be
hmited to the personal belongings of the patient, aU arms, accoutrements, etc., having been
turned in for salvage at the hospital.
Before loading the commanding officer of the train and evacuation officer wiU verify the
number to be evacuated. When loading is completed the commanding officer of train advises
the railway transportation officer who furnishes him with an order of transport showing desti-
nation, stops, and load; the commanding officer advises him of his readiness to leave and dis-
patches the several telegrams previously mentioned. It is important that the arrival of the
train at the destination be announced in advance, in order that the receiving officer of the
hospital or hospital center may arrange for the prompt and efficient transportation of the
patients to the various hospitals.
Trains may be stopped en route at hospitalization points to unload patients when the
commanding officer considers them unfit to complete the journey. To arrange for such stops
and to assure quick action and preparation, the commanding officer will telegraph ahead to the
railway authorities and the regulating officer concerned, as well as to the commanding officer
888
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
of the hospital to receive the patients; the commanding officer of the train will report such
cases to the regulating officer and will request a receipt for all patients removed from his train
at other tlian designated points.
Accidents or derailments should be reported immediately, by telegram, to the regulat-
ing officer, and should be confirmed by letter giving full particulars. The regulating officer will
do everything in his power to expedite the sending of relief and wrecking crews to the place
where an accident has occurred.
Unauthorized individuals will not be transported upon hospital trains. Authority to
travel upon a hospital train, for other than train crew, personnel, and patients being evacuated,
will be obtained in writing from the office of the chief surgeon of the forces.
Frequent inspection of trains will be made by the surgeons of the regulating station
groups, who will note carefully the conduct of the command and personnel, reporting any
unfavorable conditions to the chief surgeon of the forces, recommending changes in personnel
when they are for the best interest of the service.
Requests for leave of absence or furlough will be forwarded through the proper channels
to the regulating officer by commanding officers of trains. Such absences will be granted only
when not interfering with the efficiency of train service, and not at all during periods when
extensive combat operations are contemplated or in progress.
The hospital train consists of 16 specially constructed communicating cars, in assembly
about 960 feet in length. The exteriors of the cars are the color of Army khaki, with the Red
Cross of the ]\Iedical Department imposed upon the sides, roof, and at each end of the cars.
The upper structure is almost entirely of wood, the lower structure consisting of a steel-beam
frame riding upon two sets of double trucks. There are 9 regular ward coaches, 1 coach for
contagious and infectious diseases, another for the staff officers and the nursing personnel,
2 coaches for kitchens, 1 coach devoted to a pharmacy and an emergency operating room,
another for the sleeping quarters of the personnel, while the last coach is utilized for stores
and provisions.
Each ward coach, with the exception of the infectious and contagious car, contains
36 superimposed bunks, arranged in tiers of 3; 18 placed on either side, permitting a
generous central passage. These bunks are attached to the walls of the car by collapsible
bunk standards, making it possible to remove individual bunks for the purpose of cleaning and
disinfection or for transporting cases from car to car without transferring patients to litters. It
is possible, by allowing the middle bunk of the tier to drop upon its standard and thereby
forming a back, to produce a seat formed from the lower bunk. By this arrangement it is
possible to transport 48 sitting and still utilize the 12 upper bunks for lying cases, thus making
the total capacity of the car 60 patients, should suitable cases be available. With the proper
combination of lying and sitting cases 600 may be carried, 480 sitting and 120 lying, or 718
sitting.
The infectious and contagious ward car contains 24 bunks. This car is divided into four
distinct compartments, thereby permitting the transportation of four different infectious or
contagious diseases. In case of these individual compartments there are six bunks.
At the lower end of each ward car is a small lavatory. Here are also cupboards for the
eating utensils, racks for drinking and sputum cups, tanks for drinking water, etc. Opposite
the lavatory is a small compartment containing the racks for bedpans and urinals, cupboards
for cleansing materials and disinfectants for use in that particular ward car. The toilet for
the car is also placed in this compartment, consisting of a galvanized-iron latrine bucket with
ordinary toilet seat.
Ward cars are well hghted by spacious windows. Artificial light, furnished by electric
current, generated by individual dynamos attached to each coach and stored in individual
accumulators, two sets of the latter in each car. The power for the dynamo is received by
bolt transmission from a pulley on the axle of one of the trucks, while the train is in motion.
Ventilation is brought about by upper ventilating windows in some trains and by special
roof ventilators in others. In addition to this means, three large electric fans are placed, one
at either end of the car, and one in the center. These are kept constantly in motion when the
train is loaded, this combined system effectively maintaining circulation of fresh air. In
addition to the larger fans referred to, small portable fans, five to each coach, are available,
APPENDIX
889
which can be readily placed upon receptive standards, attached to the car wall opposite
individual bunks carrying serious respiratory cases, for the purpose of affording them more and
better air. The heating of ward coaches is effected by means of cylindrical iron steam radi-
ators, placed one under each low-er bunk, and two upright in the central portion of the car,
steam being obtained from the engine.
The pharmacy and emergency operating car is placed in the center of the train assembly.
The numerous cupboards on the walls of this car contain the necessary drugs, dressings, and
appliances for use in emergency. Water and the ordinary field surgical instruments and
instrument sterilizers are carried. A complete and compact train office is situated in the
lower end of this car.
The forward kitchen car is divided into compartments; one of these is utilized as the
officers' pantry; another for sleeping quarters for the cooks of the train, still another for
patient officers' lounging and mess room, while the main and central portion of the car is
devoted to a w^ell-equipped kitchen. The rear kitchen car is also divided into compartments,
one for a personnel mess, another for noncommissioned officers' sleeping quarters, pantry, and
kitchen. The quarters of the personnel are similar in arrangement to that of one of the ward
cars.
The stores and provisions car is divided into five compartments; the lower one being
fitted up for use as a refrigerator, in which can be placed about five quarters of beef, plenty
of space remaining for other perishable articles. Another compartment is utilized for the
storing of canned rations; another for the transportation of officers' baggage, and workroom
for the mechanics of the train; while still another is for storing extra blankets, linen, repair
parts, etc.
Each train carries approximately 2,000 rations aboard at all times. The water supply
is obtained from reservoirs placed in the structure of the roof of each car. The reservoirs
of the kitchen cars contain about 800 gallons of water apiece; while those of the ward cars
carry about 150 gallons. Hospital trains, although carrying a stock of 2,000 rations, when
garaged at distant points may require replenishment of this stock by the transfer of rations
overland upon motor transportation. Rations may be drawn at any time from railhead
officers who are under the regulating officer should shortages occur when the train can not
replenish from its own depot.
The staff car is divided as follows: One compartment fitted up for combined sitting room
and dining room for the staff officers; three compartments for use as sleeping quarters for
the officers of the personnel; two compartments as sleeping quarters for the nurses and one
for the dining room of the nurses.
The personnel of each hospital train consists of three medical officers, three nurses,
three noncommissioned officers, of which two are sergeants and one a sergeant first
class, two cooks, one mechanic, twenty ward orderlies, privates or privates first class, and
ten men for general duties. The senior medical officer present is the train commander.
One assistant is designated as summary court officer, and performs, in addition, any other
duties that may arise. The second assistant acts as supply and mess officer. The senior
noncommissioned officer carries on the work pertaining to records, reports, returns, and
other office work of the organization. Another sergeant is detailed as general duty sergeant,
and the third is the mess and supply sergeant.
After the trains have been unloaded at a hospital center or base port, the mattresses,
bedding, etc., must be subjected to disinfection to free the articles of vermin as well as con-
tagion, and the interior of every car must be gone over with a 5 per cent solution of
lysol, after which the doors and windows are kept open for at least six hours.
The general plan followed after a train has been loaded, to ascertain the type of treat-
ment, diet, and orders for patients being transported is as follows: One officer, accompanied
by a nurse, commences an examination of the cases in the lower half of the train, while
another officer and nurse take up the same work in the upper half. The field medical card
of each case is examined by the attending officer, and a general survey of the case is made.
He then determines any treatment necessary for the case en route, in the way of medical
prescriptions, changing of dressings, surgical appliances, special diets, etc., while the nurse
accompanying him makes notation in the train order book of the bunk number, name of
890
ADMINISTEATION, AMERICAN EXPEDITIONARY FORCES
patient, and treatment prescribed. When this has been accomplished throughout the train,
this data is compiled, and the professional work is apportioned among the officers and nurses
for completion.
Ward attendants in each ward coach will prepare a complete list of their cases. This
list will be prepared after the medical officer has made his rounds. The consolidation of
these lists will be the basis of the train commander 's report to the regulating officer and the
chief surgeon with reference to the trip, and will become a part of the final records of the train
Upon the completion of an evacuating trip, the commanding officer of the train will prepare
a brief report for submission to the regulating officer under whose command he is assigned.
This report will cover the gross details of the evacuation and any incidents occurring during
the period thereof.
A supply of such Medical Department blank forms as are required by trains will be
kept on board each train at all times. These will be replenished from stock at replenish-
ment depots.
A list of standard equipment and composition of each train will be kept in the office
of the surgeon at regulating stations for reference. Should coaches be removed from or
added to a train, the regulating officer will be notified of the time, place, and cause of the
change, in order that he may properly alter his retained data relative to the carrying capacity
of the train.
Changes in the composition of hospital trains are authorized only by the chief surgeon
of the forces; when a regulating officer finds that conditions require such changes, he will
consult the chief surgeon's office; when cars are detached through emergency or accident,
the regulating officer will endeavor, through the proper channels, to have them returned.
Mental cases requiring special care will be put in separate compartments; if a guard is
necessary, attendants from the evacuation hospital will be detailed for the voyage in such
numbers as are deemed necessary. Contagious cases will be transported in the special car
provided for them, and when unloaded must be so designated; it is imperative that cars
carrying contagious cases be thoroughly disinfected as directed in orders issued by the chief
surgeon of the forces.
At each regulating station and embarkation point there will be established depots known
as hospital train replenishment depots, which carry on the following functions in reference
to hospital trains: Administration and regulation within sections of the services of supply,
under direction of the transportation division of the chief surgeon's office; the replenishment
of supplies for hospital trains; the replacement of personnel; general and sanitary inspection;
arrangements for minor repairs; central mail office for hospital trains; and the furnishing
of motor transportation for use in connection with the hospital train service.
Prompt delivery of mail to mobile organizations of this type will always present a diffi-
cult problem. Every effort must be made, however, to accomplish this result. Mail should
be forwarded to the chief surgeon of the section in which a train operates or to the regulating
officer in command of the regulating station to which the train is assigned.
Personnel, food, fuel, mail, and accessories intended for hospital trains will be sent
to the main depots located at the regulating station. Telephone communication between
these depots and headquarters of the regulating stations must be established. These depots
will be kept stocked with special diets and such other medical supplies conducive to the
comfort of the patients as may be available in regular depots or those of the auxiliary aid
societies. Branches of the hospital train replenishment depot may be required upon long
stretches at some convenient junction where trains stop en route.
In loading and unloading patients, prone cases will not be moved from one litter to
another except when absolutely necessary. At all hospitals and centers an adequate stock
of litters, blankets, etc., will be maintained so that the prompt exchange of these articles
can be effected without disturbing patients. Supply officers of hospitals will receipt to the
commanding officer of hospital trains for all such nonexpendable materiel for which an
exchange could not be accomplished.
Train commanders will personally arrange the exchange of linen, blankets, etc., with the
supply officers of hospital centers or hospitals to which the evacuation is made. It will
frequently be necessary for train commanders to replenish the stock of rations of their trains
APPENDIX
891
during the stop at unloading points, and this will be accomplished by making requisition upon
the hospital center or unit quartermaster.
The meals of patients are served by transporting the food from the kitchens in heat-
retaining utensils to the several ward cars, from whence it is distributed by the wardmaster.
Hospital trains will have the same hospital fund privileges that may be authorized for other
Medical Department organizations, and every effort must be made to furnish patients being
transported a varied diet of light nourishing hot food. In practice it will be found better,
as a rule, to avoid the heavier items of the ration in meals served patients upon trains where
opportunities for exercise of even those able to move about are so limited. Use of the sales
commissary will be taken advantage of at every opportunity. When trains have no kitchen-
car facilities, arrangements for feeding patients and personnel en route must be made. These
stops and messing arrangements must be provided for in the schedule for the journey.
Kitchen cars will be requested in the assembly of the train whenever it is known that they are
procurable. Even if the coaches are not intercommunicating, the inclusion of kitchen cars
will make the train independent as regards messing, since meals may be prepared en route
and served to cars during stops.
There will be maintained at the embarkation depots a unit known as the casual hospital
train unit, from which replacements are furnished to meet the deficiencies in the hospital-
train personnel, arising through transferrence of personnel to other organizations as the
result of sickness, misconduct, etc. A certain percentage of this personnel is placed upon
hospital trains for tours of instruction in that particular service, so that when replacements
are made, experienced men can be utilized to fill the vacancies.
A hospital train repair service must be maintained for making minor repairs to the
trains. At the time of inspection the general condition of the train is noted, and if breakages
have occurred during the voyage, the train is ordered to garage at a designated place, where
broken parts are repaired or replaced by the transportation repair service.
The movements of hospital trains in the Services of Supply are arranged for by the
transportation section, chief surgeon's office, with the troop movement bureau, the latter
relinquishing the trains to the regulating officers upon entrance into the Army service zone.
From a regulating standpoint, the commanding officer of the hospital train is in com-
mand of the evacuation as far as relations with the transportation service are concerned,
and acts as a troop commander of the evacuees, as defined in the rules governing ordinary trans-
portation. He receives his instructions from the regulating officer as to destination of his
train, and, based thereon, he makes out his orders of transport as directed by the regulating
officer, who will be consulted upon all movements of trains not previously authorized. Upon
completion of the evacuation, train commanders are authorized to order their trains back
to the regulating station group.
VIII
HOSPITAL CENTER HEADQUARTERS, EXPEDITIONARY FORCES
(20,000 beds)
A hospital center of 15,000 beds or more should be commanded by a brigadier general
of the Medical Corps, and the ofl?icer selected for this important duty must be active in mind
and body, as the duties are onerous and require high administrative and professional attain-
ments, for he should direct all policies and activities of the center peculiar to location and
not covered by precedent or current regulations and orders.
When the hospital center is organized the commanding officer should not be expected
to supervise personally routine matters, but as far as possible he should be left free to observe
daily the operations of the various organizations, in their professional and administrative
activities, with a view to correcting defects or to originate new policies that such observa-
tion suggests for the improvement of the service. He should have as assistant one who is
qualified to assume his duties and who enjoys his complete confidence.
His office is divided into two main groups, technical and administrative. The technical
group is composed in the main of consultants, each having general supervision over the
clinical activities in the entire center in the particular service represented, and holding
weekly conferences with the chiefs of the service he represents. In this manner the services
are kept informed of recognized efficient methods of treatment in other organizations.
892
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
At the conclusion of a conference each center consultant should make report and recom-
mendations to the commanding officer relative to personnel and methods of treatment
employed in any unit of the center within his sphere in which improvement is indicated.
Center consultant should visit such special cases from time to time as requested by the
chiefs of services.
Each consultant should render a monthly report to the center commander upon all
commissioned personnel engaged in clinical work under their supervision, with recommen-
dations which are pertinent for more efficient and harmonious service in the various hospitals
comprising the center. The main divisions of the technical group are: Surgery, Roent-
genology, and medicine. These sections are either apportioned among the component hospitals
of the center, or certain hospitals are designated for the care and treatment of certain
classes of cases as militar}^ operations demand.
Surgery. — This grand division is subdivided into sections as follows: Maxillofacial; eye,
ear, nose, and throat; neurological; orthopedic; general.
Roentgenology. — This division is supervised by an officer of the consultant bodj^ who
should be thoroughly familiar with the technic of his service and should also be qualified to
direct the necessary repairs in a defective machine.
Medicine. — This grand division is subdivided as follows: General medicine; neuro-
psychiatry; ophthalmology; tuberculosis; toxic gas.
Like those of the surgical division, these sections arc either apportioned among the
component hospitals of the center, or certain hospitals are designated for the care and treat-
ment of certain classes of cases as the military operations demand.
In addition to the foregoing, divisions of the technical group are:
Dental. — The officer in charge of this division acts in a supervisory capacity over the
dental surgeons of the center, and this duty, not being an engrossing one, he maintains an
office for the professional treatment of members of the headquarters personnel.
Nursing. — This division is under the chief nurse of the center, and she has general
supervision, under the center commander, of all policies and instructions relating to the
nursing service, that uniform application may be made to all component hospitals. She
should hold frequent conferences with the chief nurses of component units, for the purpose
of advising them of current instructions and for originating new policies for the approval of
the commanding officer toward improving the nursing service. She examines all reports
and returns relating to the nursing service and prepares them for the action of the commanding
officer.
Graves registration service. — One officer of this service is assigned prior to the opening
of the center, and he is concerned with the selection and lease of a cemetery site, subject to
the approval of the commanding officer, and with the correct registration of all interred
therein, particular attention being given to the names, organizations, and grave numbers.
The administrative group, whose activities are coordinated through the adjutant, is
composed of the following divisions:
Adjutant. — This important division should be in charge of a member of the medical
administrative service whose previous experience qualifies him to handle the routine cor-
respondence and maintain the record files of a large organization. His duties are similar
to those provided for in regulations, but being of an entirely admimistrative character,
if he is a member of the Medical Corps he should be relieved of all professional service as
contemplated in the Manual for the Medical Department, United States Army, 1916. He
should institute means for correlating the activities of officers attached to the center head-
quarters in an administrative capacity, and should publish to the center such orders or instruc-
tions received from higher authority and provide for the execution of policies decided upon by
the commanding officer peculiar to location. He should act as summary court officer for
the hospital center headquarters only, each base hospital maintaining its own summary court.
^ Records.— Vnder supervision of the adjutant, this division is responsible for the correct
filing and care of all official correspondence under prescribed methods originating in or
received by any office of the command requiring reference or records; he prepares all official
correspondence emanating from the center headquarters; is responsible for proper acknowl-
edgment of all mail received or dispatched, keeping accurate record of the same. He
APPENDIX
893
should assume responsibility for telegram numbers and their proper sequence, maintaining
a telegraph file; preserve all records of public property chargeable to center headquarters.
This division has three sections — postal, mailing, and distribution.
Postal. — Conducts center post office, which should be in charge of a noncommissioned
officer having general supervision of all mail orderlies of separate units and responsible
for their receiving and properly distributing all mail of the center. Improperly addressed
mail will be corrected by reference to index of patients kept in evacuation office. Receipts
for registered mail will be taken from all individuals concerned.
Mailing. — This section prepares both official and private mail for shipment, noting
compliance or lack of it with existing censor regulations.
Distributing office. — This office will be responsible for the prompt and accurate dis-
tribution of all instructions, orders or official communications relating to the command
under methods prescribed by center headquarters. An index should be kept of all instruc-
tions or orders issued from headquarters and should provide that all orders, memoranda,
etc., requiring numbers are used in proper sequence. Numbers should be issued and charged
to the various departments requiring them. This office indexes orders for use at headquarters,
and all blank forms for use of the center should be requisitioned by and distributed from
this office.
Statistics. — In so far as is pertinent, the duties and responsibilities of this office should
conform to those indicated for personnel office (q. v.) relating entirely to patients in the
center. Index of all deaths occurring in the center will be compiled and correctly kept
from records available in the center, cause of death being shown under separate classification.
Personnel. — This division is charged with the instruction of subordinate officers in
separate units for correct and punctual rendering of all reports relating to personnel of
command required by regulations or current orders; the keeping of the records of all organ-
izations, showing strength present and authorized; the issuing of orders pursuant to com-
petent authority for the change of status of all organizations or individuals of the command,
making the same when applicable a part of the personnel record of personnel as is hereafter
provided, and providing for the notification to proper offices of such changes; the keeping
of separate card files of all personnel, classified as officers, Army Nurse Corps, enlisted men
and civilian employees, showing those present or absent or transferred, who are carried
on rosters of various organizations of command. In addition, to be a part of the above
records, should be kept a record of duties performed, qualifications military, professional
and technical, and such other information as may be of value; consolidation of the morning
reports of various organizations, and the check against records of office; the correctness
of ration returns of separate organizations; the keeping of separate files of special and
professional services of center.
The office is divided into sections, as follows: Detachment, deaUng with center detach-
ment; orders and leaves, dealing with entire subject in center; assignments, dealing with
assignments based upon qualifications.
Fire marshal. — The center fire marshal is responsible for the proper distribution of
his assistants, of the orders governing this division, and the instruction of the entire cominand
in fire duties. He will divide the personnel of the center and each component unit into
fire-fighting squads, and drill each in its duties to insure efficiency and uniformity, this
being done daily until proficiency is attained; after that, weekly. He will make weekly
inspection of fire-fighting apparatus, to insure its readiness for prompt use, and make to
the commanding officer such recommendations for improvement in facilities as are needed.
He will also make a weekly report to the commanding officer of the activities of his division.
Sanitation.— The duties of this division are under supervision of the commanding officer
of the sanitary squad, who functions as center sanitary officer. He should make daily
inspections of the center, paying particular attention to grounds, drainage, wastes, water
supply, and internal sanitary conditions of units. The daily inspections should include
messes and all that pertains to them, including prevention of waste and the carrymg out
of the directions of the commanding officer relating to messes. Upon the appearance of
epidemic or contagious disease he should make exhaustive effort to determine the source
and should make provision for its suppression, through the cooperation of other divisions
894
ADMINISTKATION, AMERICAN EXPEDITIONARY FORCES
necessary to that end. He prepares the monthly sanitary report for the approval of the
center commander. The sanitary squad, whose duties are given in another chapter, is
under his control. These assistants are trained in inspections and in the repair of all sanitary
apparatus, particular attention being paid to its conservation and proper working. If latrines
or pits or tubs are used, the cleanliness thereof is insisted upon, care of them being given
either to civilian employees or to enemy prisoners. Destruction of all waste wliicli can not
be used is carefully supervised, as is also the care of the incinerator. Careful inspection
is made for prevention of fly breeding, by maintaining perfect police of garbage cans and
horse standings or stables. Adequate measures are taken to prevent mosquito breeding.
Ventilation and heating of wards are inspected and report made to the center commander
if defects and deficiencies are found. In conjunction with the officer in charge of laboratories,
search is made for "carriers" among those who have to do with the preparation and han-
dling of food. If drinking water is not above suspicion, daily tests are made in cooperation
with the laboratory section for the use and sufficiency of chlorination.
Evacuation. — In so far as it is applicable, this division bears the same relation to the
center as the receiving and discharging officers of a general hospital, with such additional
duties as the exigencies of the service may require. Through consultation with the proper
authorities, the officer in charge keeps an up-to-the-minute list of available beds by classes.
He is charged with responsibility for classified evacuations and the correct issuance of com-
petent orders governing them. He keeps a record of all patients present and disposed
of in the center each day. One study should be instructed in each unit in train, boat, and
ambulance evacuation, both from the receiving and discharging side, and enlisted men detailed
in each unit as litter bearers should be trained by him in their duties relating to boats, trains,
and ambulances. When notified of the arrival of a train of boat, he must see that litter
bearers and ambulances are on hand and that adequate supplies of blankets and hot-water
bags are assembled at the platform. Having a list of vacant beds and receiving the list
of patients from the train or boat commander, he is in a position to make prompt distribution
of those received. Upon evacuation of the center, knowing the capacity of the boat or
train, and having a list of evacuables by classes, he is in a position to embark or entrain
them promptlj\ He turns over to the boat or train commander the list of patients evacu-
ated, by classes. Before assuming his duties, he should, if possible, gain experience in evacu-
ation work at an active evacuation hospital.
Motor transport. — The duties of the motor transportation officer are primarily the
maintenance and repair of all motorized vehicles under his control. He instructs the per-
sonnel of the service in the duties required for proper operation of this service. He renders
all reports required by this branch of the service, submitting to the commanding officer
such requisitions for supplies currently needed to maintain the service.
Messes. — The mess officer, under direction of the commanding officer, exercises general
supervision over all mess officers of the center and should hold such conferences with mess
officers of separate units as may be necessary. He should make frequent inspections of
organization messes as to operation and personnel, making such recommendations to the
commanding officer as will provide for increased efficiency. He maintains a school for the
instruction of cooks, helpers, mess sergeant, and others engaged in this class of work. He
should keep informed upon the availability of local markets and the prices. He makes
purchases for the separate hospitals and distributes the supplies purchased. He prepares
the menus for the entire center and submits them to the commanding officer for approval
two days prior to date effective.
Quartermaster. — The officer in charge of this important division is the group or depot
quartermaster. He has general supervision over all the various quartermasters of the center.
He makes daily inspections of all storehouses to see that stores are properly cared for, ample
fire protection afforded, and precautions taken against loss. He supervises the preparation
of requisitions before submission to the commanding officer for approval. He superintends
the construction and repair of buildings, roads, walks, sewers, power plant, ice plant, laundry,
etc. He inspects the supply officers of the center from time to time to see that they under-
stand and perform their duties properly. He sees that troops are promptly paid and rationed,
APPENDIX
895
that requisitions are promptly filled, and that ample stock is on hand at all times to provide
for the needs of the center. He keeps a record of all reports that are required in his various
sections, and sees that they are forwarded. He should cooperate in every way with the
commanding officer and the heads of other departments. His office is divided into the
following sections:
Rail transportation. — This furnishes transportation and travel allowance to troops,
casuals, and men on leave status and routes them by the most practical routes; arranges
for the movement of units from the center and notifies all concerned when the movement
will take place. He receives and ships supplies and baggage, reporting daily by wire to the
regulating officer the number of cars and kinds of supplies received and shipped; traces
cars, express shipments, and baggage delayed and lost in transit; cares for all railway trans-
portation department property at station; reports monthly to the chief quartermaster the
amount and kind of transportation issued to the troops at the center; and reports to the
central baggage office the data upon unclaimed baggage at the center.
Laundry. — Beyond having an expert personnel and civilian employees on hand, ironing
and mending, this section needs no comment.
Subsistence. — The office force of this section makes requisition from class A-1 supplies
upon a designated depot. He sees to the unloading, checking, and storage of supplies for
sale or issue; issues rations on ration returns approved by the commanding ofl^cer; issues
travel rations on travel orders issued by the commanding officer; sells commissary supplies
to all who are authorized to make purchases. He supplies, on charge accounts to hospitals,
subsistence stores required or which are authorized for sale; turns over daily the amount
of cash received from cash and charge sales; abstracts the following day the articles sold
for cash; abstracts during the month in which sold the articles sold on charge sales; makes
the monthly abstract of subsistence stores sold, both charge and cash; abstracts at end of
accounting month articles issued on ration returns or on special issue, etc. (See Manual
for the Quartermaster Corps, and orders and circulars) .
Property. — The officer in charge of this section is accountable and responsible for all
property in his section. He prepares all requisitions for clothing, miscellaneous quarter-
master supplies, fuel, forage, and ordnance, and supervises the issue of the same; sees that
all salvage is collected and shipped; checks the property and ordnance accounts and returns;
keeps informed by personal examination of the quantity and condition of property on hand
and is responsible that it is reported upon his return; makes all reports called for.
Finance. — This section provides for all payments, handles the cash, keeps the cash
books, examines all vouchers before payment, and renders all prescribed reports. The
officer in charge is required to be bonded.
Maintenance. — This detachment is concerned with repairs and maintenance and is
composed of carpenters, plumbers, electricians, and helpers, with a sufficient personnel to
handle accounts, prepare food, and provide for police.
Salvage. — This division is under a small detachment of the Salvage Corps, which col-
lects the miscellaneous articles deemed worthy of salvage and prepares them for shipment,
turning the bundles over to the quartermaster for shipment to the designated depot.
Laboratory. — This division is under the charge of an ofl^cer responsible to the com-
manding officer for all the laboratory work of the center. He is in charge of the center and
all subsidiary laboratories. He provides for distribution of all laboratory materiel of the
center; makes recommendations to commanding officer to promote eflJiciency; indicates for
commanding officer's approval the class of work to be done in the center laboratories; makes
monthly consolidated report of all activities of laboratories in the center, with positive
findings listed under proper headings.
The medical supply depot, base hospital, convalescent camp, evacuation ambulance
company (ambulance company) and the sanitary squad are considered separately under
appropriate headings in other portions of this manuscript.
13901—27 57
896
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
IX
THE BASE HOSPITAL
(Numbered from 1 up)
Base hospitals of 1,000-bed capacity should be provided in the proportion of four to
each division of an expeditionary force. These should be services of supply organizations,
and in order to faciUtate their supply and simplify the evacuation problem, should be grouped,
as far as it is possible to do so, in centers of from 5 to 20 units." Hospital centers should
be under the direct control of the chief surgeon of the forces, but detached base hospitals
should be administered by the chief surgeons of the service of supply sections or army service
area. Hospital centers and base hospitals should be located in army service areas, intermedi-
ate, and base sections at points offering the greatest rail and water facilities, advantage
being taken of suitable existing buildings. The equipment of these units has been stand-
ardized to avoid the confusion inevitably created by personal predilection.
Base hospital projects approved for construction should be turned over to the con-
struction service for completion. This construction should include proper sidings for hos-
pital trains if rail facilities are available, water, lighting and disposal systems and adequate
roads and streets. These hospitals should be prepared to give definitive treatment and so
organized and equipped as to be in conformity with that idea.
It is essential that the operating surgeons be afforded opportunity to acquire a knowl-
edge of battle casualty surgery, and to that end they should be assigned for periods to oper-
ating and attached to evacuation hospitals. Officers of the medical service, too, should
be given similar assignments in order that they may become familiar with the care and
treatment of toxic gas cases.
The commanding officer should insist that ward surgeons and chiefs of service reahze
the importance of correct and prompt preparation of case histories.
The officer in command of a base hospital should possess administrative as well as pro-
fessional qualifications, and his office should have the following divisions. (It will be noted
in this plan of organization that the office of director, having been considered superfluous,
has been eliminated.)
Adjutant. — An officer of the medical administrative service should be detailed to this
division to coordinate the work of the other divisions and their sections, to maintain the
record files of the unit, prepare all communications arriving at or leaving the unit, to super-
vise the distribution of mail, and to conduct censorship of outgoing mail.
Guard. — This is exterior and is maintained by selected noncommissioned officers and
enlisted men of the detachment according to roster, or from detachments from near-by
line troops. The officer in charge of guard is charged also with policing of the unit area.
Records. — Concerned with maintenance of the miscellaneous records of the unit and
statistical reports of the personnel.
Nurse Corps. — In charge of the chief nurse of the unit who controls the nursing serv-
ice, making assignments to duty under authority of the commanding officer, and prepares
all reports and returns relative to the nurses for approval and forwarding by the command-
ing officer.
Detachment. — Concerned with the orders relating to and assignments to duty of the
enlisted personnel, and maintains the individual records of the detachment, and prepares
the pay roll and muster roll.
Medical supply. — Under an officer of the medical administrative service, and con-
cerned with the preparations of requisitions for replenishment for approval of the command-
ing officer, the receipt, storage, preservation and issue of medical supplies to the unit, and
the maintenance of records pertaining to medical property as required by orders issued by
higher autnority.
» These units are now designated as general hospitals. When not less than three general hospitals are operat-
ing in a group, the hospital center organization is authorized. See Tables of Organization, 683-W and 688-W.—
APPENDIX
897
Religious and recreational. — Under control of the unit chaplain who, in addition to his
spiritual welfare work, makes provision for the maintenance of reading and writing rooms,
entertainments, games, both indoor and outdoor, assistance of the voluntary aid associa-
tions being solicited to this end.
Registrar. — In charge of an officer of the medical administrative service, who main-
tains the records of the sick and wounded, making the necessary alterations and additions,
preparing them to accompany all evacuable cases or for forwarding to the chief surgeon's
office in case of death, keeps the file of completed cases, and prepared sick and wounded
cards of such cases for forwarding, prepares the daily statistical reports of the sick and
wounded, and keeps a diary of the unit in which is entered from day to day all that trans-
pires of interest, including orders involving movement of the unit.
Pharmacy, in which is maintained, under lock and key, the stock of those drugs and
medicines capable of inducing drug addiction, and the nonhabit-forming medicines to be
issued upon prescription, a file of prescriptions being kept for all issues and frequently
scrutinized to preclude the unauthorized use of habit-forming drugs or intoxicants, check
being made against the issues from the medical supply storeroom and the amount on hand
in the dispensary.
Laboratory. — Equipped to perform the routine duties required in a large hospital, and
divided into subsections for deaUng with pathology — which includes the morgue — -bacteri-
ology, and serology, the latter being equipped for Wassermann and spinal-fluid tests.
Quartermaster, under an officer of the Quartermaster Corps, who is concerned with the
supply of all articles and materiel not comprised in the medical supply, maintenance of
the records and requisitions pertaining thereto. The office is divided into the following
sections:
Disbursements, dealing with the pay, travel allowances, etc., of personnel and patients, *
and the pay of civilian employees. This officer is bonded, keeps the hospital fund, and pre-
pares statements.
Supply and issues, dealing with the requisition for, the receipt of, issue of, and record
of all property and supplies furnished by the Quartermaster Corps, including clothing.
Salvage, dealing with the collection of all equipment and materiel of every kind for
sacking and turning over to the salvage officer of the center.
Laundry, heat and light. — Conducts these plants, with the assistance of civilian help,
the laundry maintaining a linen exchange.
Transport, which cares for all transportation assigned the unit, and conducts this
service under orders of the commanding officer.
Rations and messes, which draws and distributes the rations required, maintains super-
vision over the various messes, sees to the supply of fuel for them, and keeps the accounts.
Surgical service. — Under control of a medical officer of surgical ability who supervises
the services. Subdivided into the following sections: Eye, ear, nose, and throat; genito-
urinary; dental, including amxillofacial; general, with its subsection of Roentgenology;
orthopedic; head.
These services are dealt with under the heading "Hospital center."
Medical service, under control of a medical officer, who supervises the service. This
is divided into the following sections: Neurological; general; contagious.
Convalescents. — In hospital centers convalescents are concentrated in a unit provided
for their care.'' In detached base hospitals these patients are formed into a detachment
under an officer of the medical administrative service who is known as the patients' detach-
ment commander. He is responsible for their pay, clothing, discipline, nursing and amuse-
ment and recreation, all of which should be conducted through the proper agencies of the
hospital.
«> A convalescent camp is authorized for each hospital center and normally should provide a capacity for 20
per cent of the normal capacity of the hospital center to which it pertains. See Tables of Organization, 685-W.— £d.
898
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
X
SANITATION IN CAMPAIGN
From his induction into the service, through the vicissitudes of training camp, trans-
port, and battle to his discharge, a soldier must be subject to the rules of sanitation if the
force to which he is attached is to be effective. It behooves all officers, line and staff alike,
to possess a knowledge of practical sanitation as applied to military life in contradistinction
to the complex sanitation surrrounding one in well-ordered civil life.
All must accept as axiomatic the statement that the sanitary apparatus found in pro-
fusion in civil communities and mobilization camps, for very obvious reasons may not be part
of the sanitary 3quipment of a force in campaign, and that the successful field sanitarian
must draw upon his fund of common sense and employ the simplest resources at hand which
he must personally apply to the requirements, and not content himself with the issue of
an order that often contemplates the use of materiel which is not obtainable.
Most literature upon sanitation of the Great War is based upon the trench system,
which many deemed the normal, and as a result the literature is replete with descriptions
of appliances in the trenches of all contending forces, leaving upon the reader an impression
that war may not be prosecuted successfully without this mass of impediments to the trans-
portation and use of which in open warfare he gives no thought. Successful warfare
resolves itself into a question of mobility, and mobility signifies transportation. Therefore
a military sanitarian must be gifted with vision broad enough to differentiate the essential
from the nonessential, and must apply the well-known principles of sanitation to any form
of warfare in a manner that will be productive of good, without laying himself open to the
^ charge of being a nuisance through insistence upon the application of measures which a little
thought would show to be impossible of performance.
The one and only object of field sanitation is to maintain a command in the most per-
fect condition of health compatible with military conditions, through reducing to a mini-
mum the incidence of infectious diseases, by attention on the one hand to the individual
and on the other hand to his environment.
Preparation of a soldier for his military service commences at the depot, where, if not
previously immunized against smallpox, he is vaccinated and also inoculated against typhoid
and paratyphoid, the efficiency of these measures having been proven beyond question. At
the depot he is inculcated thoroughly with the necessity for personal cleanliness, involving
attention to his teeth through use of the toothbrush, frequent ablutions of the body, washing
of the hands after defecation and before going to meals, and the necessity for the prompt
application of prophylactic measures after exposure.
Attempt is made to imbue him with the value of neatness in dress and care of clothes,
with the double intent of improving his appearance and of creating a pride in the uniform,
both reflexly arousing a desire for cleanliness of body and equipment. He is furnished with
sufficient clothing, footgear, and personal equipment to make him fairly comfortable in the
field, barrack, or billet except under the most extreme conditions, and is taught the care
and use of his equipment in every phase of his new career.
Having acquired protection from the scourges that formerly decimated troops — small-
pox, typhoid, and paratyphoid — and been taught the dangers of venereal infections and the
surest means of precluding them, and through setting-up exercises and drills been made an
up-standing, self-respecting man, the recruit is assigned to a command and enters upon his
military career.
It is incumbent upon the medical officers at the depot to keep constant watch upon
recruits, and particularly upon those from the rural districts, to detect the first symptoms
of infectious diseases that most city-bred men acquire in childhood, and the methods of
dealing with those infectious need no comment in a book of this nature.
The medical officers of the command to which the recruit is assigned must not be less
vigilant in the detection of infectious disease than those at the depot, and frequent inspections
must be made to weed out the infected or suspected, special attention being given cooks and
those concerned in the handling of food to promptly detect and eliminate "carriers."
APPENDIX
899
When the command to which the recruit has been assigned is designated for service,
either at home or abroad, just before entraining the medical officers should thoroughly
comb the command for detection and elimination of infectious disease, including, of course,
venereal diseases. En route to another station, either by train or by boat, daily inspection
of the command should be made to detect infectious disease and also to insure the proper
preparation of food and provision for pure drinking water.
Arriving at a camp or port of embarkation, constant inspection is to be made with a
view to prompt eUmination of the infected, and just prior to embarkation, all the medical
officers obtainable should make a most thorough inspection of officers and men to exclude
the unfit or diseased from the transport; for it should be constantly in the mind of every
medical officer that the worst nuisance on shipboard is a case of infectious disease and that
the value of a command may be nullified absolutely by its presence.
Daily inspection of the men, the living quarters, lavatories and toilets, and kitchens
and pantries of the transport must be thorough to insure the highest degree of physical clean-
liness. Ventilation must not be overlooked, and suitable provision must be made for the
thorough washing and rinsing in hot water of all mess kits.
Upon arrival at the port of debarkation the command should be placed in barracks for
adjustment and further weeding out of the unfit, but the military exigencies usually demand
prompt transit to the zone of activity, and in this case the medical officers need to redouble
their vigilance for the detection and elimination of infectious disease. The men must be
instructed to report at once the appearance of body lice, these pests always being encountered
at this stage of the journey regardless of personal cleanliness of the command, for this species
of vermin is always found on military routes. Medical officers need to bear in mind that from
this time on the louse will be the constant companion of troops until facilities for its elimina-
tion are provided.
The command may be en route to a training area, where the men are usually billeted
in villages, and in this situation the efficiency of the medical personnel has its severest test.
Eternal vigilance over every factor in the soldier's life is necessary to maintain a command at
the highest physical standard. Latrines have to be prepared and maintained in perfect
sanitary condition, being made fly-proof as well, and for the first time the medical officer
realizes that such aids as crude oil, lampblack, or lysol are unobtainable, by reason of the
difficulty in transport, and that his sole recourse is perfect mechanical cleanliness and constant
instruction and supervision for its maintenance.
Of equal importance is the supply of water for drinking, and instead of waiting for the
usual pronouncement of the bacteriologist upon the purity of the water, he should at once
assume that it is impure and should see to the prompt installation of Lyster bags and the
correct process of chlorination, at the same time placarding all other sources as dangerous,
and he should see that guards are stationed to enforce his orders.
Billets should be examined for their capacity, 40 square feet per man being the minimum,
and if ventilation is inadequate steps should be taken at once to provide the necessary amount.
Kitchens are to be maintained in scrupulous cleanliness and facilities for the washing
and rinsing of mess kits installed, two galvanized-iron cans, one with hot, soapy water and the
other with plain water, being sufl^icient for each company. Provision has to be made for the
drying of clothes and shoes in each company, and if no room is obtainable for this purpose
construction must be instituted. A small stove, with wires or lines strung across the space
for suspending wet or damp clothing, being sufficient for the purpose.
Bathing facilities should be installed, and if a portable shower bath is not obtainable,
recourse can be made to perforated tin boxes suspended in a convenient place, with simple
facilities for heating water.
Kitchen and stable waste must be disposed of without creating a nuisance or permitting
flies to breed.
Shovild the command be under canvas— which would be unusual in a foreign country—
the requirements outlined herein would obtain, tents being substituted for billets.
The venereal rate always reaches its highest point in rest and training areas, and pro-
phylaxis stations conspicuously marked must be provided in sufficient number, and records
should be inspected daily. As sexual intercourse is a habit and not a necessity for soldiers,
900
ADMINISTRATION, AMERICAN EXPEDITIONARY P^ORCES
advice in regard to abstention from it is seldom heeded and all known houses of prostitution
should be placed off limits, with a guard to enforce the order, and prompt and adequate
punishment instituted for failure to observe orders concerning prophylaxis and the report-
ing of venereal disease, for it should be borne in mind that all venereal disease can nullify
the military value of a command as quickly as an epidemic of infectious disease.
In every training area is located a camp hospital of about 300-bed capacity, and all
cases of disability should be promptly transferred to it.<^ Uncomplicated venereal cases,
however, should be formed into a venereal battalion segregated from the remainder of the
command. This battalion should not only receive intensive training under supervision
of a competent urologist but should also be subjected to disciplinary control and given
approximate police duties. In this way perfect control is exercised and the diseased isolated
from the well with a view to the sudden transference of the command to another sphere
of activity and the avoidance of confusion in segregation at the last moment. This system
of segregation should be enforced during the entire period of the life of the command, whether
in the front line or back areas. When the command is assigned to the front line its location
is usually reached by marching, and medical officers must exercise constant vigilance for
elimination of the unfit, must see to it that straddle trenches are provided, food and water
surrounded by adequate precautions, and resting places properly policed upon departure.
As the command approaches the front line, facilities for personal cleanliness and waste-
disposal become fewer; so care must be observed to dispose of waste in a manner that will
not prove a menace or a nuisance to succeeding commands or to the civil population, and
recourse must be had to prevent as much as possible the infestation of the command with
lice, for these insects, feeding twice daily and multiplying with astonishing rapidity, may
soon reduce the stamina of the command through the loss of sleep consequent upon irritation
from the bites, which become infected and invite disaster should the victim be wounded.
Literature on the subject is full of suggestions for the easy freeing of a command from these
pests, but what is possible in trench or stable warfare is impossible in a marching column
or in open combat, and it needs but little thought to understand the absurdity of attempting
to use the heavy, clumsy and slow disinfestors which are the piece de resistance of most
writers upon sanitation in war under the latter conditions. The reader should firmly fix
in his mind the fact that trench warfare is an unfortunate incident which is an open con-
fession of the lost power of offense and is the last objective that any military commander
desires or would permit if he had the power to make other choice.
The question for medical officers to decide when a command en route to or entering
the line of combat is infested is what simple measures can be employed to reduce if not to
entirely destroy these vermin, and the solution is^ found in the employment of hot flat-
irons over damp clothes, pressed upon the seams of clothing and underwear, and the use
of certain drugs which are repellant to lice. With the knowledge that the command will
be deprived of steam disinfectors in forward areas, each company should have on hand two
flatirons and cloths and a quantity of naphthalin, creosote and iodoform for dusting upon
the inside of clothing with happy effect. The hot iron pressed over damp cloth immediatelv
destroys both adult and egg, while the N. C. I. [naphthalin, creosote, and iodoform] powder
applied biweekly will act as a deterrent to further visitation. But the most efficacious
and least unpleasant deterrent is ordinary tar soap, which wet and rubbed on the seams of
clothing repels not only lice but also fleas; and as a cake of this soap used in this wav will
last a long time and is inexpensive, every soldieV should have one in his kit and provision
be made for replenishment. This use of tar soap was most successful in preventing infesta-
tion of the China contingent during the typhus season in 1912, 1913, and 1914, when the
disease was rampant among the natives, and lice were omnipresent.
Having arrived at the front line, the command mav enter either trench or open war-
fare, and If the latter, the conditions obtaining during the march must continue until the
command IS withdrawn to a rest area well behind the line, where facilities should be avail-
able for tliorough bathing, delousing, and reclothing, and where a more or less quiet military
life may be enjoyed.
'Hospitals of this type are now designated station hospitals and have a normal capacity for 2,50 natients They
are communications zone units. See Table of Organizations, 684- W.-£rf. w paiiems. iney
APPENDIX
901
Trench or stable warfare imposes conditions upon a command in which it lives and
fights in a very restricted area, in which death or injury is always imminent, and where, for
obvious reasons the most perfect sanitary conditions must be maintained. As even in
the quietest sectors, life in the trenches is none too enjoyable, it behooves the units occupy-
ing them to observe strictly the common-sense principles of mechanical cleanliness for their
own sake as well as for the sake of units which succeed them, for otherwise conditions would
speedily become intolerable. To that end provision must be made for the disposal of human
waste, and such provision must naturally be placed so as to be readily accessible and yet
offer protection from injury by the enemy.
With the knowledge that a command is to occupy trenches, the medical officers and
quartermasters should prepare the simple equipment beforehand, and upon relief this
equipment should be turned over as sector property. Latrines being out of the question
in firing and support trenches, either oil drums, cracker boxes, or buckets should be pro-
vided, to fit snugly against the top of a box with a hole and a lid, the whole made fly-proof
and placed for accessibility in an outshoot on the communicating trench and behind the
support trench. If obtainable, a 5 per cent solution of cresol in water should be placed in
each receptacle; otherwise, wood ashes should be provided in a box for a covering layer for
each increment. Two of these receptacles are sufficient for each company, first firing and
support trench, a similar receptacle being placed opposite in an outshoot, for officers.
In an outshoot from the communicating trench between the first firing and support
trench should be dug a urine-soakage pit 4 inches in depth and width, the hole filled with
small stones, broken bottles, or flattened tin cans, over which is thrown a thin layer of porous
earth or sand, this being covered with gunnysacking, if handy, the surface being kept mois-
tened with 5 per cent cresol if obtainable. Another of these pits should be placed between
the feces receptacles for the men behind the support trenches, but none should be used if
the soil is not porous. Latrines of the usual type may be dug farther back of the com-
municating trenches for use of the reserve, and these should be in dugouts, for protection.
Care of these receptacles should be exquisite, and men detailed for this duty should
not be selected for punitive reasons but for their intelligence and zeal, and the fact should
be impressed upon the command that this duty is just as necessary as a detail in the firing
trench, for buckets or boxes must be emptied frequently and their contents carried the
entire length of the communicating trench for disposal in one of the dugout tienches, and
sometimes for a long distance behind that point.
Cooking in the front firing trenches is out of the question, as smoke and light immedi-
ately draw enemy fire. Food and water must therefore be brought from a distance, heat
being maintained by the use of marmites. These are merely one receptacle within another,
enough space being left between for an insulating layer of felt or hay. Too much care can
not be expended upon marmites, for unless kept scrupulously clean they cause food fer-
mentation. With this fact in view it is far better to provide them ready-made, with smooth
inner container and a complete juncture between the inner and outer shell to preclude soiling
of the insulating material; an accident invariably occurring in improvised marmites.
The usual period of trench service is four days, this being the longest period that
the enervating duty may be performed without detriment to a command, though in times
of stress the period is prolonged; and as the men may not leave the trenches for any pur-
pose while able to perform duty, facilities for washing hands and face must be provided
(as much for the sake of appearances as for the stimulating effect of the water) and a few
basins provided as part of the equipment, water being brought to the trenches by a detail
assigned that duty.
Drinking water must be chlorinated carefully, and a Lyster bag is necessary for each
company. Depending upon the length of its occupancy, the trench may be a simple ditch
or one provided with small dugouts containing bunks, stoves, lanterns, stools, tables and
whatnot, and provided also with gas curtains. But whatever the nature of construction,
if occupancy has been long the whole system is sure to be infested with vermin and with
rats, and as men may not remove their clothing with impunity, the value of vermin repel-
lants is enormous. Rats may not only constitute a menace by their presence but a menace
as well through their bites and their fleas; and while the latter may be remedied by the use
«
902
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
of tar soap on the clothing, energetic measures are necessary to reduce rodents, large num-
bers of traps and the extensive use of phosphorus pastes being given preference. The use
of Hce and flea repellants is not only indicated for the comfort of the men, but it should be
remembered, too, that the enemy may be afflicted by typhus and plague, and prisoners
taken in trench raids may be the means of starting an epidemic spelling disaster.
Great care must be observed in trench life to detect and remove promptly any case
of infectious disease, for the close contact of the men makes dissemination rapid, partic-
ularly in those diseases communicated through the medium of the mouth and nose secre-
tions. All such cases should be promptly masked before their removal to a hospital, and
contacts similarly made innocuous to others.
As trenches are open, both rain and ground water enter, and in spite of duck boards
the men's feet are always wet and if the temperature is not very warm the constant macer-
ation of the skin, with compression from shoes, socks, and puttees, gives rise to "trench
foot," which, after the various theories have been discarded, still remains the old-fashioned
chilblains and adds immeasurably to the victim's discomfort. To prevent this condition,
the men's feet should be kept as clean as possible and whale oil or any other grease rubbed
in with prolonged friction. Above all, means must be provided for the drying of shoes the
minute a man is reheved from his post, and every man should have an extra pair of shoes
and socks, so that he will always have one pair dr\'.
Having survived the ordeal of trench life, the command is relieved — for obvious rea-
sons always at night — and is marched back to a rest area, where it should be afforded
faciUties for bathing, delousing, and reclothing.
Should the fortunes of war permit the command to give over trench warfare and take
up offensive in the open, or even to pursue the enemy, exhausted nature requires its relief
b}^ a fresh command, and upon relief it goes into rest.
Whatever the situation, medical officers should not relax their vigilance for a moment,
for a fatigued command is more susceptible to infection than is a fresh one, and as during
rest periods replacements may impart all manner of infections, the greatest care devolves
upon medical officers at this time. Upon appearance of the first case of infectious disease
the victim and his contacts must be segregated and dealt with according to the nature of
the disease. Diseases which are disseminated by nasal and mouth secretions demand that
those who have them and all who have been exposed to them be masked at once and before
anything else is done.
Upon completion of a campaign a command reverses the steps outhned herein, ever
under the watchful eyes of the medical officers, and before being demobiHzed and returned
to civil fife it must be held in detention sufficiently long to free it from any desease which
would be a menace to those in the homeland.
CIRCULARS PROMULGATED BY THE CHIEF SURGEON, A. E. F.
Circular No. 1, 1917.
Headquarters American Expeditionary Forces,
Chief Surgeon's Office.
It is planned that the medical laboratory work for the American Expeditionary Forces
shall be done by the following organizations:
1. Field laboratories, located in each division camp hospital, will do all work that it is
possible to do for the division and for the camp hospital, and will send other work to an army
laboratory.
2. Army laboratories will do the bulk of the work for the troops in the field including
water analyses, Wassermann reactions, detection of carriers, cultural and serological work
in general. These laboratories may be specialized later. Laboratory No. 1 is already
established, address P. O. No. 709.
3. Laboratories of base hospitals will do principally routine and special work for cases
in hospital.
Specimens from each division should be sent to the field laboratory at the camp hospital
of the division for examination or transmittal to the army laboratory. As soon as containers
for specimens are available they will be kept on hand at the field laboratories for distribution.
Pneumonia. — Type determination of pneumococci should be carried out whenever
possible in cases of lobar pneumonia. Sputum should be sent to the army laboratory direct,
with as little delay as possible.
Syphilis. — Specimens for Wassermann reactions will be sent to LTnited States Army
Laboratory No. 1, through division laboratories.
DIPHTHERIA AND MENINGITIS
Sporadic cases of diphtheria and meningitis are to be expected and do not call for
medical preventive measures. But if secondary cases occur in the same group of men, such
radical measures will be undertaken as the limitations of field conditions permit.
Diphtheria. — 1. Any clinically suspicious case will be cultured on Loeffler's media, and
the culture will be sent to the division laboratory as soon as possible. The case should be
treated with serum if sufficiently suspicious and sent to the camp or base hospital for isolation.
2. If the culture is reported positive, immediate contacts will be examined clinically
each day for one week and cultures made in any suspicious cases. Isolation, the prophy-
lactic use of antitoxin, and examination for carriers among contacts are not indicated after
sporadic cases. Inquiry should be made as to the existence of diphtheria in the civil popu-
lation, especially among the children of the neighborhood.
3. If secondary cases occur in the same group of men, contacts will be isolated and
examination for carriers will be requested through the division laboratory.
4. If cultures on contacts are negative they will be released from isolation. Carriers
will be sent to the camp or base hospital. If virulence tests can be made on carriers and
are negative, the carriers will be released; otherwise, two negative cultures at intervals of
three days will be required before release.
Meningitis.— I. Anv clinicallv suspicious cases will be given a spinal puncture as soon
as possible and the fluid sent to the laboratory. The case will be given serum treatment if
sufficient] V suspicious and sent to the camp or base hospital for isolation.
2. If meningococci are found in the fluid by smear or culture, contacts will be kept
under clinical observation for three weeks and spinal punctures will be made in all suspicious
C&SGS.
3. If secondary cases occur in the same group of men, contacts will be isolated and
examination for carriers will be requested through the division surgeon.
4 If cultures on contacts are negative they will be released from isolation. Carriers
will be sent to a base hospital for isolation and treatment. Two negative cultures with
intervals of one week will be required before convalescents or carriers are discharged from
^'o^P'^^^l A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
903
904
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 2.
(This circular will be superseded by Circular No. 25 which will soon be issued.)
Circular No. 2.
Headquarters American Expeditionary Forces,
Office of the Chief Surgeon,
France, November 9, 1917.
1. The War Department has approved the plan of the Surgeon General's Office, creating
professional divisions in his office with a director at the head of each division in the United
States, and a director for each division with the American Expeditionary Forces. These
divisions are:
(1) Division of general medicine.
(2) Division of general surgery.
(3) Division of orthopedic surgery.
(4) Division of surgery of the head.
(5) Division of venereal, skin and G. U. (urology).
(6) Division of laboratories.
(7) Division of psychiatry.
(8) Division of Roentgenology.
2. For the expeditionary forces, Maj. John M. T. Finney, M. R. C, has been designated
as director of general surgery; Maj. Joel E. Goldthwait, M. R. C, as director of orthopedic
surgery; Maj. Hugh H. Young, M. R. C, as director of urology; and Lieut. Col. Joseph
F. Siler, M. C, as director of laboratories. The names of officers designated for the
remaining divisions will be announced later.
Additional officers will be named from time to time as assistant directors and con-
sultants for corps, sections of the lines of communication, large hospital centers, and other
areas. ,
3. The professional authority of directors, assistant directors, and consultants, within
their respective divisions, will be recognized by all concerned and duly respected and observed,
it being fully understood that this authority does not in any way include administrative
control.
4. The directors, each for his particular division, will be immediately responsible to
the chief surgeon, A. E. F., for the work performed in these various divisions. In general,
they will direct and coordinate the professional service of all sanitary formations and hos-
pitals so that there will be a continuity of treatment along lines of recognized approved
practice, from the front to the rear, in each professional division.
They will also act as consultants and advisors, and, when necessary in the interest of
the service, they will change professional procedure or inaugurate new methods. .
5. In order to carry out these plans, the professional service of base hospitals and general
hospitals, and other hospitals as far as practicable, will hereafter be subdivided into eight
sections, as follows:
(1) Section of general medicine.
(2) Section of general surgery.
(3) Section of orthopedic surgery.
(4) Section of surgery of the head.
(5) Section of venereal, skin, and genitourinary (urology).
(6) Section of laboratories.
(7) Section of psychiatry.
(8) Section of Roentgenology.
The commanding officer of each hospital will organize his hospital as indicated, assign-
ing a suitable officer to duty in charge of each section. He will assign an adequate number
of assistants to each section as far as it may be practicable. In making these assignments
the professional qualifications of an individual in a particular specialtv will receive due
consideration. The chiefs of sections will report direct to the commanding officer, to whom
they will be responsible, each for the satisfactory operation of his particular section.
By command of General Pershing:
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Approved: > j y
J. G. Harbord, Chief of Staff.
APPENDIX
905
Circular No. 3.
Headquarters American Expeditionary Forces,
Office of the Chief Surgeon,
November 24, 1917.
The following instructions are issued for the guidance of all medical officers:
1. Cases of slight illness which apparently will require but a few days on sick report,
and cases of uncomplicated venereal diseases which can not receive proper care on a duty
status, will be treated in camp infirmaries as far as the capacity of the camp infirmary will
permit.
2. Cases of a more serious nature will be sent to camp hospitals of the divisional train-
ing areas. These will include the overflow of the mild cases from the camp infirmaries and
those who will require retention on sick report for more than one week.
3. Cases of a severe nature that will require hospital treatment for a period of more
than two weeks or cases for which there is inadequate equipment at camp hospitals and
those that require experienced nursing will be promptly evacuated to base hospitals. It
is not intended that all mild cases which will require hospital treatment for a period longer
than two weeks must be evacuated to base hospitals, but two weeks is placed as a reasonable
time limit for their retention in camp hospitals and is intended to serve as a guide.
4. In this connection attention is called to paragraph 4, General Orders, No. 34, Head-
quarters A. E. F. No uncomplicated cases of venereal disease will be sent to base hospitals.
By command of General Pershing:
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Approved:
J. G. Harbord, Chief of Staff.
Circular No. 4.
Headquarters, American Expeditionary Forces,
Office of the Chief Surgeon,
France, December 22, 1917.
The following instructions relative to charges for certain classes of dental work requir-
ing precious metals and other^ expensive materials not furnished by the Government are
issued for the guidance of all concerned.
1. It is contemplated that dental officers on duty at general headquarters, headquarters
line of communications, division headquarters, separate brigade headquarters, army sanitary
school, the several base hospitals, A. E. F., and general hospitals, B. E. F. (where there are
complete laboratory equipments) will carry these materials.
2. The following list of fixed charges to reimburse dental officers using these supplies is
announced, same being based upon the actual cost (in France) of materials necessary for the
designated class of work, plus a small per cent to cover construction losses.
3. List of charges:
Molars —
Swaged cusps $6. 00-7. 00
Solid cast cusps 7. 00-8. 00
Gold-porcelain crowns 5. 00
(Richmond, Goslee, Steele, or Ash fac-
ings, and bridge dummies)
Porcelain crowns, with cast
gold base -$3. 00
Gold fillings:
Simple $2. 00
Compound 2. 50-3. 50
Gold inlays:
Simple 3. 00-3. 50
Compound 4. 00-5. 00
Gold shell crowns (gold bridge dummies) :
Bicuspids —
Swaged cusps 5. 00
Solid cast cusps 6. 00
Bridges: Charges to be based upon foregoing figures covering components, i. e., abut-
ment crowns, inlay anchorages, and dummies, plus a charge for consolidation not to exceed
$1 for each interproximal space soldered.
Bv command of General Pershing:
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Approved :
J. G. Harbord, Chief of Staff.
906
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 5.
Headquarters, American Expeditionary Forces,
Office of the Chief Surgeon,
France, January 15, 1918.
duties of medical officers detailed as psychiatrists in army divisions in the field
1. The following outline naturally does not indicate all the means by which medical
officers detailed as psychiatrists in Army divisions in the field can be of service in dealing
with the difficult problems arising in the diagnosis and management of mental and nervous
diseases among troops. These officers are under the direction of the chief surgeons of the
divisions to which they are attached, and they must be prepared at all times to render such
services as he may require. These officers are not members of division headquarters staff.
They are attached to the sanitary train.
2. It is essential for such officers to bear in mind the prime military necessity of pre-
serving or restoring for military duty as many as possible of the officers and enlisted men who
may be brought to their attention. On the other hand, they should recommand the evacu-
ation, with the least practicable delay, of all persons likely to continue ineffective or to
endanger the morale of the organizations of which they are a part. This is particularly
true in the case of the functional nervous disorders loosely grouped under the term "shell
shock," but more properly designated as war neuroses. Psychiatrists detailed to this duty
have an unique opportunity of limiting the amount of ineffectiveness from this cause and of
returning to the line many men who would become chronic nervous invalids if sent to the
base. At the same time they can bring to the attention of other medical officers and com-
pany commanders individuals who possess constitutional mental defects of a type which
make it certain that they will break down under stress.
3. Specific duties which may be performed by psychiatrists in Army divisions are as
follows :
(o) Examine all officers and men under observation or treatment for mental or nervous
diseases in regimental infirmaries, field hospitals, camp infirmaries, and other places, and to
advise regarding their diagnosis, management, and disposition.
(6) Examine all mental or nervous cases in the divisional areas when directed to by the
chief surgeons or requested to by other medical officers or company commanders.
(c) Examine and give testimony regarding officers and men brought before court-
martial or under disciplinary restraint, when directed or requested by competent authority.
{d) Give informal clinical talks to groups of medical officers in the divisions to which
they are attached upon the nature, diagnosis, and management of the mental and nervous
disorders peculiar to troops.
(e) Keep careful records of all cases examined.
(/) Make such reports to the chief surgeons of divisions as they require and to make
monthly reports of their operations to the director of psychiatry, bringing especially to his
attention any matters likely to increase the efficiency of this part of the medical work of the
American Expeditionary Forces.
By command of General Pershing:
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Approved :
J. G. Harbord, Chief of Staff.
Circular No. 6.
General Headquarters, American Expeditionary Forces,
Office of the Chief Surgeon,
France, January 28, 1918.
1. The attention of medical officers, A. E. F., is directed to the absolute necessity for
the prophylactic administration of antitetanic serum (A. T. S.) under the following conditions:
(a) Immediately after the receipt of a wound of whatever character, if a battle casualty,
preferably at the regimental aid station.
APPENDIX
907
(6) Upon the recognition of so-called "trench foot" with or without skin abrasions.
(c) During operations performed under conditions of unsatisfactory asepsis, e. g.,
emergency operations, operations for hemorrhoids, or when there has been contamination
from the contents of the large intestine.
id) During secondary operations necessary in the course of the treatment of wounds
received 10 or more days previously.
(e) Following manipulations incident to the reduction of compound fractures or dis-
locations, after the removal of adherent drains, or any other procedure resulting in a serious
disturbance to the healing tissues consequent upon a wound 10 or more days old.
2. One dose of 1,500 units is sufficient, and should always be administered under any
of the above conditions. It should be injected subcutaneously, preferably over the lower
abdomen.
3. The serum should be administered by or under the immediate supervision of a medical
officer. If for any reason this is impossible, it should be given by some responsible member
of the Medical Department.
4. A record of the administration is to be made upon the individual's diagnosis tag
and clinical record by the letters A. T. S., followed by the date and hour; in the case of the
freshly wounded, the letter T should be plainly marked upon the forehead with an indelible
pencil.
5. Absence of any records on the patient's card or face as indicated in the preceding
paragraph is to be accepted as evidence that the A. T. S. has not been given. The first
medical officer to assume subsequent control of a patient thus neglected should administer
the serum immediately.
6. Medical officers, who are thus compelled to administer A. T. S. because of the
failure of any medical officer or officers previously responsible for this administration to
carry out the above instructions, must make an immediate report of such omissions to the
chief surgeon. A. E. F., through the director of general surgery, with sufficient data to establish
the time and circumstances of the omission.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 7.
General Headquarters, American Expeditionary Forces,
Office of the Chief Surgeon,
France, January 28, 1918.
1. The following detailed instructions supplementing and amplifying General Order
No. 43, headquarters, A. E. F., September 30, 1917, and General Order No. 74, December
13, 1917, and relative to requisitions and finance papers, are published for the information
and guidance of all concerned. *
2. Accountable officers of base hospitals and sanitary schools will not be affected by
the provisions of the paragraphs of this circular, in so far as they apply to property responsi-
bility and accountability.
3. All accountable officers of Medical Department units coming under chief surgeons
of divisions will at once invoice upon Form 28, M. D., all property of whatever nature for
which they are accountable, to their respective divisional medical supply officers. Under
the supervision of the chief surgeons of divisions this property will be issued and held upon
memorandum receipt, Form 28, M. D., so modified as to meet this need.
4. The medical supply officer of each division will prepare, after this transfer has been
completed, accurate final returns upon Forms 17, 17a, 17b, and 17c, in duplicate, of all
equipment, property, and supplies for which he may then be accountable. The upper
certificate upon Form 17c will be used by the officer completing the final return, the lower
form, as modified, by the officer making final inventory. One copy will be retained and
one copy forwarded to the chief surgeon, line of communications.
5. There will be detailed by the chief surgeon of each division a disinterested officer
of the Medical Department and senior to the Divisional medical supply officer, if practi-
908
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
cable, to make personally a complete physical inventory of balance of supplies, property,
and equipment on hand at time of final return. The officer making this count will certify
to the facts on the final return.
6. Accountable officers of Medical Department units, not under chief surgeons of
divisions, will proceed as per instructions contained in paragraph 4 above, and subparagraphs
1 and 2, paragraph 1, General Order No. 74, above quoted. These final returns will be made
in duplicate and one copy retained by the accountable ofl^ccr and one forwarded to the
chief surgeon, line of communications.
7. For the method of the invoicing of and receipting for equipment, property, and
supplies from depots to units, divisional or otherwise, attention is invited to paragraph 10,
General Order No. 43, headquarters A. E. F., September 30, 1917.
8. Requisitions for all property Hsted upon tables of supply will be made for divisional
units in quadruplicate, and in all other cases in triplicate upon Forms 33, 35, or 36, M. D.
In each case one copy will be retained and the others forwarded for action. Requisitions
for blank forms will be made as in the past upon Form 37 and for all organizations but one
cop}' forwarded for action.
9. All equipment, property, and supplies needed for use of divisional units will be
requisitioned for by the divisional medical supply officer, and his requisitions will be forwarded
to the chief surgeon of that division for his action. The chief surgeons of divisions will forward
all approved requisitions, or those approved as modified, except for transportation as noted in
paragraph 11, direct to the officer in charge of the issuing depot. The same disposition will
be made of reciuisitions from organizations other than divisional, and with the same exception.
The chief surgeon, line of communications, will publish from time to time detailed instructions
relative to the exact depot to which requisitions from the various units should be sent. These
instructions will also contain a statement of poHc\^ as regards "articles due."
10. Requisitions or requests for transportation of any kind whatever will be forwarded
in every instance to the chief surgeon, line of communications, through divisional chief
surgeons in the case of such units and direct in all other cases. These instructions will also
govern where special or unusual equipment, supplies, or property are required.
11. All unserviceable property of whatever class will be disposed of ultimately through
the salvage service. Such property will, however, for the present be held awaiting further
instructions from the office of the chief of the salvage service.
12. Where purchases and payments are made necessitating the use of public voucher
forms, great care will be exercised to see that the signature of individuals to whom payments
are to be made are in accordance with the name of the party or company to whom the United
States is declared debtor. The vouchers will show clearly upon their faces the authority for
the purchase and the rate of exchange used in figuring totals. These totals will, in all cases,
be made in terms of United States currency.
13. The public vouchers referred to above will be made in duplicate and accompanied by
the proper forms. In cases where the purchase has been made under the supervision or
authority of a divisional chief surgeon, the vouchers will be sent to that office for visa and
approval after which they will be sent direct to the proper disbursing officer for payment.
The papers referring to transactions not falling normally within the province of divisional
chief surgeons will be forwarded to the chief surgeon, fine of communications, for final action.
14. The chief surgeons of divisions may authorize ordinary and emergency expenditures
of public funds for their own department in amounts not to exceed $100. All such expendi-
tures so authorized will be reported to this oflice monthly upon a consolidated list showing the
larger groups and not each individual item.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
APPENDIX
909
Modified Form C, Medical Department
I certify that the foregoing return, slips Nos. to , inclusive, is a true and
correct statement of all medical property for which I am accountable for the period ending
, 191 _.; that the expenditures for which credit is claimed therein were
made in strict accordance with regulations.
Accountable Officer.
Final return of medical property, Division, A. E. F., per G. O. 74, H. A. E. F.
December 13, 1917.
I certify that I have this day of , 191__,
made a complete personal physical inventory of all property enumerated upon slips Nos.
to , for which the above officer is accountable and find' the total balance on hand to be as
stated in the above certificate with additions and subtractions as indicated upon my list here
attached.
Inventory Officer.
Final leturn of medical property, Division, A. E. F., per G. O. 74, H. A. E. F.
December 13, 1917.
Circular No. 8.
General Headquarters, American Expeditionary Forces,
Office of the Chief Surgeon,
France, February 4, 1918.
The following information is published for the guidance of all concerned:
* * * * * * . *
1. There arrived at , 7.25 p.- m., January — , 61 enlisted men of this division.
These men were in charge of Sergeant -, Headcjuarters Company, Infantry.
They were all being returned to duty from Base Hospital No. . Copy of order and
written instructions to Sergeant hereto attached. (See Exhibits A and B.)
2. These men were not furnished with rations when they left the hospital; and as very
few of them had any money, the large majority went without anything to eat from 6.10
a. m. to about 8 p. m. No notification was sent to the authorities at from Hospital
No. to expect these men, and when they arrived, about 8 p. m., there was therefore
no provision for taking care of them until they could be forwarded to their respective
organizations.
3. Many of the men were without sufficient warm clothing, according to the sworn
statement of Sergeant , as well as my own observation.
4. Sixteen of the men were admitted to the camp hospital here immediately on arrival.
Thirteen of them were returned to duty next day, but three were found to require hospital
treatment. (See Exhibit C.)
5. It is recommended that steps be taken to require the hospital authorities to see
that men discharged from a hospital are warmly clothed on leaving, and to provide for ration-
ing such men for the trip back to their organizations. Also that they notify by telegram
the authorities of any intermediate station where such men must be taken care of on their
journey back to their organizations.
*******
The recommendations set forth in paragraph 5 above will be strictly observed. The
general staff at these headquarters is now engaged on the preparation of an order that will
cover an automatic method of returning men from hospital to duty.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
910
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 9.
General Headquarters, American Expeditionary Forces,
Office of the Chief Surgeon,
France, February 7, 1918.
The following memorandum has been issued by the Surgeon General, and as far as it
is applicable will be observed by all concerned in the American Expeditionary Forces:
Memorandum for all division surgeons, and surgeons at ports of embarkation, and for com-
manding officers of general, base, embarkation, and other hospitals:
Reports of inspectors indicate lack of uniformity in the care and isolation of infectious
disease in hospitals, and in many instances the steps taken are reported to be insufficient to
prevent possible spread of infection and development of complications. The following
procedure should be followed whenever local conditions permit. When any or all of the
necessary medical department material is lacking, requisition should be made by telegraph
for the needed articles, and referring to this memorandum as authority. Such additional
precautions should be taken as are deemed advisable by the commanding officer of the hospital.
1. Meningitis. — Strict isolation should be instituted. Male attendants should be
segregated and not allowed to eat or sleep with the sanitary detachment. The same steps
should be carried out with female nurses as far as possible. When on duty in wards all
female nurses, male attendants, and medical officers should wear operating gowns, caps,
and gauze masks over nose and mouth. The hands should be thoroughly washed and
disinfected after coming off duty and before leaving the ward. Cultures should be taken
every fourth day from medical officers, nurses, and male attendants on duty in meningitis
wards, and no such nurse or attendant should be assigned to other duty until a negative
culture is obtained. Bedding, clothing, etc., of patients and gowns and caps of attendants
should be thoroughly disinfected by steam or chemicals before going to the laundry. Nasal
and oral discharges of patients should be disinfected or burned. Dishes, etc., for bringing
food should be sterilized before being returned to the general kitchen. Meningitis con-
valescents and carriers will not be returned to duty until after three consecutive negative
cultures taken at intervals of from 3 to 6 days. Meningitis carriers should not be segregated
in the same room with men sick with meningitis, but in .a suitable segregation ward, camp,
or barrack.
2. Diphtheria.~The same precautions should be taken as prescribed for meningitis.
In addition, the Schick test should be applied to nurses and male attendants, and those
not immune should be immunized.
3. Measles. — An allowance of at least 1,000 cubic feet per patient should be provided
in wards or barracks used for treating measles patients. Wires should be arranged across
measles wards and sheets, or newspapers, hung over these in such a way as to form a screen
between each two patients; or some other suitable screening arrangement should be pro-
vided. This is with a view to preventing spread of pneumonia by droplet infection during
coughing. Patients convalescent from measles should be retained in hospital, or in a well-
warmed convalescent barrack, for at least 10 days after the temperature has permanentlv
returned to normal. Medical officers, nurses, and male attendants in measles wards will
wear gowns, caps, and masks. Nasal discharges and sputum of patients will be disinfected.
Oral cleanhness should receive special attention. Attendants who have had measles should
be selected, if possible, for duty in measles wards. Floors of wards should be gone over
daily with a cloth w-et in disinfectant. Dishes and eating utensils should be disinfected.
Individual drinking cups should be used. Particular care should be taken to disinfect ther-
mometers and other utensils as they pass from patient to patient. Wards should be kept
warm. A urinary examination should be made before discharge from hospital.
Patients developing pneumonia should immediatelv be removed from the measles
wards. They should not be placed in the same wards with primarv lobar pneumonia.
4. Pneumonia.— Pneumonia patients should be treated in wards used exclusivelv for
pneumonia. Ordinary lobar pneumonias and post-measles and post-scarlet-fever pneumo-
nias should not be treated in the same wards. At least 1,000 cubic feet of air space per pa-
tient should be provided, and all of the precautions referred to in the section on measles
should be carried out, viz, gowns, caps, masks, screens between beds, disinfection of uten-
sils, thermometers, excretions, and floors. Convalescent pneumonia patients should use a
mild antiseptic mouth wash as long as they remain in hospitals, and should pav special
attention to oral hygiene. Special attention should be given to the earlv detection of
empyema.
5. Scarlet fever.— AW of the precautions prescribed in mesales should be carried out
in the treatment of this desease. Attendants who have had scarlet fever should be selected
when possible.
Patients should not be released from quarantine until nasal, aural, glandular, or other
abnormal discharges have ceased, and all open sores have healed, nor earlier than six weeks
fniX u ^^^^""f ""•^'^r ^ii-cumstances. A urinary examination should be
made before discharge from hospital.
in should be handled with the same precautions as meningitis, and
in addition all attendants, and others in the vicinity, and all contacts should be revacci-
APPENDIX
911
nated. Smallpox may safely be treated in a room in the isolation ward if these precautions
are observed.
7. Where the hospital facilities are insufficient to provide treatment for measles and
scarlet fever patients for the periods above prescribed, request should be made for the setting
aside of the necessary barracks or tentage for use as convalescent hospitals. Special atten-
tion should be given to keeping such convalescent quarters well warmed, and additional
stoves should be installed if necessary. Warm and conveniently located lavatories are
essential. Patients in the acute stage of measles and scarlet fever should use commodes.
8. Enlisted attendants in wards for infectious diseases should wear white cotton coats
and trousers, which should be changed twice a week. These garments are on hand in depots,
and should be required for at once by the local quartermaster.
9. No nurse or attendant should have charge of two different classes of the above-
mentioned infectious diseases. Medical officers in charge of different classes of infectious
diseases will carefully disinfect the hands before passing from one class to the other.
10. No blanket or mattress cover used for any of the above-mentioned diseases should
be used for another patient until it has been disinfected by steam or chemicals or laundered
at a steam laundry. Preferably they should be laundered. The underclothes of patients
admitted for the above-mentioned diseases should be disinfected by steam or chemicals at
once or laundered, preferably the latter. Outer clothing, except in the case of measles,
should be disinfected by formaldehyde in a closed box, and then aired and sunned for three
consecutive days.
11. In wards used for the above-mentioned infectious diseases, paper napkins are rec-
ommended for receiving nasal secretions. At the head of each bed will be kept a paper
bag, fastened to the bed by adhesive plaster. These bags will be used for napkins, gauze,
swabs, and other infected refuse, and will be burned when full. Napkins and paper bags
may be purchased locally, quoting this memorandum as authority.
12. The above precautions in regard to measles are prescribed primarily to diminish
the incidence of the very fatal post-measles pneumonia which has reached alarming propor-
tions in some camps. There has been widespread failure to appreciate the seriousness of
measles under existing camp conditions.
13. Immediately on receipt of this memorandum, the commanding officer of a hospital
will hold a conference with such of his assistants as are concerned with the handling of in-
fectious diseases, and will arrange for the carrying out of the details as far as local condi-
tions will permit. Report of action taken will be made to this office.
*******
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 10.
American Expeditionary Forces,
Office of the Chief Surgeon,
France, March 4, 1918.
1. Allowance for soldiers sick in hospital. — Paragraph 1212, Army Regulations, has
been amended so as to provide for commutation of rations for soldiers sick in hospital and
members of the Army Nurse Corps at the rate of 60 cents a day at all stations where pur-
chases of subsistence supplies from Quartermaster Department are possible, and at the rate
of 75 cents a day at stations where purchases must be made in open market — effective Feb-
ruary 16, 1918.
From and including February 16, the claim upon the Red Cross for 35 cents a day for
additional rations will be discontinued.
Red Cross allowance for soldiers of the allied armies in American hospitals. — The Red
Cross has agreed to continue an allowance for members of the allied armies in American
hospitals. Vouchers therefor will be submitted through this office, accompanied by the
certificate that these funds have been or will be actually expended in providing additional
rations in accordance with the purpose for which the money has been appropriated by the
.\merican Red Cross. The amount allowed is 20 cents a day for patients.
2. Misuse of adhesive tape and surgical bandages. — It has been reported to this office
by a collector of internal revenue in the United States that large numbers of packages are
being received from the American Expeditionary Forces secured with adhesive tape and
surgical bandages. Such waste of material is reprehensible under present conditions. All
commanding officers will immediately take steps to prevent any such misuse of these supplies.
13901—27 58
912 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
3. Reports on civilians. — Hereafter, report called for by General Order No. 13, head-
quarters, A. E. F., ill the case of civilians employed, will be made out on the following form
(letter size) :
191..
From
To Chief, Intelligence Section, A. E. F.
Subject: Investigation of employee.
It is requested that whose description follows, be
investigated by your office, with a view to employment as
at a salarj^ of
(Signature)
Name and all surnames
Nationality
Place of birth
Date of birth
Address (actual lodging; not business address)
Last employment
Name and nationality of father _
Name and nationality of mother
References (3)
4. Use of medical supplies. — Medical officers are urged to effect every possible economy
in medical supplies of all kinds, and to give careful consideration to every requisition, bearing
in mind the problems which confront the supply division. Every item should be considered
from the standpoint of its relation to the success of our Army and not alone from its con-
venience and desirability under peace conditions.
The tonnage situation necessitates the utmost economy, and does not permit the fur-
nishing of our hospitals with as elaborate an equipment as would otherwise be possible.
The ehmination of all supplies that are not directly beneficial to the health of the
soldier or to the success of our Army will permit larger shipments of the essential and vital
articles and will help to avoid a possible shortage later.
While price is not yet an important factor, a diversion of labor from the manufacture
of essential articles is and such diversion results from the purchase of nonessential articles
however desirable they may be. The careful cooperation of all medical officers in this matter
of economy will be of very great value. Economy should be practiced both at the time
requisitions are made and in the use of the articles when received.
It is not desired that medical officers economize in any way that will interfere with
the recovery or comfort of the patients. There is no need therefor. Tonnage for all such
essentials for the medical department will be forthcoming.
But the needs of the medical department are only a part of the great needs of our Army,
and the fact that the requirements for the sick are given precedence over a great many other
supplies should make us insistent that the privilege is not abused. Every item saved will
not insure the only future supply of the essential articles, but will aid materially in the success
of the Army, whose interests we serve.
5. Supply of nonperishable subsistence stores. — Base hospitals are authorized and
directed to carry in stock a 15 days' supply of nonperishable subsistence stores based on the
maximum strength of patients and personnel. Requisitions will be submitted at such times
as to maintain this stock and meet the current needs. Should the hospitals be located in
hospital centers where quartermaster depots are established, this stock need not be carried
at each hospital if the facihties of the depot are sufficient to maintain that stock for the
entire area.
6. Empttj Prest-o-Lite tone's.— Empty Prest-o-Lite tanks should be sent direct to the
purchasing officer, medical department, Paris, for transmission to the Societe des Appareils,
Magondeaux, No. 6 Rue Denis-Poissons, Paris, advising him by mail of all shipments and
of the number of tanks shipped.
7. Ordre de transport.— The following, from Circular No. 9, office of the chief quarter-
master, general headquarters, A. E. F., is repeated:
APPENDIX
913
1. The proper disposition of the pink and yellow folds of the ordre de transport does
not seem to be clearly understood hy many shipping and receiving officers, and, pending
issuance of new forms, which are designed especially for use bj^ the American Expeditionary
Forces, officers should strictly observe the following instructions in the use of the French
forms.
2. When a passenger is given his ordre de transport he should be told to present it to
the chef de gare (railroad agent) at point of departure, that the chef de gare will retain
the pink fold, but will stamp and return to him the yellow fold, which is his ticket for the
trip; that he must preserve and turn over this yellow fold on arriving at destination to
his commanding officer.
3. When the commanding officer receives the yellow fold of the ordre de transport
from a soldier, or detachment of soldiers, arriving at destination, he will note the number
of persons actually transported thereon, if there is a discrepancy, and forward it to the
chief quartermaster, A. E. F.
4. When a shipment of freight reaches the point of delivery the receiving officer will
take the yellow fold of the ordre de transport (which has been forwarded to him by the ship-
ping officer) and present it to the chef de gare who will deliver the shipment to him. He
will carefully check the shipment with the ordre de transport, noting on the reverse side,
in the spajce provided therefor, any shortage or damage, and will see, before signing it, that
the chef de gare makes similar notations on the pink fold held by him. The yellow fold,
after the necessary notations have been made and signature of the receiving officer affirmed,
will be forwarded at once to the chief qaurtermaster, A. E. F., accounting division.
5. Many copies of the pink fold of the ordre de transport (A-2 and B-2) are being
forwarded to this office, which is a mistake. This part of the ordre de transport is property
of the carrier, on which the transportation charges are based, and has no place in the records
of this office.
6. A careful observation of these rules will greatly facilitate the settlement of trans-
portation accounts with the French Government.
8. Report of supplies received not properly marked. — The commanding general, S. O. R.,
directs all officers receiving shipments not properly marked, as provided in General Order
17, general headquarters, A. E. F., 1918, paragraph 2, subparagraph 4, to make report, in
detail to headquarters, S. O. R.
9. Report on civilians. — The commanding officer of each Medical Department organ-
zation will submit to this office at once a report showing the present status and number
of civilian laborers employed, giving location of labor, nature of work at which employed,
and terms under which employed, including copy of any written contracts made in connec-
tion with same.
10. Transfer of patients with self-inflicted gunshot wounds. — In compHance with section
D, paragraph 1()2}4, Army Regulations, the report of the board of officers which investigated
the case will hereafter invariably accompany the patient upon his transfer, that whether
his injury occurred in line of duty may be determined.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 11.
Headquarters, American Expeditionary Forces,
Office of the Chief Surgeon,
France, March 4, 1918.
The following instructions are issued for the guidance of all medical officers:
1. Injuries to the bones and joints, as well as of the muscles and tendons adjacent
to these structures, represent a large percentage of the casualties of both the training the
combat periods of an army.
2. To restore useful function to these injured structures is one of the purposes of the
medical organization of the Army. The problems involved in this have to do not only
with the cleansing and healing of the wounds, but also with the restoration of motion in
the joint or strength to the part. This latter part naturally follows the first, but it is essential
that the first part be carried out with reference to that which is to follow. Unless this second
part of the treatment, the restoration of strength and motion, is carried out, much of the
first part is purposeless.
3. To insure to the man not only the proper treatment for this type of injury, but the
proper supervision until he is as fully restored as possible, necessitates some form of radial
control that makes it impossible for a man to be overlooked in inevitable transfers, from
service to service, or hospital to hospital.
914
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
4. Since so much of the ultimate result in these conditions depends upon orthopedic
measures after the first treatment of the wounds has been carried out, the following will
govern :
The director of orthopedic surger\- is responsible for the treatment of the injuries or
diseases of the bones or joints, exclusive of the head and face.
He will be held responsible for the treatment of injuries or diseases of the ligaments,
tendons, or muscles that are involved in the joint function of the extremities.
Officers attached to other divisions may operate upon and treat such conditions, but the
division of orthopedic surgerj^, through its director, will be held responsible for the character
of the treatment and for the final results.
It is expected that the direction and supervision of the treatment here indicated will
be carried out, in so far as is possible, in cooperation with the director of the division of general
surgery.
5. To carry out the instructions of this circular, the director of the division of orthopedic
surgery will arrange so that representatives of his division will see all cases of the nature
described, to determine whether or not their management is proceeding satisfactorily so
as to obtain the best possible results. These representatives will report to the commanding
officers of the hospitals in which such patients are being treated and their services as con-
sultants will be freely utilized; any recommendation made by them as to change of treatment,
transfer to some other professional service, or hospital, will ordinarily, if the military situ-
ation permits, receive favorable consideration.
6. It is not the intention of this order to interfere with the routine work of hospitals,
but to insure to the soldier proper supervision during the time of his treatment and the
period of his convalescence.
Bj- command of General Pershing:
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Approved:
J. G. Harbord, Chief of Staff.
Circular No. 12.
American Expeditionary Forces,
Headquarters, Services of Supply,
Office of the Chief Surgeon,
France, March 6, 1918.
1. Hereafter all requisitions from Medical Department organizations, American Expe-
ditionary Forces, will be made in quadruplicate, one copy being retained and three copies
being forwarded directly to the supply depot.
2. Of the three copies received at the depot, one will be retained for file, one will be
returned to the organization with marks as set forth below (indicating the action taken on
each item), and the other copy will be similarly marked and forwarded to the chief of the
division of accounting and finance. Medical Department, headquarters. Services of Supply.
3. The copy returned to the organization will serve both as an invoice and as a packing
list, and those two forms heretofore furnished organizations will no longer be prepared. Upon
receipt of the marked copy from the depot, the organization making the requisition will
erase all articles on the corresponding retained copy except those shown on the copy from
the depot as having been shipped (showing the amounts shipped in any article cut) and will
then forward the copy so marked to the chief of the division of accounting and finance, Medi-
cal Department, headquarters. Services of Supply, direct, acknowledging receipt across its
face.
4. The depot copies may indicate certain articles as having been placed upon the due
list. Such due lists will be made in triplicate. When shipments are made of these articles
previously due listed, one copy of the due list will be sent to the consignee, one copv to the
chief of the division of accounting and finance, and one copy retained, all copies being marked
as shown in paragraph 5. Upon the receipt of such marked due lists by the consignee, he
will change his retained copy of the corresponding requisition to include the articles received,
APPENDIX
915
will sign the due list and forward it to the chief of the division of accounting and finance,
Medical Department. When partial shipments are made upon the due lists, the articles not
shipped will again be due listed and the same procedure carried out.
5. The marks show^n will be as foUow's:
Check mark (requisition filled in full).
Number replacing the original number (requisition cut to that amount) .
Erasure (requisition disapproved).
D. L., followed by number (amount placed on due list; shipment to be made
when stock is received).
6. Articles not in stock or not expected within a reasonable time will not be due listed
and should therefore be again requisitioned for, but not until the lapse of a sufficient interval
to w^arrant expectation of their receipt from the States. Articles not on hand, but expected
within a reasonable time, will be due listed and will be furnished upon receipt without further
requisition.
7. Telegraphic requisition will be made in actual emergencies only and must be followed
by a requisition made out in proper form in quadruplicate, triplicate copies being forwarded,
marked "Confirmation of telegraphic requisition." When requisitions are made in letter
form they also will be forwarded in triplicate.
8. In order that the receiving officer may be able to check several shipments arriving
at the same time, resulting from two requisitions, or a requisition and a previous due list,
the following methods of marking shipments at depots will be established:
All boxes will be marked with the number given the requisition at the depot, followed
by the number of packages in the shipment, thus: 25 — 48 would mean that the shipment was
made on requisition No. 25 and that 48 packages were shipped. The copy of the requisition
or due list returned by the depot to the consignee w^ould carry the number 25.
9. Attention is again called to the very great importance of conserving medical supplies
in every possible way. It must be remembered that supplies are obtainable only with the
very greatest difficulty, and every unnecessary expenditure is both hurtful to the country
and to the individual soldiers, who by such unnecessary expenditure are deprived of their
legitimate due. Frequent inspection of storerooms and the closest scrutiny of all expendi-
tures is enjoined upon all commanding officers and surgeons.
Hospital fund statements. — These statements for the month of April and thereafter,
for all organizations of the American Expeditionary Forces in France, will be rendered upon
the basis of the amount received, expended, etc., in francs — the rate of exchange employed
being set forth if conversion from dollars and cents to francs has been necessary. Any loss
resultant from this conversion will be shown as an expenditure by expenditure vouchers.
Typewriter repair. — Hereafter all typewriters requiring repair wall be shipped to the
Medical Department repair shop No. 1, liter Ave. de la Revolte, Neuilly, Department of
Seine.
A. E. Bradley,
» Brigadier General, Chief Surgeon.
Circular No. 13.
General Headquarters, American Expeditionary Forces,
Office of the Chief Surgeon,
France, March 11, 1918.
1. A daily report of all new cases or suspected cases of any one of the diseases named
below will be made from all hospitals by telegraph, telephone, or messenger to this office:
Chicken pox. Plague.
Cholera, Asiatic. Scarlet fever.
Diphtheria. Smallpox.
Dysentery. Typhoid fever.
Meningitis (meningococcus). Typhus fever.
Paratyphoid fever.
2. The report wall include name and organization of the patient and the diagnosis.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
916 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 14.
Fkanck, March 13, 1918.
1. In view of the great importance of scabies as a cause of prolonged disability unless
prompt diagnosis is made and early treatment instituted, each division surgeon is directed
to select a suitable field hospital to which all cases of scabies of the division will be sent.
2. A medical oflScer of the division, with an adequate knowledge of dermatology,
should be used to instruct regimental medical officers in early diagnosis and treatment of
this disease if necessary.
3. The urgent necessity of close inspection frequently repeated for skin parasites of
all kinds is in this connection again brought to the attention of all medical officers.
Office circular No. 15.
Office of the Chief Surgeon,
American Expeditionary Forces,
Headquarters, Services of Supply,
France, March 25, 1918.
office regulations, correspondence practice, etc.
1. The office hours will be 8 a. m. to 12; 1.30 p. m. to 5.30 p. m.
2. Orderhes will regularly distribute the incoming mail to the several offices and collect
the outgoing mail. The regular distributing and collecting system will be placed on an
hourly basis. Within a few days a buzz system communicating with the orderlies will be
installed.
3. Incoming and outgoing baskets (so labeled) will be maintained in each office.
4. Central correspondence files will be maintained in room No. 1. Consolidation of
the American Expeditionary Forces and Services of Supply files is under way, as a result
of which a single system of numbering will be provided.
5. A central mailing section (receiving and dispatching) will be maintained in room
No. 6. Both incoming and outgoing mail will be cleared through the office of Major Dickson,
When action takes the form of an indorsement to original papers which leave the
office, necessary copies of the indorsement for file purposes will be prepared. In addition,
the office making the indorsement will prepare an abstract of the original papers wherever
the indorsement does not fully explain the nature and basis of the action taken. This abstract
will be detached in the file room. Such abstracts should be very brief and prepared only
for important papers.
7. Half sheets should be used for correspondence or memorandum purposes whenever
possible; but nothing smaller than half sheets. The use of smaller pieces of paper causes
confusion in the filing.
8. Telegrams will proceed through the regular correspondence channels of the office
except that an identifying number will be assigned and a brief record made in the mail room
as prescribed by Services of Supply circular.
9. The typing of envelopes in the office where correspondence originates will be dis-
continued beginning Thursday morning, March 28, 1918. Envelopes will be addressed in
the central mailing room, where an official list of stations and addresses will be kept. As
prescribed by regulations, each communication will contain the official address of the station
to which it is sent.
10. A central stenographic section will be maintained (rooms 20 and 21). Any officer
desiring additional stenographic service will make informal request upon the clerk in charge
of this section. This section will furnish the mimeograph and multigraph service for the
chief surgeon's office.
11. Cablegrams to the United States will be dictated direct to the official cable clerk.
This clerk can be reached at any time in room No. 20.
12. Office supplies will be issued from the property room between the hours 8 a. m.
and 10 a. m. each day. An issuing clerk will be on duty during those hours. The orderlies
APPENDIX
917
will replenish the supply of ink in the several offices as the need arises. Informal requests,
verbally or in writing, for other office supplies should be made upon the issuing clerk during
the hours mentioned.
13. Commander in chief, G-1, to commanding general, First Corps, under date of
March 22, 1918, states:
It has been decided to designate the senior staff officer of each division as "division
adjutant," "division inspector," "division ordnance officer," "division signal officer,"
"division veterinarian," instead of "inspector general," "judge advocate," "chief quarter-
master," "chief surgeon," "chief ordnance officer."
The title "division surgeon" will be used instead of "chief surgeon" in all official
designations of the senior medical officer of Infantry divisions.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 16.
American Expeditionary Forces,
Headquarters, Services of Supply,
Office of the Chief Surgeon,
France^ March 28, 1918.
I
The following extract from a letter. Surgeon General's office, dated February 25, 1918,
is pubhshed for the information and guidance of medical officers of the American Expedi-
tionary Forces:
1. * * * It is requested that whatever steps are necessary be taken to carrv out the
plans laid down in the Manual of the Medical Department, which provide that pathological
specimens of military interest be forwarded through regular channels to the Army Medical
Museum accompanied by complete histories.
2. In turn, the Army Medical Museum will distribute all duphcate specimens and parts •
of specimens, together with the clinical histories, to teaching institutions throughout the
United States, both in and out of the service. Since all medical students above those in
the first year are now in the Enlisted Men 's Reserve Corps, every teaching medical institution
becomes for all practical purposes a part of the service, and it is desirable to secure an equi-
table distribution of material for teaching purposes.
II
To Medical Department personnel: 1. The Assistant Auditor for the War Department
has stated that he sees no objection to quartermasters paying civilian employees of the
Medical Department from quartermaster funds, provided the civilian employees payable
from Medical Department funds are vouchered on separate roljs, and the Medical Department
appropriation to which chargeable is clearly shown thereon, and that such rolls are entered
on the abstract of disbursements under the same medical appropriation as is shown on the
voucher. Under this decision, it is possible for quartermasters at all base hospitals to make
the necessary payments to all civilian emplovees of the Medical Department on the approval
of the pay roll by the commanding officer of the hospital, which action the commanding
officer is authorized to take.
Another method of ready payment to civilian employees of the Medical Department
lies in making the payment from the hospital fund, if there be enough on hand. A notation
to the effect that the payment was made from the hospital fund should be made upon the
voucher by the paying officer, and the voucher subsequently forwarded to medical
disbursing officer, who will draw one check for the whole amount payable to the hospital
fund, noting on the check the object for which drawn and on the pay voucher the number
and other data of the check.
2. Recent arrangements with the French central authority provide that notifications
of property shortages occurring in official shipments should be made immediately upon the
discovery of the shortage of the local chef de gare of the railroad company concerned. It
is, of course, necessary that immediate action should be taken upon the receipt of a shipment
918
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
to determine whether shortages are existant, in order that no allegation may be lodged that
the propert}' was received in good condition, and the abstractions subsequently' made at
the point of receipt. The fact that the report has been made to the chef de garc should
be reported to the chief surgeon, American Expeditionary P'orces, along with the report of
shortages.
3. Commutation for allied patients in hospital. — The commutation for patients of this
class has now been determined to be 60 cents a day, w'here commissar}' privileges are available
and 75 cents a da\', where such is not the case. Under these conditions, it will not be neces-
sary to draw the additional 20 cents from the Red Cross, as heretofore authorized. This
change becomes effective from April 1, 1918, and after that date the 60 cents allowed will
be drawn as the entire compensation to the hospital fund for l>oth officer and soldier patients
of the allied armies.
Ill
1. The attention of all medical officers commanding hospitals and Medical Department
detachments is called to the importance of carrying out closely all the details of military
administration required by existing regulations, orders, and customs of the service, to the
end that their commands may at all times be ready to pass with credit the inspection of
superior officers.
2. Cases of neglect or slackness in carrying out ordinary measures of discipline, adminis-
tration, and sanitation having been brought to the notice of the chief surgeon special emphasis
is here given to the following jDoints: Discipline and administration — the reveille and check
roll calls are to be invariably observed in every hospital and detachment; the weekly forma-
tion and inspection of the detachment must never be omitted and military drill for all available
men of the Medical Department will be held as often and to as great an extent as circum-
stances permit, with the object that every soldier may present a well-poised, alert, and
soldierly appearance.
A correct military bearing of officers, nurses, and soldiers must be insisted upon and the
personnel should be instructed in forms of military address, manner of saluting, standing
at attention, and all the fine points of military etiquette. Correct uniform properly worn
and neatness of person and clothing should be required of all members of the command.
3. Sanitation. — Details of sanitation for the maintenance of a clean hospital are only
to be carried out properly by frequent and patient instruction to subordinates, by officers
and noncommissioned officers responsible for the care of the wards, mess rooms, kitchens,
and other parts of the hospital.
Attention to the personal cleanliness of the convalescent patients as well as those in
bed should be given.
Garbage unless entirely removed from vicinity of the hospital should be destroyed
by incineration, and excreta, in the absence of a sew^er system, should be burned if possible.
Cleanliness and order will render even a primitive and extemporized hospital attractive,
but slovenliness and disorder will spoil the efliciency of the best-equipped institution. To
utilize to the utmost advantage the often imperfect buildings and equipment which war
conditions impose, is the ideal to be striven for and this ideal is only to be approached by
unremitting attention to the small details of discipHne, management, and sanitation.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 17.
American Expeditionary Forces,
Headquarters, Services op Supply,
Office of the Chief Surgeon,
France, April 2, 1918.
instruction concerning autopsies
In order to secure proper records of causes of death of American troops in France and
specimens of scientific value for the Army Medical Museum, the following procedures' con-
cerning autopsies will be followed: * xuteuures con
APPENDIX
919
1. Autopsies are authorized in all cases of officers and soldiers, and should be performed
whenever possible. These autopsies shall be perfornaed only by medical officers or authorized
assistants. At the conclusion of the autopsy the body must be restored, as far as possible,
to its original form.
2. The blank form supphed for the autopsy protocol indicates in general the order and
extent of the examination as well as the order to be observed in completing the final record.
The protocol is also to be used for recording prehminary notes w^hen complete dictation at
the post-mortem is not possible. It is not to be used for the final record.
3. The headings on the protocol are to be filled out in every case and transferred in the
same order to the final record.
4. Clinical data should include only such essential facts as date and nature of wound
or first symptoms, length of stay in hospital, operative procedures, cHnical course and diagnosis.
5. Weights and measurements should be indicated by the metric system.
6. In performing the post-mortem attention should be directed when possible, not only
to the condition primarily responsible for death but also to evidence of previous disease
(tuberculosis, syphilis, etc.) and to all anomalies of development.
7. Bacteriological examinations, when indicated, should be undertaken and the results
appended to the final record.
8. When necessary to perfect the diagnosis, tissues for microscopic examination should
be removed and preserved in 10 per cent formal or other suitable fixative.
9. Gross specimens suitable for museum purposes are to be removed and preserved in
10 per cent formal. Such specimens are to be sent to the central Medical Department
laboratory, A. E. F., as soon as possible, for eventual transference to the Army Medical
Museum. Each specimen must have attached an identification tag with name and organi-
zation of patient, date, diagnosis of specimen, and name of sender. In case special tags for
this purpose are not available, an ordinary label protected by dipping in melted paraffin
may be used. For further details as to handling gross specimens, see supplement to section
135, Manual of the Medical Department.
10. At the earliest possible moment following the examination, a complete record
should be made. In addition to the required copies, one copy is to be sent to the central
Medical Department laboratory, A. E. F. If additional bacteriologic, microscopic, or other
data are obtained, additional reports will be made in the same manner, in each report repeat-
ing the name, rank, and organization of the case.
A. E. Bradley,
Brigadier General, Chief Surgeon.
Circular No. 18.
American Expeditionary Forces,
Headquarters, Services of Supply,
Office of the Chief Surgeon,
France, April 3, 1918.
1. In order that patients and Medical Department personnel in mobile sanitary forma-
tion and evacuations hospitals located in the zone of the advance may be prepared for gas
defense in emergencies, the following instructions are issued to responsible medical officers
concerned :
(a) The gas mask of each incoming patient should be separated from his other equip-
ment, and kept at the head of his bed.
(6) To supply such patients as are admitted without proper gas defense equipment,
requisitions should be made on the proper officers for a reserve supply of masks, based on
20 per cent of the maximum bed capacity.
(c) The personnel of these units should be equipped with masks and instructed in the
necessary routine gas defense measures.
{d) The commanding officer of each unit should so organize and drill the personnel as
to insure the quick adjustment of gas masks to patients, especially to those patients who
are more or less helpless, in the event of an alarm being given.
920
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(e) The plan to be prescribed for announcing the gas alarms is left to be determined by
the commanding officer concerned.
(/) Paragraph 3, General Orders, No. 25, A. E. F., chief surgeon, prescribes that all
militar}^ equipment of a soldier be forwarded with him when he is transferred to a hospital.
This equipment includes gas masks. Should patients be received at hospitals in appreciable
numbers without this equipment, report of same, particularly giving the soldier's organization,
will be made to this office for the action of the commander in chief.
A. E. Bradley,
Brigadier General, Chief Surgeon.
Circular No. 19.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
France, April 4, 1918.
1. Accountable office for Medical Department transportation. — There seems to be some
misunderstanding by organizations in the different sections regarding the accountable office
for Medical Department transportation in France.
M. S. D. No. 3 is the only accountable office for Medical Department motor trans-
portation.
Motor ambulances and motor cycles with and without side car are Medical Depart-
ment transportation; touring cars and trucks are Quartermaster Department property, and
memorandum receipts for the latter should not be sent to M. S. D. No. 3.
2. Charging excess leave against nurses under General Order No. 6. — The commanding
officers of base hospitals where nurses are stationed will take care that no excess leave is
charged against nurses who are granted leave under General Order No. 6, general head-
quarters, A. E. F., c. s. Several instances have occurred where nurses have been charged
on efficiency reports and returns of Nurse Corps with the time taken going to and returning
from the places where leave was spent. Attention is invited to the provisions of paragraph
7, General Order No. 6.
3. Shoes for distribution to Medical Department personnel. — The quartermaster has in
storage a certain number of shoes without hobnails, for distribution to Medical Department
personnel serving in base and camp hospitals. Requisition therefor should be made asking
specifically for special shoes for base hospitals.
4. Care of unwounded cases of gas poisoning. — The dangerous results of poisoning by
irritant gases are essentially limited to their effects on the respiratory tracts, and all such
cases should be under careful medical supervision in view of the danger of pulmonary edema
and pneumonia. It is directed therefore that all unwounded cases of gas poisoning be placed
in the medical wards of the hospitals to which they are admitted. Such burns as occur
from mustard gas poisoning may be readily treated in medical wards.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 20.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
France, April 12, 1918.
1. White clothing for hospital attendants. —So much of paragraph 8, Circular No. 9,
office chief surgeon, A. E. F., February 7, 1918, as provides for the wearing of white cotton
coats and trousers by enlisted attendants in wards is changed to provide for the wearing of
blue dungarees under the conditions named. Requisitions on the Quartermaster Depart-
ment for clothing to be worn on ward duty will specify the blue dungaree, instead of white
clothing. The Quartermaster Corps has made provision for the supply of white clothing
for cooks; and requisitions may specify this class of clothing for this class of personnel.
2. Red Cross allowance for soldiers of allied armies in United States hospitals —So much
of paragraph 1, Circular 10, office chief surgeon, A. E. F., March 4, 1918, as provides for the
APPENDIX
921
payment of 20 cents per diem by the Red Cross is rescinded. Quartermasters are paying
60 cents per diem for subsistence of allied patients, or 75 cents as the situation may demand,
dependent upon the presence or absence of commissary facilities. No voucher for Red Cross
subsistence, therefore, will be rendered in the future, the cost of allied patients being collected
from the quartermaster in the same way that it is collected for patients of our own Army.
3. Manual, sick and wounded reports. — A manual dealing with the sick and wounded
reports and returns for the American Expeditionary Forces, and with the methods of pre-
paring the same, will be issued shortly from the office of the chief surgeon, A. E. F., Services
of Supply.
It is desired that every medical officer of the American Expeditionary Forces and all
medical officers arriving hereafter in France and England be furnished a copy of this manual.
Copies will be sent to division surgeons, section surgeons, and commanding officers of
camp, evacuation, and base hospitals, who will immediately distribute them to each officer
of their command.
Sufficient copies to supply all incoming medical officers will be sent to surgeons of ports
of debarkation, who will be responsible for their distribution.
Instructions for obtaining the blank forms prescribed for the new system will be issued
later.
4. Splint repair shop at Dijon. — The Red Cross has installed a splint repair shop at
Dijon for the purpose of repairing the ironwork of splints and re-covering the splints.
All organizations having broken splints in sufficient quantities to make a case will
ship to the Croix Rouge Americaine entrepot, gare Dijon Ville (Cote d'Or), cases to be plainly
marked "For splint repair shop."
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 21.
April 13, 1918.
SUPPLY AND DISTRIBUTION OF BIOLOGICAL PRODUCTS (HUMAN)
1. The following standard biological products are available for issue to Medical De-
partment units of the American Expeditionary Forces:
(ffl) Bacterial vaccines. — Triple typhoid vaccine — typhoid, para "A," and para "B"
(1 c. c, 5 c. c, 10 c. c, and 25 c. c. ampules).
(6) Serological products. — (1) Sera, agglutinating for diagnosis:
Typhoid.
Paratyphoid A.
Paratyphoid B.
Dysentery, Flexner.
Dysentery, Shiga.
Dysentery, Y.
Cholera.
Malta fever.
Pneumococcus Type I.
Pmeumococcus Type II.
Pneumococcus Type III.
Meningococcus, polyvalent.
Meningococcus, normal.
Meningococcus, intermediate A.
Meningococcus, intermediate B.
Parameningococcus.
Gas gangrene {B. welchi).
The diphtheria toxin unit for applying the Schick test will be issued to meet special
indications.
(2) Sera, therapeutic and prophylactic:
Antimeningococcus serum, polyvalent (15 c.c. bottles).
Antistreptococcus serum (50 and 100 c. c. bottles).
Antipneumococcus serum, polyvalent (50 and 100 c. c. bottles).
Antipneumococcus serum, Type I (50 and 100 c. c. bottles).
Diphtheria antitoxin (bottles containing 1,000 and 10,000 units).
Tetanus antitoxin (bottles containing 1,000, 1,500, 3,000, and 5,000 units).
Normal horse serum.
2. In view of the well-known instability of these products unless kept under very
special conditions, to avoid wastage, and to insure prompt distribution, reserve supplies of
922
ADMINISTEATION, AMERICAN EXPEDITIONARY PX:)RCES
these products will be kept on hand onh^ at the laboratories mentioned below. It is not
contemplated that a supply greater than a reasonable amount to meet actual emergencies
be kept on hand in other Medical Department units.
Central medical department laboratory, advance section, Services of Supply, A. P. 0.
No. 721.
Army laboratory No. 1, advance section. Services of Supply, A. P. O. No. 731.
Base laboratory, base section No. 1, headquarters base section No. 1, Services of
Supply, A. P. O. No. 701.
Base laboratory, base section No. 2 (Base Hospital No. 6), headcjuarters base section
No. 2, Services of Supply, A. P. O. No. 705.
Base laboratory', base section No. 5, headquarters base section No. 5, Services of
Supply, A. P. O. No. 716.
Base laboratory, intermediate section. Services of Supply, headquarters Services
of Supply, A. P. O. No. 717.
Laboratory, American Red Cross Military Hospital No. 2, Services of Supply,
A. P. O. No. 702.
3. Hereafter, biological products will be obtained from the commanding officer of the
nearest designated distributing center by telephonic or telegraphic request. In emergency,
deliveries will be made by motor-cycle courier whenever necessary and feasible. In
instances where travel b\' train would be in the interest of economy and would not result in
delay in delivery, the commanding officers of the laboratories designated above are author-
ized to dispatch couriers by train to make the deliveries.
4. The designated distributing centers are so located that deliveries, as a rule, can be
made to any Medical Department unit of the American Expeditionary Forces within a
few hours. The geographical location of these laboratories can be ascertained by appli-
cation to the headquarters in which the medical unit is located.
5. It is not deemed advisable to furnish therapeutic antipneumococcus serum except
to hospitals that are prepared to make pneumococcus type determinations. Whenever the
disease assumes epidemic proportions, special laboratory personnel and equipment will be
detailed to handle the situation.
6. Requests for special biological products will be made directly to the director of
laboratories, A. E. F., A. P. O. No. 721, indicating the necessity for their use. The director
of laboratories and the commanding officers of laboratories designated as distributing centers
are authorized to modify requisitions whenever the demands are manifestly in excess of
actual requirements or when the biological products requisitioned for are of such a nature
as to require careful laboratory control in their administration and it is definitely known
that such laboratory facilities are not available.
7. Additional distributing centers will be designated as necessity for their establish-
ment arises.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 22.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
France, April 17, 1918.
1. The attention of all medical officers is again called to the extreme importance of
bodily cleanliness and freedom from vermin throughout the troops of the American Expedi-
tionary Forces. The following notes are furnished for the information and guidance of all
concerned:
Scabies and lousiness, with their resulting inflammations and scratch infections of the
skin; also trench fever, due to lice, bid fair to cause more ineffectiveness than any other
disease or disease group in the American Expeditionary Forces.
The experience of the British is well summarized in the lectures of Major McNee and
Captain Parkinson :
Trench fever, scabies, inflammatory processes in the skin such as boils and furuncles
(the pyodermias), etc., caused 90 per cent of all diseases in the British armies in France in the
summer of 1917. (]Major McNee.)
APPENDIX
923
At the head of the diseases which actually cause loss of efficiency is scabies, and its
frequent sequelaj, impetigo, and ecthyma. Impetigo means a loss of 10 to 12 davs at the base,
and scabies means a loss of 50 per cent of a man's efficiency from loss of sleep by itching and
scratching. Nearly all cases of fever of unknown origin (F. U. O.) are accompanied by lice.
This F. U. O. is a serious cause of sick wastage among the English. (Captain Parkinson.)
Sanitary reports from our own divisions, and from numerous scattered organizations in
France, indicate that infestation with lice and scabies is widespread, in some large commands
as many as 75 per cent of the men being infested.
The steady and heavy demand at dispensaries and regimental infirmaries for ointment
to relieve itching indicates that there is a great mass of infestation which is not recorded on
sick report.
Sanitary reports should show the incidence of scabies and the extent of the louse infesta-
tion. The causes of infestation should be indicated and measures necessary to correct the
condition recommended. The remedial action taken must be invariably recorded.
Advantage should be taken of the opportunity to inspect the person and clothing of the
command at the semimonthly inspection for venereal diseases, as specified in M. M. D. 1917
(par. 198-c, p. 75). General bodily cleanUness and cleanUness of underclothing are quite as
much an evidence of good mihtary discipline and adequate medical service as is a low rate for
venereal infection.
*******
HINTS FOR DIAGNOSIS AND TREATMENT
All scratch marks, complaints, or evidence of itching, or " p-yodermias " should be con-
sidered as due to scabies or lice until proved to the contrary.
Although in civil life the characteristic distribution of scabies is between the fingers and
and on the anterior surface of the wrists, the site of infestation among our troops, even when
severe, may be exclusively beneath the clothing, and must be sought by thorough inspection of
the genitals, the buttocks, the belt line, the arm pits, and behind the knees.
The characteristics lesions of scabies, in addition to the burrow in the skin, are papules,
superficial crusted ulcerations (often called impetigo and ecthyma), and in severe cases
extensive areas of dermatitis resembling eczema and furunculosis. These secondary lesions
may predominate and conceal all burrows. The Acarus scabiei, or itch mite, can not
usually be found. The scratching in scabies usually does not tear the skin deeply nor form
linear welts, in spite of the intensity of the itching.
Body lice, on the contrary, are more generally distributed over the body and are to be
found commonly on the hairy parts and in the bodj'^ creases and where the clothing is tight, and
it is in these regions that the long deep linear scratches are found. Lice and nits are to be
sought for and can be readily seen in the seams of the clothing.
Prevention of general infestation of men and their clothing can be assured by the dis-
covery of early cases, through careful inspection and accurate diagnosis, and the instant
removal of the patients and their possessions from barracks or billets, to avoid the general
infestation of quarters. All men should be questioned as to itching of the skin, and no
complaint considered too trivial to investigate.
The treatment of scabies requires prolonged scrubbing of the entire body with hot water
and a generous soap lather, followed by thorough immction with sulphur ointment. Clean
underclothing must be put on after each such treatment to avoid reinfestation.
A complicating eczema or furunculosis may prevent the above radical treatment of
scabies until the secondary lesions are controlled, but then the scabies must be treated as
above.
Thorough hot water and soap bathing will free the body from lice, but the Uce and nits
in the clothing and blankets must be destroyed, preferably by dry heat, at the same time
in order to prevent immediate reinfestation.
Every medical oflScer in the American Expeditionary Forces will be expected to give his
personal attention to the prevention and treatment of scabies and louse infestation in the
command for which he is responsible.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
924
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 23. a i aa imo
France, April 22, 1918.
1. Payment of civilian employees by quartermaster. — Whenever payment of civilian
employees is made by the quartermaster under the method laid down in paragraph 1, section
2, Circular No. 16, this office, a true copy of the roll as paid will be sent to this office, through
the section surgeon, by the commanding officer of the hospital concerned.
2. Repair of surgical instruments and typewriters. — The surgical instrument repair
shop is now ready to repair surgical instruments and typewriters at U. S. A. P. O. No. 702.
When articles need repair they should be sent to the repair shop or turned into the nearest
supply depot, dependent upon the relative distance of the depot and repair shop from the
point where the instruments or typewriters are held. It will often be advisable to send
instruments of precision and of delicate makeup by special messengers, and authority should
be obtained for their transportation from the nearest headquarters authorized to order
the travel.
3. Ordre de transport for movements made by hospital trains. — Copies of those orders
which are furnished to train commanders for each trip made by their trains should be retained
until the end of the month, at which time they should be forwarded to this office, where
they are checked against the journey reports and forwarded to the chief quartermaster,
Services of Supply.
4. Return of blankets to hospital trains. — Hospital trains have been unnecessarily delayed
at base hospital awaiting the return of blankets delivered by them with patients. These
blankets are to be returned with expedition in order to avoid delaying the trains.
5. Report of French patients in American military hospitals. — Hereafter when French
military patients are admitted to or discharged from American military hospitals, notifica-
tion of the fact will be sent immediatelj^ to the Service de Sante, No. 1, Rue Lacretelle,
Paris, on Form 52, Medical Department. The data on the report card will show the name,
number, rank, and organization of the patient, the diagnosis, whether or not the disability
was incurred in line of duty, and the designation of the hospital to which he was admitted
or from which discharged. Information in this form is strictly for the use of the French,
and no duplicates of these cards shall be sent to the chief surgeon's office, A. E. F. The
month!}' list of French patients in American Expeditionary Forces hospitals, giving the
above data, will be continued.
6. Discontinued medical forms. — Forms 83 and 85, Medical Department, and so much
of Form 84, Medical Department, as applies to daily field report of patients, are discontinued.
Circular No. 24. American Expeditionary Forces,
France, April 23, 1918.
Disability boards passing upon mental and nervous cases under section I, General
Order No. 41, general headquarters, A. E. F., March 14, 1918, will, as far as practicable, be
governed by the following considerations.
general
In dealing with these cases, there should be borne in mind their chronicity, the prob-
ability of recurrences or acute episodes in constitutional disorders, and the bearing which
abnormal mental states have upon questions of responsibility. The special mental stresses
of modern warfare and the fact that the safety of many soldiers often depends upon the
conduct of one of their number should be given due weight in considering the fitness of men
with mental or nervous diseases for service at the front. At the same time the importance
of utilizing, in any safe and suitable way, the services of men partially incapacitated should
not be overlooked. The essential question for boards to decide is usually whether, taking
all the facts into consideration, the individual before them will be an asset or a liability to
the Expeditionary Forces. Whenever possible a psychiatrist or a neurologist should act
as one member of a board passing upon mental cases.
APPENDIX
925
PSYCHOSES (INSANITY, MENTAL ALIENATION, MENTAL DISEASES)
All officers and enlisted men in whom frank psychoses exist should be marked "D"
and returned to the United States as soon as this can be done without injury or endangering
their chances of recovery. It will often be advantageous to hold these cases in the psvchi-
atnc departments of base hospitals at base ports until acute and severe manifestations have
passed or, in cases of an especially favorable type, until recovery has taken place, but it
should not be made the practice to provide extended treatment in hospitals of the American
Expeditionary Forces.
In exceptional cases where it seems desirable to depart from the rule of returning to
the United States soldiers who have or who have had psychoses, the patients may be classi-
fied "B," and the special considerations which make a departure from the rule desirable
must be noted on the report card.
MENTAL DEFICIENCY (FEEBLE-MINDEDNESS, DEFECTIVE MENTAL DEVELOPMENT)
The existence of a readily demonstrable degree of mental deficiency should almost
invariably be sufficient reason for not classifying soldiers as "A," but it should by no means
be regarded as sufficient reason in itself for placing them in class "D." In recommending
mentally defective soldiers for duty in labor organization at the rear, especial weight should
be given to good physique, emotional stability, and freedom from such delinquent traits
as alcoholism, dishonesty, nomadism, and the like. Mihtary delinquents, of whom the
mentally defective constitute a large proportion, are a source of almost as much noneffective-
ness as illness, and it is important that the Expeditionary Forces should not be burdened
with their care and supervision. Defective delinquents should always be classified "D."
CONSTITUTIONAL PSYCHOPATHIC STATES
In making recommendations as to the disposition of soldiers found to have constitu-
tional psychopathic states, the considerations mentioned under the preceding heading should
govern. It should be remembered that many individuals with volitional defects are ame-
nable to military control. Conditions which should usually indicate the wisdom of return-
ing these cases to the United States are marked emotional instability, sexual psychopathies
(homo-sexuality, etc.), paranoid trends, and specific criminalistic traits. These cases should
be classed "D." Excessive fear or timorousness should prevent return to duty at the front.
For military reasons it is especially undesirable, however, to return such cases to the United
States. They should be recommended for duty in labor organizations and marked "C."
EPILEPSY
Epileptics should be classed as "D," the only possible exceptions to this rule being
individuals in robust physical health who have attacks of moderate severity at long inter-
vals and those in whom treatment has had this result.
In making the diagnosis of epilepsy the fact should be borne in mind that attacks are
likely to be less frequent in the favorable environment of the hospital while observation is
being carried on than in the organizations from which patients are received. Great weight
should be given to a well-authenticated history of epileptic seizures, especially when wit-
nessed by medical officers or other persons who can give a clear account of their character.
While the possibility of malingering should not be overlooked, it should be remembered
that attacks similar to those in epilepsy are much more frequently psychoneurotic in their
nature than feigned. The high prevalence of epilepsy among soldiers should be remem-
bered.
DRUG ADDICTION AND ALCHOLISM
These conditions are essentially curable. Inebriates and drug addicts should not be
recommended for return to the United States with a view to their discharge until thej^ have
failed to respond to adequate treatment. Then, their disposition should depend upon the
type of personality presented, the effects of alcohol or drugs in physical deterioration or
damage to the central nervous system, and the conditions to which they will be exposed
when they are returned to duty. It will often be found that these cases do better at the
front than in duty at the rear.
926
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PSYCHONEUROSES (HYSTERIA, NEURASTHENIA, PSYCH ASTHENIA)
These conditions must be dealt with as disorders amenable to treatment under proijcr
conditions. Individuals who fail to benefit from such treatment in the special hospital
which has been provided, either because of severe defects in make-up or on account of pre-
vious mismanagement, should be returned to the United States for continued treatment
unless it seems likely that good results can be obtained from their assignment to duty at
the rear. A very large proportion of the severe neuroses seen in war are of the "situation
type," rather than psychoneurotic manifestations in persons who have had many previous
episodes of the same kind in civil life.
A. E. Bradley,
Brigadier General, N. A., Chief Surgeon.
Circular No. 25.
American Expeditionary Forces,
France, May 5, 1918.
organization of professional services, medical department, a. e. f.
There has been appointed, by General Order No. 88, general headquarters, A. E. F.
June 6, 1918, for the Medical Department:
A director of professional services, A. E. F.;
A chief consultant, surgical service, A. E. F.;
A chief consultant, medical service, A. E. F.;
Senior consultants in special subdivisions of surgery and medicine;
Division specialists; and
Consultants for base hospital centers and other formations.
In order to utilize the professional services of the specialists of the Medical Depart-
ment, A. E. F., in a manner which will best facilitate complete coordination between forces
from front to rear, the following instructions are issued:
Director of professional services. — The director of professional services, under the hos-
pitaHzation division of the ofl^ice of the chief surgeon, will supervise the professional activi-
ties of the Medical Department, A. E. F., and coordinate the work of the consultants and
specialists of the Medical Department.
Chief consultants. — The chief consultant, surgical service, will supervise the professional
surgical subdivisions in the American Expeditionary Forces. He will organize and coordinate
these divisions in a manner which will permit him to anticipate, as far as possible, necessary
changes in personnel so that timely requests for such changes may be made. He is responsible
for the proper formations of the surgical teams in the American Expeditionary Forces, and
those attached to the units of the Allies, and he will keep lists and records of the teams
whereby the amount and the efficiency of their work may be checked. For this purpose he
will require from each surgical team suitable monthly reports of the number of operations
performed and the results obtained. He will make such recommendations as he may deem
necessary for inspections as to technical procedure and instruction, details of operating sur-
geons, details to surgical teams, and appointment of surgical consultants in the American
Expeditionary Forces.
The chief consultant, medical service, will supervise all medical subdivisions in the
American Expeditionary Forces, and will make such recommendations as may be necessary
to insure a high professional standard and complete harmony among his assistants functioning
in all formations.
Senior consultants. ~\]ndev supervision of the director of professional services and the
chief consultants in surgery and in medicine, senior consultants of the special subdivisions
of medicme and surgery will coordinate professional activities relating to their specialties.
They will make such recommendations to the chief consultant as are deemed necessarv
for the instruction of consultants and specialists in divisional and other armv formations, in
order that prompt execution of directions relative to professional subjects may be assured.
Senior division consultants.— One senior medical and one senior surgical consultant will
be assigned to all tactical organizations which are the equivalent of one army corps and
APPENDIX
927
consultants will be appointed in such numbers as may be necessary to assist the senior divi-
sion consultants. Senior division consultants will hereafter be responsible for the duties now
being performed by the division consultants.
The senior division surgical consultant, under the chief surgical consultant, A. E. F.,
will be expected to make at frequent intervals a complete survey of the professional instruc-
tion, surgical technique, and the methods of treatment in use in the division, and he will
render from time to time such reports and recommendations to the chief surgical consultant,
A. E. F., as will promote a free interchange of suggestions and the most effective coordination
with the other professional services.
He will supervise the professional activities of all consultants, operating teams, and
operating surgeons attached to his division, in a manner which will permit him to familiarize
himself with the individual capabilities of the men, with a view to selection, based on
observation, of those likely to adapt themselves to modern military surgical teams formations,
rather than individual work.
He will be responsible for the organization, effecienc}- and distribution of surgical teams,
and he will make such recommendations to the chief surgical consultant, A. E. F., as will
facilitate the formation of sufficient teams to meet the constantly increasing demands incident
to the arrival in France of new formations.
The senior divisional consultant will also coordinate the activities of the professional
personnel in his divisions in a manner that will be conducive to high surgical standards,
and elimination or reassignment to other duties of those who fall below the requirements.
He will spare no effort to promote professional harmony and unity of treatment in the
divisional formations.
Senior divisional medical consultants. — The senior divisional medical consultant will, by
frequent inspections, satisfy himself that the various classes of patients suffering from medi-
cal disabilities are receiving the best and most advanced treatment possible. He will report
from time to time to the chief medical consultant, A. E. F., the results of his inspections, and
make suggestions looking toward the perfection of the medical services of the American
E.xpeditionary Forces.
Divisional surgical consultants. — The divisional surgical consultant will, under the senior
divisional surgical consultant, supervise the immediate surgical activities of operating teams
within his division. During mobile or semimobile warfare, when established evacuation
hospitals are absent, the operative work, in formations for nontransportable cases, will be
handled, when practicable, by surgical teams functioning under the supervision of the senior
divisional surgical consultant, or his assistant.
Divisional medical consultants. — Divisional medical consultants will supervise the imme-
diate medical activities in the division to which they may be assigned.
Relation of the division surgeon to senior division surgical consultants and consultants
functioning with divisions. — The many details of organization and administration which will
devolve upon the division surgeon, in the care of sick and wounded and their evacuation,
will so tax his time and ability that it is not believed that the supervision of the technical
surgical work, which at times must be done in divisional formations, should be added to his
already serious responsibilities; therefore, the direction and supervision of the purely opera-
tive side of the work done in divisional formations is placed upon the senior divisional surgical
consultant, or his assistants.
The division surgeon will supply the necessary hospital facilities, supplies, and personnel
other than those forming teams. He will spare no effort in technical cooperation which may
promote harmony of action between the professional services with the fighting forces, from
the front to the rear.
Division specialists.— One orthopedic surgeon, one urologist, and one neuropsychiatrist
will be appointed from the division sanitary personnel, and, under the direction of the divi-
sional chief surgeon, they will perform the duties pertaining to their several specialties, in
addition to the other duties of medical officers which may be required of them by the exigen-
cies of the service.
13901—27 59
928
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
CortsiiUants for base hospital centers. — Upon the recommendation of the chief surgical
and medical consultants, A. E. F., there will be appointed for base hospital groups such
consultants as may be necessary from time to time. These consultants will at all times be
within reach of the base hospital group to which they are attached.
The organization of base and general hospitals and other hospitals, as far as practicable
will be made on the basis of three services — surgical, medical, and laboratory — each composed
of sections coordinated through a chief of service designated by the commanding officer,
who may be selected from any section, ability and experience being the determining factors.
In detail, the professional services of hospitals are divided according to the following:
ORGANIZATION OF BASE AND GENERAL HOSPITALS
Surgical services.
Chief of service.
First section. General surgery (general, chest, abdomen fractures).
Second section. Orthopedic surgery.
Third section. Urology.
Fourth section. Head surgery (brain (also neurological); ear, nose, and throat:
eye; oral, face and mouth).
Fifth section. Roentgenology.
Sixth section. Dentistry.
Medical services.
Chief of service.
First section. General medicine.
Second section. Neurology.
Third section. Psychiatry.
Laboratory services.
Chief of service.
First section. Pathology.
Second section. Bacteriology and serology.
Circular No. 2 of this office, November 9, 1917, is hereby revoked.
M. W. Ireland,
Brigadier General, U. S. A., Chief Surgeon.
American Expeditionary Forces
Director Professional Services
Chief Consultant, Surgical Service
Chief Consultant, Medical Service
ARMY
Senior consultant, surgery, A. E. F. :
1 general surgery.
1 orthopedic surgery.
1 urology and dermatology.
1 eye.
1 ear, nose, and throat.
1 neurological surgery.
1 maxillofacial surgery.
1 Roentgenology.
1 research.
1 formations, equivalent to an army
corps.
4 consultants (assistants to division sen-
ior consultants).
Senior consultant, medicine, A. E. F. :
1 general medicine.
1 neuropsychiatry.
1 formations, equivalent to an army
corps.
2 consultants (assistants to division sen-
ior consultants).
(Others as required.)
APPENDIX
929
(Army corps)
DIVISION
Specialists: Each tactical division
(A part of division sanitary personnel, Tables of Organization)
Surgery :
1 orthopedic surgery.
1 urology.
Medicine:
1 neuropsychiatrist.
HOSPITAL CENTERS
Consultants, medicine (each hospital cen-
ter, Services of Supply) :
1 general medicine.
1 neuropsychiatry.
(Others as required).
Consultants, surgery (each hospital center,
Services of Supply) :
1 general surgery.
1 orthopedic surgery.
1 urology and dermatology.
1 eye.
1 neurological surgerj\
1 ear, nose, and throat.
1 maxillo-facial surgery.
1 Roentgenology.
Surgery (as needed) :
General surgery.
Orthopedic surgery.
Urology and dermatology.
Neurological surgery.
Eye.
Ear, nose, and throat.
Roentgenology.
Maxillo-facial surgery.
SERVICES OF SUPPLY
Specialists: Each base hospital
(Part of unit personnel)
Medicine (as needed) :
General medicine.
Psychiatry.
(Others as required.)
Circular No. 26.
American Expeditionary Forces,
France, May 4, 1918.
1. Requisitions for medical supplies for army troops. — So much of Circular No. 12,
office chief surgeon, A. E. F., March 6, 1918, as conflicts with the procedure prescribed in
paragraphs No. 27 and No. 29, General Order No. 44, general headquarters, A. E. F., March
23, 1918, is rescinded. Organizations of the Medical Department serving with a division,
corps, or army will hereafter obtain medical supplies in the manner prescribed by the general
order and paragraphs cited. A combined packer's list and invoice will be furnished the
receiving officer.
2. Shipments to Medical Department repair shop No. 1. — In connection with paragraph
2, Circular No. 23, this office, April 22, 1918, it is directed that when typewriters or surgical
instruments are sent to Medical Department repair shop No. 1, an order for transport or
tlie number of the order be mailed to the officer in charge to facilitate the receipt of such
articles from railroad station. When organizations have sufficient typewriters needing minor
repairs to warrant the sending of a typewriter repair man with a portable outfit to make these
repairs, a request will be made directly to the officer in charge of the shop.
3. Manner of washing mess kits. — The Surgeon General of the Army has called atten-
tion to the fact that complaints have come from many civilian sources about the manner of
dish washing or mess-kit washing in vogue in many camps, viz, that large numbers of men
930
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
rinse their kits in the same small bucket or can of water, so that late comers really use a cold or
cool slop mixture. While this office is without evidence that disease has been spread by
the practice complained of, it must be admitted that the practice is dirty and not in accord
with the teachings of good housekeeping or good hygiene. In only exceptional circumstances
will it be impossible, by the exercise of a little ingenuity, to obtain water decently clean
and scalding hot for the use of each man. Surgeons with all commands are directed to
do everything in their power to bring about proper practices in this matter. Should they
be unable to do so, report will be made to this office.
4. Requisitions for laboratory and X-ray supplies. — It has become apparent that the
director of laboratories and the director of Roentgenology, in order to maintain proper
supervision over the technical services, must visa all requisitions for those services. Here-
after all requisitions for laboratory supplies and for X-ray supplies, including both articles
listed on the supply table and articles not so listed, will be made separately and forwarded
as follows:
Requisitions for laboratory supplies: To the directQf of laboratories, American Expedi-
tionary Forces, U. S. A. P. O. 721.
Requisitions for X-ray supplies: To the director of Roentgenology, American Expedi-
tionary Forces, U. S. A. P. O. 731.
It is desired that so far as possible these requisitions be so timed as to permit shipments
thereupon to be included in the larger shipments made on ordinary requisitions. These
special requisitions should therefore be sent approximately 10 days prior to larger requisitions
contemplated and should bear notation that shipments should be held pending receipt of
the requisition for general supplies.
6. Forwarding of purchase vouchers. — All vouchers covering purchases made under
the provisions of paragraph 4, Circular No. 15, chief surgeon's office, line of communications,
and all vouchers, for purchase made under the provisions of paragraph 1, Circular No. 19,
chief surgeon 's office, line of communications, will be sent through the section surgeon to
this office, for payment by the disbursing officer attached hereto.
6. Requisitions upon the Red Cross. — Hereafter requisitions upon the Red Cross will
be honored at the Red Cross depots after approval by the following officers:
For all troops within a division, by the division surgeon.
For all hospital and troops in the services of supply, by the section surgeons.
Attention is again invited to the fact that the Red Cross should not be asked for articles
on the supply table or properly chargeable against Medical Department funds, except in
emergencies, and to the undesirability of submitting to the Red Cross requisitions for articles
erased from the medical supply tables by reason of their unimportance.
7. Purchase of food supplies locally to he charged against hospital fund. — Due to the fact
that local French authorities are not authorized to receive payment for supplies purchased
from them the United States Government is receiving bills from the French Government
for food supphes purchased by United States Army hospitals. Commanding officers should
bear in mind that there will be ultimately a charge against the hospital fund and should
keep accurate track of all such purchases and the cost thereof and should consider the same
an outstanding charge against the hospital fund, reserving a sufficient balance to enable
prompt reimbursement to the fund from which these bills are paid.
8. Purchase of technical apparatus locally. — It is believed that many small purchases,
particularly of surgical instruments and minor technical apparatus, are being made in the local
markets. This is no doubt due to the fact that there was great difficulty in securing these
articles from the supply department in the early days. A well-balanced and well-main-
tained shipment of such equipment is now being received from the United States, and it
is desired that all requests for this material should pass first through the medical supply
depot; the officer in charge of which will, if necessary, make request upon the purcha.sing
officer.
M. W. Ireland,
Brigadier General, N. A., Chief Surgeon.
Note. — Circular No. 25 has been delayed and will be issued later.
APPENDIX
931
Circular No. 27.
American Expeditionary Forces,
France, May 13, 1918.
1. Administration of messes— Function of dietitian. — The reports of medical inspectors
and officers of the food and nutrition section show that the administration of messes is, as
a rule, the least efficient and satisfactory part of hospital administration. The defects
noted are a monotonous and ill-balanced dietary, poor service, and lack of cleanliness in
the kitchen and the kitchen personnel. These inspections show that commanding officers
have not made proper use of the agency which is especially intended to correct these defects,
that is to make proper use of the dietitians who have been assigned to the base hospitals, to
use their expert knowledge for the correction of these defects, and to exercise the constant
vigilance and attention to detail which is necessary for successful mess administration.
Dietitians are trained experts in nutrition and food preparation. If not trained nurses,
they arc civilian employees having a status analogous to that of a trained nurse. The
function of the dietitian is to supervise the preparation not only of the special diets, but to
make out the bills of fare and supervise the preparation of all food furnished by the Govern-
ment. The dietitian has expert knowledge of which the commanding officer should make
the fullest use for the benefit of his command. She should be able to relieve the mess officer
from the burden of details required to secure a well balanced ration, proper variety and
preparation, and a good service. The mess officer should make a daily inspection, accom-
panied by the dietitian and the mess sergeant, to see that the details of a good service are
carried out fully and completely.
Like all other women of the personnel of a base hospital, the dietitian is under the
disciplinary authority of the chief nurse.
2. Instructions for the use of the Lyster water sterilizing bag. — (a) The following instruc-
tions for the use of the water sterilizing bag (Lyster) are published for the information of all
concerned :
(1) Clean the inside of the bag thoroughly.
(2) Fill it to the white band, with best water available.
(3) Place a tube of hypochlorite in an ordnance cup and break the tube with the l)utt
of an ordnance knife. Mix the powder into a smooth paste with a little cold water, using
the blade of the knife to break up the lumps. (Hypochlorite tends to lump when added to
water and, therefore, special care must be taken to obtain a smooth paste.) Fill the ordnance
cup about half full of cold water, stir and pour the nearly clean solution into the water in
the bag, keeping the glass in the cup. Stir the treated water thoroughly.
(4) Fasten the cover on the bag and allow the water to stand 30 minutes before use.
(5) Never refill a partially emptied bag. Always empty the water from the bag before
filling with fresh water.
(6) Use one tube of i)owder for every bag full of water. Tubes of hypochlorite are
to be obtained from the quartermaster.
(7) Report any difficulties to the medical officer.
(8) Keep a record of the treatment attached to the card.
(b) Cards containing these directions on waterproof paper are in source of printing
and will soon be available for issue.
3. Bandaging of mustard gas cases. — The direction du Service de Sante of the first
French Army has sent to this office the following "Note de service":
It has been called to mv attention that men suffering from mustard gas conjunctivitis
arc evacuated with cotton tightly bandaged over their eyes. This is an improper dressing.
The lids should be compressed as little as possible. A small compress of dry gauze, and a
loose bandage should be applied.
4. Nurses' service chevrons. — The War Depart mcTit has informed general headquarters
that under date of January 12, 1918, authority was given for members of the Army Nurse
Corps to wear war service chevrons under the same conditions heretofore prescribed for
officers and enlisted men.
5. Vouchers to he forwarded to this office. — Attention is invited to Paragraph 2, Circular
5, chief surgeon, line of communications, September 21, 1917. All vouchers pertaining to
money or i)ropcrty accountal)ility, which formerly have been forwarded to the Surgeon
General, United States Army, will, in future, be forwarded to this office.
932
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
6. Visiting places for convalescent officers.— Commanding ofiicers of hospitals are notified
that the persons whose names and addresses are given below have expressed a willingness
to receive in their homes as guests, free of all expenses, convalescent officers to the
limit of the accommodations. Commanding officers should exercise judgment in the
selection of cases which will be received on their recommendation, and should not send any
who are not fully able to look after themselves or require hospital treatment. There is,
however, a Red Cross physician in the town of Cannes who can give treatment in the case
of emergency. Before sending an officer to either place the commanding officer should
ascertain by telegraph whether it is convenient for the host to receive him. The chief
surgeon's office should be notified by mail of each case in which an officer has availed himself
of this hospitality, and given the name and organization of the officer, and the date.
Capt. Clement Brown, Villa-les-Lotus, Cannes (A. M.).
Mr. Samuel Goldenberg, Nellecote, Villefrance-sur-Mer (A. M.).
7. Disposition of psychiatric, pulmonary tuberculosis, and war neuroses cases. — (a) Psy-
chiatric cases, including those of insanity and feeble-mindedness, should not be held for
prolonged observation, but should be sent to Base Hospital No. 8, provided the cases are in
fit condition to make the journey. Upon request, special trained attendants will be sent
from Base Hospital No. 8 to care for the cases en route. Such request should state the charac-
ter and condition of the cases. On account of the local restrictions as regards transporta-
tion of the insane, a diagnosis will not be made, nor will the patient be declared insane or
classified as of class D. Carefully prepared histories will be forwarded to the commanding
officer of Base Hospital No. 8.
(b) For the present, cases of pulmonary tuberculosis should be sent to Base Hospital
No. S. Such cases should not be classified as of class D before transfer.
(f) Cases of war neuroses should be transferred to Base Hospital No. 117.
M. W. Ireland,
Colonel, M. C, Chief Surgeon.
Circular No. 28.
American Expeditionary Forces,
France, May 15, 1918.
Subject: Sick and wounded reports for the American Expeditionary Forces.
* * * * * * *
(Additional Instructions for Form 22, A. G. O., S. D., A. E. F. (Sec. V)
1. When giving admissions on "Daily report of casualties and changes of patients in
hospital," Form No. 22, A. G. O., S. D., A. E. F., "Line of duty" or "Not in line of duty"
m&y be specified by "L" or "N" in quotation marks.
2. On that form, diagnosis, in addition to including nature of disease, injury, or wound,
will specify regional location of wounds, sUght or severe ("O" or "S"), in action or acciden-
tally incurred ("I. A." or "Acdt.").
(Amendment to Section XVI (Allied Patients in A. E. F. Hospitals)
FRENCH patients
1. Paragraphs 3 and 4 of this section are revoked.
2. When French military patients are admitted to, discharged from, or die in Ameri-
can military hospitals in the French zone of the armies, notification of the fact will be sent
within 24 hours to the Chief of the Bureau de Compatibilite of the Service de Sante des
Armees, No. 1 Rue Lacretelle, Paris, on Form 52, Medical Department.
3. When French military patients are admitted to, discharged from, or die in American
military hospitals in the French zone of the interior, notification of the fact will be sent
within 24 hours to the Franco-American section of the region (Service de Sante) on Form 52,
Medical Department.
4. The data on this card will show the name, number, rank, and organization of the
patient, the diagnosis, whether or not the disability was incurred in line of duty, and the
designation of the hospital sending the report.
APPENDIX
933
5. Information in this form is strictly for the use of the French. No duplicates of
these cards will be sent to the chief surgeon's office, A. E. F. The monthly list, required
in paragraph "1-b" of this section, is sufficient.
BRITISH PATIENTS
6. For all British patients admitted to A. E. F. sanitary formations, A. E. F. medical
cards, envelopes, etc., will be made out except where British forms have previously been
used.
7. A separate daily list of casualties and changes of patients in hospitals, Form 22,
A. G. O., S. D., A. E. F., will be made out for all British patients; one copy will be forwarded
to the deputy adjutant general's office, Third Echelon, British Expeditionary Force, France,
and another to medical communications, British Expeditionary Force, France. No copy
will be sent to the chief surgeon, A. E. F. — the monthly report called for in "1-b" being
sufficient.
8. When cases of British patients have been completed by death, return to duty, or
otherwise than by transfer, field medical card, envelope, and contents will be sent at the end
of the month to the deputy adjutant general's office. Third Echelon, British Expeditionary
Force, France, together with a list of the names of the cases so completed. No report. Form
52, need be made out.
9. If patient is transferred to a British medical unit, field medical card, envelope, etc.,
will be forwarded attached to the patient.
Change of System
1. All surgeons with troops will, upon arrival in France or England, complete the
records of all cases actively on the register either as "Returned to duty" or "Transferred
to Hospital," as the case may be. Thereafter the system set forth in this pamphlet
will prevail. If cases completed as "Returned to duty" are subsequently transferred to
hospital, they will be considered new cases.
2. Cases transferred to convalescent camps will be considered completed as far as sick
and wounded records are concerned.
3. For the purposes of reporting sick and wounded under the new system, all medical
organizations which do not habitually hold patients for more than three days will be considered
as without hospitalization facilities.
Completeness of Data
1. Whenever a patient is received by a base hospital without field medical card or
data sufficient to completely fill one in, steps will be taken to obtain the necessary data, and
the patient will be held a reasonable time in the hospital until the lacking information is
received and the card and envelope made out. Whenever this is done, statement of the fact
will be made on the back of the card, reference being made to it by an asterisk (*).
2. In stating causes of death, care will be exercised to report in terms which describe
the true cause rather than the symptoms. Reference should be made to the " Nomenclature
of diseases," Manual of the Medical Department, 1916, page 144-156, and the terminology
therein will invariably be used.
Procuring of Forms
1. Units arriving in France or England after June 15, 1918, will requisition immediately
for forms. Form No. 4, A. G. O., S. D., A. E. F., will be procured from the adjutant general's
office statistical officer, the others through the usual channels.
2. Troops serving with the British will not make requisition for these forms, but will
use the British system. This will not apply to Form 22, A. G. O., S. D., A. E. F. or Form
52 M. D. as used by the A. E. F. base hospitals with the British in France.
Important
1. Weekly telegraphic report. Form 211, M. D., will be continued to and including
the last week in July.
2. All previous instructions at variance with this circular are revoked.
934
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
3. It is essential that all medical officers in the A. E. F. have a full understaiuUiiK of
the new system. Questions should be addressed to the chief surgeon, A. E. F., Services of
Supply.
4. If the supply of this circular and pamphlet describing the new system is not suffi-
cient to furnish each medical officer in your command with a copy, request should be made
for a further supply. Care must be exercised, however, to avoid waste.
5. Every organization will send weekly venereal report to division or section surgeon,
even though no new cases have appeared since last report. It is essential that the strength
of divisions and sections be obtained through this report.
6. Attention is called to the fact that Forms No. 4 and No. 22, A. G. O., S. D., A. E. F.,
are used by both the adjutant general's office and the Medical Department. Instructions
issued by either agency relative to methods of sending reports on these forms apply only
to the copies sent to that agency. Two copies of Form No. 22, A. G. O., are required to
be sent direct to the chief surgeon's office; Form No. 4, A. G. O., is not to be sent to that
office.
M. W. Ireland,
Brigadier General, N. A., Chief Surgeon.
Circular No. 29:
American Expeditionary Forces,
France, May 21, 1918.
The following instructions are issued for the guidance of all medical officers, superseding
Circular No. 11, chief surgeon's office, March 6, 1918:
1. Injuries to the bones and joints, as well as of the muscle's and tendons adjacent
to these structures, represent a large percentage of the casualties of both the training and
the combat periods of an army.
2. To restore useful function to these injured structures is one of the purposes of the
medical organization of the army. The problems involved in this have to do not only with
the cleansing and healing of the wounds, but also with the restoration of motion in the joint
or strength to the part. This latter part naturally follows the first, but it is essential that
the first part be carried out with reference to that which is to follow. Unless this second
part of the treatment, the restoration of strength and motion, is carried out, much of the
first part is purposeless.
3. To insure the man not only the proper treatment for this type of injury, but the
proper supervision until he is as fully restored as possible, necessitates some form of radial
control that makes it impossible for a man to be overlooked in Inevitable transfers, from
service to service, or hospital to hospital.
4. Since so much of the ultimate result in these conditions depends upon orthopedic
measures after the first treatment of the wounds has been carried out, the following will
govern :
The senior consultant, orthopedic surgery, will, under the chief consultant, surgical
services, make such recommendations relative to treatment of "injuries and diseases of the
bones and joints, other than those of the head, as well as the injuries or diseases (other than
nerve lesions) of the structures involved in joint functions," as will insure early restoration
of functions, shorten convalescence, and hasten return to active military duty.
He will also supervise the subdivisions of surgery, pertaining to bones and joints, in
a manner which will permit the complete surgical harmony necessary for cooperation in
treatment of these cases by either general or orthopedic surgeons, in formations from front
to rear. To insure a minimum loss of function to the parts involved, uniform cooperation
must be maintained by the chief consultant, surgical services, during both early treatment
and all stages of convalescence.
5. To carry out the provisions of this circular, the chief consultant*, surgical services,
will make such provisions as are deemed necessary to insure a complete survey of these
cases at regular intervals, and determine if the treatment is progressing in a satisfactory
manner. Consultants in orthopedic surgery who are charged with the supervision of such
cases within hospital centers and other formations will ordinarily be called in consultation
APPENDIX
935
for special cases, through the commanding officers of the units in ciuestion, and the consul-
tants will report to him prior to completion of their investigations. Commanding officers
of hospitals are expected to freely utilize the services of these consultants in the manner
described above. Any recommendation made by them as to change of treatment, or transfer
to some other professional service or hospital, will ordinarily, if the military situation permits,
receive favorable consideration.
6. It is not the intention of this order to interfere with the routine work of hospitals,
but to insure to the soldier proper supervision during the time of his treatment and the
period of his convalescence.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
Circular No. 30.
France, May 23, 1918.
1. Auxiliary optical units supplying and repairing of spectacles. — (a) An auxiliary optical
unit has been sent to each of the following stations, viz, Base Hospital No. 6; Base Hospital
No. 8; Camp Hospital No. 27; Base Hospital No. 1; Base Hospital No. 18; attending sur-
geon's office, general headquarters; Base Hospital No. 17; Base Hospital No. 23.
A central optical unit has been sent to the instrument repair shop of the medical supply
depot in Paris.
(h) Prescriptions for spectacles, to be supplied free of charge to officers, nurses, and en-
listed men of the American Expeditionary Forces may be sent to the commanding officers of
these stations.
These standard spectacles are of nickel, steel, round glass, and any combination of lens
can be supplied or repairs made on short notice.
Unusual prescriptions and ordinary prescriptions for troops near Paris may be sent to the
central unit. This unit will also fit glass eyes or upon request will send to base hospitals
assorted sets of eyes for selection.
It will also repair any optical instruments used in hospitals.
(c) Prescriptions should include not only the lens prescription, but accurate measure-
ments for frame, stating the following dimensions, viz, pupilary distance; temporal width;
height of crest above pupilary line; width of bridge at the base; inset or outset, in millimeters;
length of temple.
As the size of the lens will be the same in all cases, namely 40 mm., it will not be necessary
to state that dimension.
2. Historical records. — (a) With a view to securing material from which the medical and
surgical history ot the war may eventually be written, base surgeons and division surgeons
will prepare and maintain a historical record of the Medical Department activities of the
commands of which they are in charge.
(6) Commanding officers of base, camp, and other hospitals, hospital train, and other
independent organizations of the Medical Department will also maintain such a record.
(c) The historical data need not be voluminous nor trivial, but should be sufficiently
complete so that from them in connection with the regular official and clinical records of the
organization a report to date of its activities can at any time be made. The historical records,
if not already begun, will be initiated without delay and written up from the beginning of the
activities of the organization or command in connection with the present war and they will be
maintained by careful notation of all matters of historical interest involving the organization.
3. Replacement of X-ray tubes.— Broken X-ray tubes will be sent to the repair shop,
Paris, by messenger, who will carry back the replacement tube. Unless urgent, two or more
tubes should be sent at one time. If the travel involved requires an order from the command-
ing general, Services of Supply, a request for such should be made to these headquarters.
4. Travel orders and classification of patients discharged from hospital under General Order
41, general headquarters, 1918.— Orders directing the travel of patients discharged to duty from
Services of Supply hosi)itals should in each instance indicate the classification to which the man
belongs under General Order 41, general headquarters. In the case of men of B and C classes,
copies ot reports of disability boards on the prescribed form should be attached to travel
orders.
936
ADMIXISTKATION, AMERICAN EXPEDITIOXAKV FORCES
The authority for issuing the travel order should be indicated therein as: "G. O. 11
S. O. S., 1918."
5. Admission of officers and soldiers to Services of S upply hospitals. — The attention of com-
manding officers of Services of Supply hospitals is called to the following extract of General
Order 46, general headquarters, the provisions of which have been disregarded in number of
instances. Prompt rendition ot the required report is enjoined :
Sec. VII (par. 4.) To insure the information reaching the unit commander, as to the
admission of an officer or soldier of his command to a Services of Supply hospital, the Services
of Supply hospital commanding officer who receives the individual will notify the unit com-
mander at once.
6. Demands for chloride of lime or chlorine products. — The supply situation is such that
all demands for chloride of lime or chlorine products should be restricted to those which are
absolutely of an emergency type, and requirements should be the lowest possible.
7. Nurses' regulation uniforms. — The regulation uniform is to be worn by nurses and
reserve nurses of the Army Nurse Corps at all times, and is as follows:
A suit, waist, and hat, of prescribed color and pattern for outdoor wear; gray or white
uniforms, aprons, and caps, will be worn while on duty in hospital, and shall be made in accord-
ance with specifications furnished by the office of the Surgeon General, but reserve nurses
will wear caps made in accordance with specifications furnished by the Red Cross; white,
tan, or black shoes, high or low, may be worn, but pumps, French heels, and fancy shoes will
not be allowed; the United States pin and the insignia of the Army Nurse Corps should be
worn, but not fancy pins or furs. There are no occasions when the wearing of civilian dress
will be permitted, and any individual modification of the regulation uniform will not be allowed.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
Circular No. 31 France, May 23, 1918.
Subject: evacuation of French and British patients in A. E. F. hospitals; effects of allied
patients dying in A. E. F. hospitals.
1. Paragraphs 2 and 3, Section XIV, and paragraph 2, Section XVI, " Sick and wounded
reports for the American Expeditionary Forces," are revoked.
2. The following translation of extracts from Circular 684 Ci/7, Sous-Secretaire d'Etat
du Service de Sante, of April 6, 1918, are published for the information and guidance of
medical officers:
AMERICAN SOLDIERS IN FRENCH SANITARY FORMATIONS
The French sanitary formations must keep only American sick and wounded who can
not be evacuated without inconvenience. Consequently, as soon as an American patient
is susceptible of being evacuated, he will be evacuated to the nearest American hospital
without other formality than a previous understanding with the chief surgeon of that hospital.
If, for any reason, the transfer of the patient necessitates the presence of nurses, the
surgeon of the American hospital should be requested to send one or two nurses to insure
the transfer in satisfactory conditions.
Medico-surgical documents which may be useful to the American doctors regarding
the patient will follow the latter, those of confidential nature being sent under closed envelope.
FRENCH SOLDIERS IN AMERICAN SANITARY FORMATIONS
French soldiers hospitalized in American sanitary formations will be evacuated to
the nearest French hospital as soon as their transfer can be made without risk.
The evacuation of the sick and wounded will take place without any other formality
than a previous understanding with the medicin chef of the French hospital, who will
furnish one or several nurses if necessary.
All medico-surgical documents will follow the patient under closed envelope.
APPENDIX
937
AMERICAN SOLDIERS DEAD IN FRENCH HOSPITALS
(a) Hospitals of the zone of the army. — In conformity with steps foreseen for allied
soldiers in the instructions of July 2, 1916, the property of American soldiers dead in French
hospitals will be forwarded to the "Chef de Bureau de Compatibilite du Service de Sante
aux Armees," No. 1 Rue Lacretell, Paris, where they will be transmitted to the command-
ing officer, effects depot, base section No. 1, at St. Nazaire.
Cash will be forwarded by order on the Treasury made out to the commanding officer
of this last named depot.
(6) Hospitals of the zone of the interior {includes regional hospitals of the army zone). — •
The forwarding of soldiers' personal property will be made by the administration officer
to the commanding officer, effects depot, base section No. 1, at St. Nazaire.
(a) Hospitals of the zone of the army. — The personal property of French soldiers dead
in American hospitals will be forwarded to the French military mission with the American
Army at Chaumont.
(b) Hospitals of the zone of the interior {includes regional hospitals of the army zone). —
The personal property will be turned over to the commanding officer of the nearest French
hospital, permanent military hospital, or complementary hospital, who will look after the
settlement.
Note. — In all cases mentioned above it will be necessary to make out in a complete
manner on a form of accompanj^ing model an inventory of the personal property; in each
case the inventory will be forwarded at the same time as the personal property to the
consignee:
(Translation of form to be utilized in accompanying personal property of soldiers forwarded)
Ministry of war, Office of Pensions, Bureau of Successions, Paris, 1 Rue Lacretelle (15th)
From "
Address
Name of the soldier
Surnames *
Regiment
Rank Class
Place of enlistment
Number of enlistment
Died at
On the
Address of famih^
(a) Amount of cash comprised in the shipment Indicate whether cash has
been forwarded in any other way > ^^o^^' much ,
and to whom forwarded
(6) Savings Book No.
(c) Detailed statement of amount and objects forwarded
FRENCH SOLDIERS DEAD IN AMERICAN HOSPITALS
Date 191 --
(Signature of sender)
js-QTE. — Send the form and shipment to the above address.
» Indicate name of hospital and address.
» All surnames and in their proper order.
938
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
EVACUATION OF BRITISH PATIENTS
3. British patients in American hospitals fit to travel should be evacuated to Paris.
The office of the assistant director medical services, British Expeditionary Force, No. 6,
Rue Capucines, Paris, should be given 24 hours' notice by telegraph of date and hour of
arrival of patients. Patients should be evacuated by express train and should be routed so
as not to arrive in Paris late at night.
The personal effects of British soldiers dying in A. E. F. hospitals should be sent to the
deput}^ adjutant general (effects branch), headquarters, third Echelon, British Expedition-
ary Force, France. Public clothing and equipment should be sent to the commanding officer,
ordnance base, British Expeditionary Force, France.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
American Expeditionary Forces,
France, June 7, 1918.
Circular No. 32.
1. The following "don'ts" for the guidance of medical officers in gas warfare have been
prepared by the medical director of the gas service and are hereby published.
THIRTY "don'ts" WITH WHICH EVERY MEDICAL OFFICER IN THE AMERICAN EXPEDITIONARY
FORCES SHOULD BE THOROUGHLY FAMILIAR
1. Don't fail to realize that gas warfare is the most dangerous enemy confronting our
army to-day and that a great number of patients will be gassed.
2. Don't fail to keep thoroughly posted in all matters pertaining to warfare gasses.
3. Don't forget that common sense and good judgment are the essential requirements in
treating gassed patients.
4. Don't fail to realize that the enemy uses every kind of device in his endeavors to
make gas attacks serious.
5. Don't fail to reaUze that the enemy uses many different kinds of gasses, sometimes
alone, at other times mixed together. Each gas produces its separate and distinct line of
sj'mptoms, and therefore requires its own particular line of treatment.
6. Don't forget that all gassed cases require: First, rest; second, warmth; third, fresh
air; fourth, attention.
7. Don't permit gassed men to walk, talk, or move about.
8. Don't fail to realize that all gassed cases should be considered as serious until proven
otherwise.
9. Don't fail to keep all gassed cases under strict observation during the first 48 hours.
10. Don't forget that lung irritants such as phosgene and chlorine act early and that
deaths in the trenches or front lines during a gas attack are probably due to one of these
gasses.
11. Don't forget that the lesions produced by warfare ga.sses are: (a) Lesions resulting
from local actions of the gas; (6) lesions due to complications and mechanical results of
local action; (c) lesions due to general toxic effects.
12. Don't forget that disturbances caused by mustard gas are characterized by more
or less late symptoms of irritation and by vesicle formation in the integuments and mucous
membranes, especially the conjunctival, nasal, pharyngeal, and laryngeal, which are produced
chiefly by direct action of the vapor and small droplets which are acid.
13. Don't forget that broncho-pneumonia resulting from secondarv infections often
follow mustard gas poisoning.
14. Don't forget that clothing, linen, blankets, etc., remain for a long time impregnated
with mustard gas.
15. Don't forget that fumes and vapor of mustard gas remain in certain localities for
days following gas attacks.
APPENDIX
939
16. Don't forget that essentials indicated in the treatment of mustard gas poisoning
are: First, removal of clothing; second, neutralizing of acid gas with an alkaline substance;
third, avoiding contact with soiled clothing; fourth, treatment of the eyes, lesions of mucous
membranes, lesions of the respiratory tract, lesions of the digestive tract, and lesions of the
skin.
17. Don't forget that cases of irritant gas poisoning, with severe oedema of the lungs,
may often be saved by prompt and copious bleeding.
18. Don't forget that cases of gas poisoning with marked cyanosis are benefited by
oxygen inhalations, which in order to be efficient should be given continuously. The oxygen
to be administered either by mask or introduced into the posterior nares by means of a
small rubber catheter connected with the oxygen tank through a double tube in a bottle
half filled with water.
19. Don't place too much reliance on drugs in the treatment of gassed cases.
20. Don't forget that disorders of the heart which arise after gassing will in some cases
make soldiers unfit for active fighting in the front areas.
21. Don't bandage the eyes. Pressure bandage over the eyes locks up the lids and
retains the secretations, which after a term of hours may become purulent.
22. Don't forget that in treating eye symptoms following mustard gas poisoning, it is
most important that the use of eye shades or dark glasses should not be continued beyond
the inflammatory stage, otherwise functional photophobia is likely to result.
23. Don't forget that one group of symptoms often seen in all forms of poisoning —
i. e. dyspnoea, pain in the chest, palpitation, rapid pulse, dizziness, and fatigue are closely
associated with nervous symptoms more frequently than other cases. They cause the most
frequent contributions of partial or complete unfitness for further military duty.
24. Don't forget that the symptoms enumerated above rarely follow mustard gas
poisoning.
25. Don't forget that in this class of patients prolonged rest in bed is contraindicated.
They should be given graduated exercises, and their physiological reaction to these should
be carefully noted.
26. Don't forget that prolonged stay in hospitals is particularly apt to exaggerate
neurotic conditions which are difficult to overcome.
27. Don't forget that vomiting and stomach trouble which persist after mustard gas
poisoning is usually functional, especially when occurring some months later.
28. Don't forget that the nervous symptoms which follow gas poisoning are generally
functional, resembling exactly "traumatic neurosis."
29. Don't forget that pulmonary cases following mustard gas poisoning are the most
important. They entail prolonged absence from military duty and may simulate pulmonary
tuberculosis so closely that it will be difficult to decide, in some cases, whether tuberculosis
exists or not.
30. Don't forget that it is often difficult to differentiate between -slightly gassed cases
and malingering, so don't be misled by the latter condition.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
Circular No. 33.
American Expeditionary Forces,
France, June 12, 1918.
1. Hospitalization and evacuation of cases of -pulmonary tuberculosis and suspected pul-
monary tuberculosis — (a) Collecting and observation centers have been established at the
licspitals indicated below for cases of pulmonary tuberculosis and suspected pulmonary
tuberculosis which may occur in the American Expeditionary Forces.
(6) In future the diagnosis "pulmonary tuberculosis" should be limited to cases in
which tubercle bacilli are found in the sputa. Cases in which this diagnosis has been es-
tablished should be evacuated to Base Hospital No. 8, at Savenay, or to Base Hospital No.
3, at Vauclaire, which are designated as collecting centers for these cases during the period
preceding their evacuation to the United States.
940
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(c) Cases of suspected tuberculosis should be diagnosed "tuberculosis, observation."
Such cases should be evacuated to Base Hospitals No. 8, No. 3, or No. 20, at Chatel Guyon,
which are designated as observation centers.
(d) Base Hospital No. 3 will receive only such cases as originate in base sections No.
2, No. 6, and No. 7, For cases originating elsewhere the hospital most convenient to the
locality will be selected.
2. Return to duty oj student officers and soldiers from army and corps scfwali. — Instruc-
tions have been received from the commander in chief directing that student officers and
soldiers from army and corps schools who have been admitted to hospitals will be returned
to the school upon being evacuated to duty as of class A.
3. Travel orders to individuals or units forwarded to the advance section. — The following
instructions of the commander in chief, A. E. F., are published for the information and
guidance of medical officers:
(a) Hereafter all individuals or units forwarded to the advance section will be given
travel orders indicating the organization to which they are to be sent, and will be directed
to report to the proper regulating officer, who knows the location of all organizations and
will see that they are forwarded to the proper destination.
(6) In case of doubt as to which is the proper regulating officer to whom they should
be directed to report, information will be obtained by the officer arranging for the move-
ment from the headquarters, Services of Supply.
All such individuals or detachments should be furnished with rations to include two
days' travel beyond the time of their expected arrival at the regulating station.
B}- order of the commander in chief.
4. Etiquette of visits to French hospitals. — Correspondence recently received from the
French Service de Sante indicates that in certain cases medical officers of the American
Expeditionary Forces have visited American patients in French hospitals without first caUing
on the medecin chef of the hospital to get his permission.
It is a military principle which governs in all armies, to which the French attach much
importance, that an officer should not go into any militarj- organization for the purpose of
inspecting without first calling on the commanding officer of that organization to get his per-
mission. It is very desirable when the visit is one of inspection, and not merely a personal
visit to individual patients, that the medecin chef or an officer designated by him should
accompany the American medical officers. This is an important matter of miUtary ad-
ministration, as well as miUtary courtesy, which all medical officers should be careful to
observe.
5. Method of requisitioning fuel. — The attention of commanding officers of hospitals
is invited to the provisions of General Order 19, Services of Supply, 1918, which order makes
certain changes in the method of requisitioning fuel. The chief quartermaster advises that,
as far as pos.sible, supplies of fuel for hospitals for winter use be secured and stocked during
the summer. It is especially desired that emergency requisitions for fuel be reduced to a
minimum. Proper anticipation of the demand for wood is fully as essential as that for coal.
6. Worker s permits for all nurses. — Attention is again invited to the fact that all nurses
must be provided with worker's permits. These are furnished as prescribed in General
Order 63, A. E. F., 1917. Three unmounted photographs, not to exceed S}4 by 2}^, name
of the nurse, permanent station, and number of passport, if any, must be furnished. Re-
quests for worker's permits should be forwarded to this office, giVing the data stated above.
7. Vouchers and pay rolls to be sent through proper c/ianne/s.— Paragraph 1, Circular
No. 14, office of the chief surgeon, headquarters lines of communication, A. E. F., Decem-
ber 4, 1917, is modified as follows:
All vouchers and pay rolls will hereafter be sent through proper channels directlv to
this office instead of to the officer in charge, intermediate medical supplv depot No. 3.
Requisitions will continue to be sent as directed in the circular quoted.
8. Report of all divisions surgeons.— {a) All division surgeons will report immediately
to this office by wire, the designations of all field hospitals operating under their control and
subsequently any change in status in field hospitals, such as the opening, closing, consoli-
dation, reorganization, or abandonment of such units as soon as such changes occur
(6) For the purpose of reporting sick and wounded under the new svstem all medical
organizations which do not habitually hold patients for more than three^davs will be con-
APPENDIX
941
sidered as without hospitalization facilities. All units which care for patients for a period
longer than three days will be considered as hospitals regardless of official designation All
units in the sections of the Services of Supply faUing under the latter class, but which are
not officially designated as hospitals, will be instructed by the section surgeon to begin re-
porting as hospitals and to make requisition on medical supply depot No. 3 for necessary
forms. Requisitions for Form No. 1, M. D., A. E. F., will be filled as soon as supply is avail-
able. Section surgeons will notify this office of all such units in their sections.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
Circular No. 34.
American Expeditionary Forces,
Office of the Chief Surgeon,
France, June 12, 1918.
The following information will be given the widest possible circulation among the medi-
cal officers of the American Expeditionary Forces. Each medical officer should possess
and keep at hand a copy of this circular.
Short R^isum^; of the Symptoms and Treatment of Poisoning By Irritant Gases"
The gases which have been met with most commonly up to the present time may be
divided schematically into three classes:
(1) Suffocative gases, which exercise their main effect on the lung tissue (chlorine,
phosgene, diphosgene, chloropicrin).
(2) Vesicants, the prime effect of which is exercised upon the skin conjunctivit* and
upper air passages (dichlorethyl sulphide-mustard gas or Yperite).
(3) Pure lachrimatory gases (Xylyl-bromide).
Gas may be liberated from cylinders in clouds, a method not now commonly employed
or from shells.
The general aim of the enemy in the present use of gas shells is to fire simultaneously
shells of different types, some of which will cause so much sensory irritation that the man
will discard his respirator and then become vulnerable to lethal shells, phosgene and similar
substances. Owing to this mixture of shells the symptoms reported by patients are often
very confusing.*
For this purpose several arsenical compounds have been tried.
symptoms of gas poisoning
Suffocative gases. — Suffocative gases which are relatively nonirritative on inhalation
in the concentrations ordinarily used, induce some hours after their entrance an intense
cedema of the lungs. Through the great outpouring of fluid into the lung tissue the patient
drowns in his own serum; the blood becomes greatly condensed and viscious; there is marked
polycythsemia; the capillary flow is obstructed; thromboses are not uncommon; a greatly
increased strain is put upon the right heart; the patient suffers from intense oxygen want.
Sequence of events. — The immediate effects of irritation of the eyes may be prominent
at first, but as a rule quickly pass off; within 3 to 12 hours after exposure to the gas the main
symptoms, asphyxia and prostration, due to affection of the lung alveoli and accumulation
of fluid in them, appear. In this state the patient's respiration is rapid and usually ac-
companied by pain (often intense) in the chest; there may be fits of coughing, but the
amount of expectoration is very variable, being profuse in some cases and very scanty in
others; in the more severe cases the patient is restless and anxious, or may be semicomatose
with muttering delirium. Therefore many patients will be unable to give a definite account
of their symptoms as loss of memory of immediate events may last for several days. Patients
with severe pulmonary cedema fall into two groups.
" Much of this material has been extracted from the valuable reports of the British Chemical Warfare Medical Com
mittee and from the excellent report of Lieut. Col. H. L. Gilchrist, issued by the office of the Chief of Gas Service, A. E. F.,
Mar. 15, 1918.
Medical Research Committee: Reports of the Chemical Warfare Medical Committee, No. 3. The symptoms and
treatment of the late effects of gas poi-soning, Apr. 10, 1918, p. 3.
942
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(a) Those with definite venous engorgement. In these the face is congested, the hps
bhie and the superficial veins of the face may be visibly distended. There is true hyperpiicea,
i e the breathing is not onlv increased in frequency l)ut the actual amount of air reachiiifi
the lungs is greater than normal. The pulse is full and of good tension, and the rate is not
often much above 100. . , ,. r i j i rr,
(b) Those with collapse. In these the face is pale and the hps of a leaden color. Ihe
breathing is shallow, so that there is but little hyperpnoea. The pulse is rapid (130 to 140)
and weak.
In patients who recover, the oedema fluid is absorbed within a few days; in some cases
signs of bronchitis or broncho-pneumonia, due to a secondary infection, persist for some time
but in most cases the lung returns to a condition which is normal except for the presence of
some disruptive emphysema. In consequence, however, of the cedema of the lungs during
the early stage, deficient oxygenation of the blood occurs, unless prevented by the adminis-
tration of oxygen. The deficient oxygenation gives rise to widespread temporary injury
in the various sj'stems
2. Vesicants— The only one hitherto employed is dichlorethyl sulphide, an oily hquid
used in shells, and scattered from them to the ground, where it slowly evaporates. This not
only attacks those in the immediate vicinity of the shell burst, but may affect those who may
walk over the contaminated ground later. The fluid may be spattered also on clothing,
shell casings, rifles, etc., and may thus become effective through direct contamination
of the skin.
The main action of this group is an irritant one on the skin, eyes, and respiratory
passages.
Special symptoms. — (a) Early: These are insignificant, nothing being noticed immedi-
ately except a smell reminiscent of mustard, from which the gas derives its name (mustard
gas)'. A soldier may not reaUze for many hours that he has been exposed to gas, until the
more important delayed symptoms develop.
(5) Delayed: These are the principal symptoms of this group and appear 3 to 24 hours
after being gassed. They occur usually in the following order, and approximately after
the intervals stated.
(i) Conjunctivitis (3 hours). This rapidly becoines very acute, and is accompanied
by intense photophobia and swelling of the lids, which may cause closure of the eyes for days.
(ii) Vomiting and epigastric pain (4 to 8 hours) . These symptoms appear together as
a rule, and are apt to be persistent and intractable. ,^
(iii) Burns (12 hours). Widespread erythema with local vesication occurs, going on ^
to definite burns. The commonest sites are the axillaj, genitals, and back, but no area may
be exempt. The affected surfaces frequently develop very marked pigmentation. Deep
burns sometimes occur when the liquid itself comes into contact with the clothes or skin.
(iv) Laryngitis, pharyngitis, tracheitis, and bronchitis (24 to 48 hours). These are
the most dangerous symptoms. The degree and extent of the lesion may vary from a simple
irritation of the surface to an ulceration of the mucous membrane of the whole passages,
followed by infection of the raw surfaces. These conditions may be so extensive and severe
as to cause death by themselves or in consequence of the development of broncho-pneumonia.
In a certain number of cases with severe involvement of the respiratory organs, which
recover, there has evidently been some interference with the proper oxygenation of the blood,
which may give rise eventually to symptoms resembling the after effects of the suffocative
gases * * *.
When a soldier is protected by the respirator, the respiratory and eye symptoms are
absent or slight."
TREATMENT
Suffocative gases. — The grave symptoms here are due mainly to the intense pulmonary
a?dema. The conditions which we have to combat are essentially: (a) Oxygen want, (6)
condensation of blood, (c) overburdening of the right heart. Our main aims are: (a) Rest,
{b) warmth, (c) Oxygen, (d) bleeding.
(a) Rest: Protect the patient from all unnecessary physical effort in order to reduce
the oxygen needed. Do not disturb him at the advanced aid station by questioning; his
life may depend on the care with which he is handled in the early stage.
All the gassed should be stretcher cases. Small oxygen tubes, if available, should be
carried in each ambulance in the proportion of one to each stretcher case, and exchanged at
the evacuation hospital for freshly filled tubes; these can of course be used only when the
ambulance has passed out of the gassed area.
' Medical Research Committee: Reports of the Chemical Warfare Medical Committee No. 3. The symptoms and
treatment of the late effects of gas poisoning. April 10, 1918, pp. 3-4.
APPENDIX
943
Give the patient fresh air. Do not close the ambulance too tightly unless it be very
dusty.
(h) Warmth: Warmth is important. Cold and shivering mean an increased produc-
tion of CO2 and an increased demand for oxygen. The clothes must be removed at the earli-
est moment, for they hold gas and may be dangerous not only to the patient but to those
about him; warm covering must however, be provided.
((•) Oxygen: The administration of oxygen in all dyspnceic, cyanotic patients is of vital
importance. The administration should be so nearly continuous as possible up to the point
of the disappearance of the cyanosis, and should be continually repeated whenever the demand
is evident.
(d) Bleeding: In patients who are cyanotic and show engorgement of the venous system,
bleeding is indicated. By venesection we combat —
(1) Oedema of the lungs.
(2) The condensation of the blood; for with the abstraction of the polycythemic
blood, fluid is drawn from the lungs and the tissues, and the circulatory medium becomes
less viscous.
(3) The overburdening of the right heart.
The bleeding should be early and free, from 2 to 600 c. c.
Bleeding is inadvisable, nay dangerous, in the patient who is pale and gray and in
collapse.
If the heart's action be rapid or feeble, bleeding may be preceded by an intramuscular
injection, 15 minutes before the venesection, of 3^ mg. (gr. ^iTy) digitaline cristaHs^e
Nativelle. This may, if necessary, be repeated once or twice in the next 24 hours, and con-
tinued later by the mouth if necessary.
In the early stages, during the period of distressing restlessness and agitation and pul-
monary oedema, morphia may be necessary. Its action as a respiratory depressant is believed
by some to be dangerous; and the administration of oxygen, if it suffices, is the safest and the
best means of quieting the agitation. Where the distress and physical effort associated
with the struggles of the patient are great, morphia 0.016 (gr. J^), hypodermically, may be
demanded, but at the same time it should be remembered that in collapse, dulling of the
"^respiratory center may turn the scale against the patient.
Treatment of the pale, gray cases with collapse. — Oxygen is here the main aim, and the
administration should be practically continuous.
Never bleed these patients. Bleed only those with venous congestion.
Rest, warmth, and oxygen are the mainstays of treatment. Atropine and adrenaline
are contraindicated. These drugs place and increased strain on the heart. It is best to
abstain from intravenous salt solution injections. The fluid introduced puts an extra burden
on the heart, is soon absorbed into the tissues, and may increase the pulmonary oedema. In
grave cardiac weakness, preparations of camphor or caffeine may be given hypodermically,
and digitahs may be indicated, according to the nature of case.
Relapses. — In any patient who has had pulmonary oedema it may, within the first few
days, recur on slight exertion or even without apparent cause, and if there have been any
definite symptoms of oedema of the lungs the patient should be kept in bed for a week.
Smoking should be absolutely prohibited and convalescents should not be allowed to
smoke in the ward in which these patients lie.
Patients whose symptoms have been mild should, if possible, be put on graduated
exercises as soon as they are out of bed, and under military discipHne as soon as possible.
Mild cases should be back in the line in about two weeks. Severe cases may have to remain
in the hospital for three or four weeks and thereafter spend several weeks in a convalescent
camp.
Great care should be taken to protect the convalescent from secondary infections.
Wherever it is possible beds should be isolated one from another by sheets, as in acute respir-
atory infections, for secondary bronchitis and broncho-pneumonia are not uncommon and
the danger of cross infection should be provided against.
Vesicant gases.— The symptoms, here, are usually delayed from 3 to 24 hours, and
dangerous symptoms do not, as a rule, appear for from 24 to 48 hours after exposure, but
13901—27 60
944
ADMINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
pulmonary oedema and symptoms similar to those observed in the suffocative cases may
occur; moreover, the patient may have had a double exposure to different sorts of gas. All
the precautions, therefore, above mentioned should be observed at the outset, but other
special steps must be taken.
Disposition of clothes.— Wherexev exposure to a vesicant gas is suspected, the use of
external warmth should be avoided if the clothes have not previously been removed. Tlic
application of heat favors the diffusion of the gas.
Remove the clothes as soon as possible, but protect the patient from exposure during
the process.
After removal, the clothes should be sterilized in wet steam for 30 minutes; in dry heat
for 15 minutes; exposed to the air for 15 minutes. This may be carried out in the Thresh
sterilizer, and may have to be repeated twice, although two or even one treatment may be
efficacious. While waiting for sterilization, have the clothes placed outside the quarters,
in the open. All who handle the clothes must be protected by respirators and special oiled
clothing and gloves.
Removal of the poison from the skin. — The patient should be thoroughly bathed in a
warm room in soap and water at the earliest possible moment. Areas which have been
specially exposed may first be covered for a few minutes by a paste of 25 to 50 per cent
chloride of lime in water and then washed with warm water. Bathing with 0.05 per cent
permanganate of potassium is said to be useful.
Treatment of the skin and mucous membranes. — When the skin is dry, erythematous
areas may be powdered with subnitrate or subcarbonate of bismuth (oxide of zinc), talcum,
or any simple nonirritating powder. Moist and raw surfaces may also be powdered with
the same substances or a powder consisting of oxide of zinc, carbonate of magnesia, carbonate
of lime, 200 gr.; talcum powder, 400 gr., and protected from the bed clothes by cribs, or
covered by a nonabsorbent dressing.
If a moist dressing be preferred, a solution consisting of sodium chloride, 70 gr.; sodium
bicarbonate, 150 gr.; water, 5,000 gr. may be used — simply limewater.
Blisters should be carefully attended to. The contents of the vesicles are poisonous
and irritating to the surrounding skin; the blisters should, therefore, be opened carefully and
the contents taken up with absorbent cotton, which should promptly be burned. Inter-
digital areas should be washed carefully daily, powdered and bandaged.
Fatty salves, in the early stages, are inadvisable, as any undestroyed poison which
remains on the skin may be diffused underneath.
Later, deep and painful burns are much relieved by treatment with ambrine.
The eyes should be irrigated immediately with warm alkaline solutions such as the
above mentioned solution of sodium chloride, sodium bicarbonate, and water. After this,
some nonirritating oil such as liquid albolene should be instilled. The patient should be
kept in a dark room, or the eyes shaded. Compresses soaked in this solution may give
comfort in the acute stage. In severe cases, frequent (every 2 to 3 hours) irrigation of the
conjuctiva with simple boric solutions (sodii boratis 0.65) (aqua? camphora' 30), followed
by the instillation of Hquid albolene, should be carried out.
The nose should be sprayed with a warm alkaline solution (sod. chloride, sod. bicar-
bonate, and water, as above) and also with liquid albolene, to which a Uttle menthol may be
added (such as the preparation known as "Chloretone inhalant").
The mouth should be rinsed with alkaline washes and gargles.
The laryngeal inflammations may be relieved by inhalation of: Menthol 0.65, tinct.
benzoini comp. ad, 30, of which 5 c. c. are added to 500 c. c. steaming water.
Secondary respiratory infections.— " Mustard " cases may develop grave secondary
bronchitis, with broncho-pneumonia. In the treatment of such instances there is nothing
specific. Every precaution should, however, be taken to prevent cross infection. The beds
of all patients with purulent bronchitis and broncho-pneumonia should be screened one from
another and from their neighbors.
Sequels of gas poisoning. — In soldiers who have been "gassed," especially with phosgene,
symptoms similar to those characterizing D. A. H. (effort syndrome) are not uncommon-
dyspnoea on exertion, pain in the chest, palpitation, dizziness, fatigue on exertion, disturbed
APPENDIX
945
sleep with dreams, paroxysms of coughing, and even asthmahke attacks. These patients
are often polycytha?mic. Nervous manifestations unassociated with apparent organic lesion
are common.
Get these patients out of bed and start carefully graduated exercises, sending them as
soon as possible to a special training camp.
"Functional" photophobia and blepharospasm are frequent, but eye shades and colored
glasses should be discontinued as soon as the acute inflammatory stage is over. When this
has passed, the use of eye drops of a solution of:
Zinci sulphatis 0.065-0.13 (gr. I-II)
Acidi borici 3.75 (3T)
Aqua? 30 (3T)
is said to give relief. If corneal ulcers or iritis, which are not common, be present they must
be treated in the usual manner. Threatening though the ocular manifestations may be,
recovery is usually complete. Grave damage to the uveal tract is rare. It is important
not to overtreat the eyes.
In all cases preserve an optimistic attitude; the great majority of gassed patients
recover completely.
Do not let the patients become introspective or "hospitalized." Keep them occu-
pied in mind and body. Get the "mustard" gas cases who have no respiratory involve-
ment out of bed in two or three days if possible. Remove the eye shades as soon as the
acute inflammatory stage is over. Send the men out of doors; look out for their employ-
ment or amusement, and get them under army discipline as soon as may be. Far too many
convalescent "gassed" cases tend to accumulate, uncared for, in base hospitals. The
responsibility of the medical officer does not end with the disappearance of the dangerous
symptoms. See to it that the patient does not become a psychoneurotic.
Attention to these details may save a considerable wastage of men.
M. W. Ireland,
Brigadier General, Chief Surgeon.
Circular No. 35. American Expeditionary Forces,
France, June 13, 1918.
The Management of Mental Diseases and Neuroses in the American Expedition-
ary Forces
Absence of the auxiliary civil facilities that simplify the management of mental cases
in tlie Army in home territory, and the extraordinary incidence of functional nervous dis-
eases in all armies in the present war, have made it necessary to provide special facilities
and methods of procedure in the American Expeditionary Forces. These disorders, by
their very nature, interfere with the morale and efficiency of troops in war. Their proper
management in the hospitals and organizations in which they first come to notice and their
wise disposition and reclassification subsequently will not only increase military efficiency, but
in the case of war neuroses, will tend to diminish to a considerable extent their incidence.
This c'rcular is issued in order that all medical officers may become familiar with the
facilities that have been provided for the diagnosis, transportation, and treatment of soldiers
with these disorders. These facilities will be modified from time to time as changing condi-
tions necessitate, but the general plan of management here outhned will be followed:
I. mental cases (insanity, mental deficiency, observation cases)
(a) Provisions for prompt diagnosis and early care. — Tactical divisions: Each tactical
division in the American Expeditionary Forces and in the United States is provided
with a psychiatrist whose duty it is, under the direction of the division surgeon, to examine
all mental cases coming to attention in the division and to make recommendations for their
evacuation or other disposition. The psychiatrists will be detailed from the division sanitary
personnel. Their specific duties are defined in Circular No. 5, chief surgeon's office, A. E. F.
They will examine enlisted men brought before general courts-martial, as provided by
War Department order of March 28, 1918. They will also examine all other military delin-
946
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
queiits brought to their attention, especially those in whom self-inflicted wounds or malinger-
ing is suspected. Except under exceptional circumstances, no cases of this kind will be
evacuated to the rear unt-l examined by the division psychiatrists. In the case of pri.soners
accused of crimes, the maximum punishment of which is death, the division psychiatrist
should, whenever practicable, have the assistance of a consultant in psychiatry.
Base hospitals: A neurologist or a psychiatrist has been assigned to each base hospital
or group of base hospitals in the same vicinity. This provision makes it possible for mental
cases that first come to attention in such hospitals to receive early diagnosis and treatment
and prompt evacuation to hospitals provided with special facilities for their care.
(b) Provisions for hospital care. — Advance section, Services of Supply: There has been
provided in connection with Base Hospital No. 116 a neuropsychiatric department of 72
beds, which will act as a collecting and evacuating point for mental cases from other base
hosi)itals, from tactical divisions, and from training areas.
When observation cases or patients with frank mental disease or defect are recom-
mended by the division surgeon, upon the advice of division psychiatrists, for transfer to this
collecting station, the commanding officer of Base Hospital No. 116 will be notified by tele-
graph or telephone and will thereupon send a sufficient number of attendants to bring such
patients to the hospital in safety. It is necessary, in making such requests, to state the num-
ber of patients and the amount of supervision that they will require en route. When
practicable, the ambulance service to be estabhshed in connection with Base Hospital No.
117 will be employed for this purpose. In all such cases, the diagnosis will be "Observation,
mental," the type of disease being added in parentheses.
It is very important that mental cases be accompanied by records in which the circum-
stances under which their condition came to notice are fully stated. It is obvious that,
without such information, the medical officers who have the responsibility of dealing with
these cases will often have difficulty in arriving at a diagnosis or in making suitable recom-
mendations for their disposition.
Base hospitals in the advance section will transfer to this collecting station all mental
cases except those which can readily be retained until sent for by the psychiatric department
of one of the base hospitals at a base port, and those in whom complications or other reasons
render a transfer undesirable. Effort will be made to provide all base hospitals with several
nurses or enlisted men of the Medical Department who have had experience in the care of
mental cases. With such attendants it will be unnecessary to place guards in observation
or mental wards. Commanding officers will protect these cases from the ridicule to which
they are sometimes subjected even in hospitals.
Intermediate section: At least one of the large base hospital centers which it is proposed
to establish in this section will ultimately have in connection with it a neuropsychiatric depart-
ment similar to that at Base Hospital No. 116. Hospitals in this section will, in the meantime,
evacuate their mental cases to Base Hospital No. 8 in the manner specified in Paragraph I (c)
of this circular.
Base sections Nos. 1 and 2: A psychiatric department, with a capacity of 152 patients,
has been provided in connection with Base Hospital No. 8. This and a similar one to be
established in connection with a base hospital center in base section No. 2 will provide the
chief facilities for the classification and continued care of mental cases in the American
Expeditionary Forces.
Base section No. 3: Mental cases among American troops serving with British organi-
zations will be evacuated to England in the same manner as other sick and wounded from the
same organizations. In England a neuropsychiatric department will be provided for the
reception, continued care, and classification of cases from British clearing hospitals for mental
diseases and from other hospitals in Great Britain.
Base section No. 4: Any mental cases coming to notice in this section will be evacuated
to base section No, 3.
Base section No. 5: Psychiatric wards will be provided at a base port. These wards
will receive only cases which have been classified "class D" at Base Hospital No. 8, and
whose condition is such that they can be transported to home territory with the minimum of
care and supervision. This ward will receive no other cases, but will provide temporary
care for soldiers who are found insane upon their arrival from the United States.
APPENDIX
947
Base sections Nos. 6 and 7: Mental cases arising in these sections will be evacuated to a
base hospital at the port of base section No. 2.
French hospitals: Mental cases that have been evacuated from the front into French
miUtary hospitals will be transferred as soon as practicable to the most accessible neuro-
psychiatric department of an American base hospital center.
(c) Transportation. — The neuropsychiatric department at Base Hospital No. 116 will
send for patients to other base hospitals in the advance section, Services of Supply, and to
tactical divisions and training areas as provided in Paragraph I (b) of this circular. The
neuropsychiatric departments of base hospital centers to be established in the intermediate
section, Services of Supply, will send for patients in the same manner.
The psychiatric departments of Base Hospital No. 8 and the base hospital center in
base section No. 2 will send for patients to any base hospital which is nearer to them than to
a collecting station.
As mental cases of all degrees of severity can be safely and comfortably provided for at
these collecting stations, they will be retained until a sufficient number have accumulated so
that they can be evacuated in parties, the attendance being provided by the psychiatric
department at the base port to which they are sent. Ordinarily, regular passenger trains
will be used; but in special instances and where the number of patients warrants it, transfers
will be made in a car set aside for this purpose on an American hospital train destined for a
base port to which they are to be sent. In this case, as in all others, attendance will be
provided by the psychiatric department receiving the convo^^
Evacuation to home territory of patients classified "class D" will be made in accordance
with special arrangement which it is not necessary to outline in this circular.
(d) Disability boards for mental cases. — Disability boards for mental cases will be con-
vened at neuropsychiatric departments of base hospital centers and at psychiatric depart-
ments at base ports. Other disability boards should not pass upon these cases, but should
refer them to one of the points at which such boards are authorized. All mental cases to be
transported in France will be given the tentative diagnosis of "observation, mental," except
those transported to their final destination on American hospital trains.
Disability boards will be guided by Circular No. 24, chief surgeon's office, 1918, in
passing upon mental cases.
II. FUNCTIONAL NERVOUS DISEASES AND CONCUSSION CASES
(a) General consideration. — The proper management of these conditions which are
commonly included in the designation "shell shock" is regarded by this office as a matter of
much importance. This term, which, unfortunately, is being used indiscriminately by
medical officers as well as patients, includes a number of different conditions depending
upon many different causes and requiring for their successful management several entirely
different methods of procedure. Many patients in whom severe concussion symptoms
follow being blown up by shells or buried in dugouts can be returned to duty, and it is
possible to return a much larger proportion of those cases in which purely psychoneurotic
symptoms develop under shell fire or in training, if they are skillfully managed. The return
of these cases to their own organizations after a short period of treatment has a very favorable
effect in lessening the incidence among their comrades of disorders in the second group men-
tioned. If, on the other hand, a large proportion of these patients are evacuated indiscrimi-
nately to hospitals in the Services of Supply or to home territory, the effect will be to increase
their incidence.
For this reason a special hospital for these cases, Base Hospital No. 117, has been
established, and an ambulance service has been provided in connection with this hospital
l)y which cases can be received directly from tactical divisions at the front. At this hospital
tlie resources found most useful in the British and French special hospitals for these cases
are employed. Success in their treatment depends very largely upon the attitude of medical
officers generally toward the special problems in diagnosis and management which they
present. For this reason regimental medical officers should guard against making an unfavor-
aljle prognosis even in cases presenting severe symptoms.
948
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(h) Treatment. — Tactical divisions: The advice of the division jjsychiatrists should be
utilized to the fullest extent in the early treatment of these cases in division sanitary organiza-
tions and in the selection of cases for evacuation to hospitals in the Services of Supply. It will
be found advisable, whenever practicable, to receive such cases in special wards in one field
hospital and to evacuate cases to hospitals in the Services of Supply only upon the recommend-
ation of the division psychiatrist. This officer will advise with regimental medical officers
regarding the management of nervous manifestations when they first come to attention at the
front.
Hospitals in the Services of Supply in France: It is expected that a very large propor-
tion of these cases will be admitted directly from their organizations to Base Hospital No. 117
and that relatively few, unless complicated by wounds, gassing, or other conditions, will be
received in other base hospitals. Other base hospitals will promptly transfer suitable cases
to Base Hospital No. 117 except in these instances in which it is thought that they can return
directly to duty and those in which the outlook seems so unfavorable, from constitutional
neuropathic tendencies or other factors, that their reclassification is probable. Cases in which
there is some doubt as to whether an organic or functional disorder is present should be trans-
ferred to Base Hospital No. 117. No cases having wounds requiring much surgical attention
should be sent to Base Hospital No. 117. All cases in which there is doubt as to the best
disposition should be brought to the attention of the consultant in neuropsychiatry for the
hospital.
Hospitals in the Services of Supply in England: A special hospital for war neuroses will
be provided in England which will be organized and conducted upon the same lines and will
perform the same functions as Base Hospital No. 117. American soldiers serving with
British organizations will be transferred to this hospital from the British clearing hospital for
these cases or from other hospitals in England.
French hospitals: American patients with these disorders in French military hospitals
will be evacuated to Base Hospital No. 117 or to the nearest neuropsychiatric department of a
base hospital center.
(c) Disability boards for functional nervous diseases and concussion cases. — Disability
boards for these cases will be convened at Base Hospital No. 117, neuropsychiatric depart-
ments of base hospital centers, and psychiatric departments of base hospitals at base ports.
No other disability boards should pass upon these cases.
M. W. Ireland,
Brigadier General, N. A., Chief Surgeon.
Circular No. 36.
American Expeditionary Forces,
France, June 11, 1918.
Subject: Promotion in the Medical Reserve Corps.
1. The Medical Reserve Corps has not heretofore received promotions so as to fill up the
proportions to which the corps is entitled by law, because of the many difficulties which have
presented themselves in working out a system which would be just and satisfactory.
2. Great inequalities occurred in the original commissioning of medical reserve officers
by which men of mature age and high standing in the medical profession were made junior to
others who were younger and of less professional experience. Further inequalities have been
created by the promotion in the United States of younger officers who afterwards came to
France with the increased rank which had been denied to members of the Medical Reserve
Corps of the American Expeditionary Forces.
3. A plan has been, however, now prepared in this office which has met the
approval of the commander in chief and which it is desired to put immediately into operation.
This plan recognizes that several factors should be considered in determining the rank of a
member of the medical profession coming into the Army in time of war to give voluntary
service.
(a) The first is age and the length of his professional experience, which constitutes,
generally speaking, the asset of greatest value to the Government w^hich he brings into the
service.
APPENDIX
949
(b) The second is the length of his active service, which determines his miUtary
experience.
(c) The third is the character of his mihtary service, and whether it has been distin-
guished by unusual self-denial, gallantry, efficiency, or hardships which would entitle the
candidate to advancement beyond others of the same professional and military experience.
On the other hand, this factor may be one of inefficiency or ill conduct which would in justice
demand the withholding of promotion, or even separation from the service.
4. In order to accumulate the data for the determination of these factors in each case,
it will be necessary to have commanding officers and senior medical officers furnish recommen-
dations in the case of officers of the Medical Reserve Corps serving under them. An individual
report upon a separate sheet of paper should be given in the case of each officer, whether
considered deserving of promotion or not, except those under the draft age of 31 years. Officers
under the draft age will not be promoted except in special cases where the officer has rendered
unusually distinguished service and has been more than a year on active duty. This report
should in each case give the following information:
(1) Full name and rank.
(2) Date of birth.
(3) Date of graduation in medicine and institution, if these can be ascertained.
(4) Date when ordered on active duty under Reserve Corps commission.
(5) Previous active military service, if any, either in the United States Army or with
the National Guard when called into the United States service.
(6) Character of service of the officer:
(a) Has it been of a satisfactory and creditable character, such as, when his age, pro-
fessional experience, and length of service being considered, would entitle him to a higher
grade; or
(6) Has it been fairly satisfactory in positions not of great responsibility, but not such as
would warrant promotion to a higher grade; or
(c) Is the officer, on account of professional ignorance, indolence, bad habits, or moral
delinquency of any sort, undesirable for the military service. In this case, as full a statement
as is practicable should be made of all the facts throwing light upon the shortcomings of the
officer; and it should be stated whether he has been brought before a board of officers under
General Order 45, general headquarters, A. E. F., 1918.
5. Copies of this circular and the blank forms for making the reports will be sent by
this office to the base surgeons of sections, who will be charged with distributing them to
all medical organizations in their sections except the base hospitals, to which the forms will
be sent direct in order to save time and clerical labor; also to division surgeons, who will
be charged with supplying them to the senior medical officers of all medical units in the
divisions. In each case the report will be prepared by the immediate medical superior
of the medical reserve officer to be reported upon, and they will be forwarded through the
military channels.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
France, June 11, 1918.
FORM FOR REPORT AS TO THE CHARACTER OF SERVICES AND QUALIFICATIONS OF MEDICAL
RESERVE CORPS OFFICERS
1. Full name and rank
2. Date of birth
3. Medical school from which graduated, with date of graduation
4. Date when ordered into active service on Reserve Corps commission
5. Previous active military service, either in United States Army or with National
Guard in United States service
6. Character of service of officer:
(a) Has it been of a satisfactory and creditable character such as, when his age, pro-
fessional experience and length of service are considered, would entitle him to a higher
grade; or
950
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(6) Has it been fairly satisfactory in positions not of great responsil)ility, hut not such
as would warrant promotion to a higher grade; or
(c) Is the officer, on account of professional ignorance, indolence, bad habits, or moral
delinquency of any sort, undesirable for the military service? In this case, as full a statement
as is practicable should be made of all the facts throwing light upon the shortcomings of the
officer, in order that he may be brought before a board for the determination of his fitness
for the service. Any available evidence in the form of correspondence or documents which
is available should be forwarded in such cases.
(State at beginning of answer whether service has been of class A, B, or C, and write
remarks thereafter.)
Circular No. 37.
American Expeditionary Forces,
France, June 22, 1918.
1. Food and nutrition section. — Announcement is made of the organization of a food
and nutrition section in the division of sanitation, office of the chief surgeon, A. E. F. This
section will be located at Dijon, under the supervision of the director of laboratories and
infectious diseases, and its functions shall be to inspect, investigate, and make recommenda-
tions concerning those factors directly aff"ecting the nutrition of troops of the American
Expeditionary Forces. The section is authorized to advise concerning the suitability
of rations and dietaries, and all changes or substitutions proposed in rations and dietaries
for troops, hospitals, or prison camps; and in cooperation with the Quartermaster Department
the section will devise and propose measures for the conservation of food.
2. Official letters and telegrams. — Official letters and telegrams should be addressed to
the chief surgeon, A. E. F., and not to individual officers or divisions of his office.
3. Billets or shelter tents. — The attention of commanding officers of ambulance companies,
field hospitals, and other mobile medical units is invited to the fact that Medical Depart-
ment soldiers attached to these units should be sheltered in the same way as other soldiers
at the front, namely, by billets or shelter tents, it not being practicable to issue tentage
for the shelter of soldiers at the front. Commanding officers of the above-named organiza-
tions will therefore turn in to the nearest quartermaster depot the large pyramidal tents
issued to ambulance organizations and field hospitals for the use of enlisted personnel, and
such wall- tents as are issued for the use of officers not entitled to tentage in the field.
4. Surgical operations. — (a) Surgical operations of election for chronic conditions
which existed before the war and do not incapacitate for the performance of ordinary duty
will not as a rule be performed during periods of military activity, and will only be done
in well equipped base or camp hospitals of the American Expeditionary Forces.
(6) Hernias should be operated upon subject to the foregoing restrictions, bearing in
mind military convenience and the extent of present or threatened disability.
(c) Operations for varicocele should as a rule not be performed at all.
id) Removal of tonsils is not to be done, except when marked destruction to respiration
exists, or when they are a source of infection in a systemic disease.
(e) Hemorrhoids should be operated upon subject to the restrictions of paragraph 1.
(/) Special instructions for the handling of orthopedic patients are in course of
preparation.
5. Orders involving travel of over 10 persojis.— When orders, involving travel of over
10 persons, are received by the commanding officer of a base hospital or other sanitary
formations of the Services of Supply, he should at once notify the railroad transportation
officer at his station and should not comply with the order until notified bv the railroad
transportation officer that a schedule has been arranged.
If no railroad transportation officer is at the point where the movement originates details
of the movement should be wired to the troop bureau of the transportation department at
these headquarters, with request that proper arrangements be made.
6. Proper handling and disposition of slightly wounded men.— Attention is directed to
the importance of early, proper handling and disposition of slightlv wounded men in all
hospital formations. While the handling of seriously wounded usuallv entails a greater
exercise of technical skill, the claims of the slightly wounded for equal attention mav be
APPENDIX
951
overlooked. It must be borne in mind that a neglected or improperly treated slight wound
may have serious consequences and cause prolonged hospitahzation. Slightlv wounded
men form the greatest military asset among all those admitted to hospitals, in that their
early return to duty can be looked for if properly treated. The tendencv in some hospitals
IS to delegate the care and treatment of slightly wounded men to the medical officers voung
in experience and skill in surgery.
Without deflecting the full measure of attention to be given to serious cases, surgical
personnel at hospitals should be so assigned as to bring skill and attention to bear upon
slightly wounded men equal to that given to more serious cases, carrving into effect that
principle of military surgery which contemplates the greatest good to the greatest number.
7. Telegraphic and mail communications.— All communications, both telegraphic and
mail, intended for the chief surgeon, A. E. F., should be addressed to the chief surgeon,
A. E. F., Services of Supply, and not general headquarters.
8. Reports of Y. M. C. A. personnel— For all Y. M. C. A. personnel treated in American
Expeditionary Forces formations the following information will be sent to the Y. M. C. A.
headquarters, 12 Rue D'Aguesseau, Paris: (o) Date of entry to hospital, (6) diagnosis,'
(c) disposition, {d) date of disposition, (e) any facts pertinent to the further care of the case .
9. Autopsy reports.— In the future, all autopsy reports will be made in triplicate. One
copy will be sent to the chief surgeon's office, one direct to the central medical labora-
tory, U. S. A. P. O. No. 721, and one to the commanding officer of the medical unit for
which the autopsy is performed.
10. Disposition of ordnance equipment. — The attention of commanding officers of hospi-
tals is invited to the fact that all available ordnance equipment is needed, and such equip-
ment should not be allowed to accumulate in hospitals. It should be turned in to a salvage
officer when there is one near the hospital, with instructions to ship it to advance ordnance
depot No. 1, Is-sur-Tille. If there is no salvage squad in the vicinity of the hospital, it
should be shipped by the commanding officer of the hospital direct to advance ordnance
depot No. 1, Is-sur-Tille.
11. Prescriptions for lenses. — Prescriptions for glasses are being received at the central
optical unit in one-eighth diopter, or multiples thereof, which necessitates grinding the
one-fourth diopter stock lenses. It has been found by experience that for all practical
purposes a correction down to one-fouth of a diopter is sufficient. Hereafter, prescriptions
for lenses will not be written in less than one-fourth subdivisions of a diopter.
M. W. Ireland,
Brigadier General, M. C, N. A. Chief Surgeon.
Circular No. 38.
American Expeditionary Forces,
France, July 1, 1918.
1. Class D patients not to he sent to St. Nazaire. — Class D patients intended for evacu-
ation to the United States via St. Nazaire will be sent to Base Hospital No. 8, at Savenay,
and not to St. Nazaire.
2. Change of circular No. 31. — Paragraph 3, under "Evacuation of British patients,"
Circular No. 31, American Expeditionary Force, May 23, 1918, is rescinded, and the following
substituted therefor:
{a) To carry out the wishes of the director general, medical service British armies in
France, all British patients fit for travel discharged from American base hospitals in France
will be ordered to report to D. D. M. S., Rouen, and not to A. D. M. S., Paris. Telegraphic
report will be made to D. D. M. S., Rouen, British Expeditionary Force, and at the same
time to medical communications, British Expeditionary Force, stating number of patients,
time and place of departure, probable time of arrival at Rouen.
{h) The effects of deceased British soldiers should be sent to "The D. A. G., effects
branch, general headquarters, third Echelon, British Expeditionary Force," and public
clothing and equipment to the commanding officer, ordnance base, British Expeditionary
Force. Unless otherwise directed, commanding officers of hospitals, in returning British
officers and soldiers from hospital to place directed, will furnish their transportation on
"Order of transport, model A," indicating on it in red ink "British Expeditionary Force."
952
ADMINISTRATION, AIMERICAN EXPEDITIONARY FORCES
(c) The provisions of the first sentence under "French soldiers in American sanitary
formations," Circular No. 31, A. E. F., May 23, 1918, do not apply to those hospitals where
a definite number of beds has been reserved for the reception of French patients, and when
this number has not been exceeded.
3. Disposition of sick and wounded of American Expeditionary Forces on duty with Brit-
ish Expeditionary Force.— In accordance with agreement of May 6, 1918, between the Brit-
ish War Office and representatives of the American Expeditionary Forces, sick and wounded
of American Expeditionary Force troops on duty with the British Expeditionary Force
are to be evacuated into^British Expeditionary Force hospitals. As far as practicable,
this evacuation will be into hospitals staffed by American sanitary units.
4. Instructions pertaining to evacuation of patients to United States. — (a) Surgeons of
base sections will be responsible for and regulate the evacuation of class D cases to the United
States from hospitals at base ports. They will keep informed as to the number and
types of cases awaiting evacuation, the dates of departure, and carrying capacity of trans-
ports and hospital ships, in order that there may be no delay in the movement of sick and
wounded. They will see that transport surgeons receive lists of patients and the necessary
papers pertaining to the cases which are to be sent to the United States, (see instructions on
"Field medical card," and par. 7, Sec. VI, p. 9, and par. 1, Sec. VIII, p. 10, "Sick and
wounded reports for the A. E. F."), including the classification of mental and other cases.
They will obtain from transport surgeons receipts for patients and the papers pertaining
thereto, as well as receipts for valuables and effects of insane and helpless cases.
(6) When patients of class D collect at any base port in such numbers that they can
not be properly cared for, and the facilities for evacuating them to the United States by
transport are insufficient, the base surgeon will send such cases as deemed advisable to an-
other base section, in accordance with such agreement as is made with the base surgeon of
that section.
(c) Surgeons of base sections, on request of surgeons of other base sections, will make
the necessary preparations for the reception and embarkation of patients sent to their re-
spective ports with the view to evacuation to the United States. They will also assist sur-
geons of other base sections to obtain sufficient information, so as to enable them to send
patients at the proper time for embarkation.
(d) Under the provisions of article 1, of an agreement entered into by the Secretaries
of War and Navy, March 28, 1918, the Navj' is charged with the care of sick and wounded
of the Army sent from France or England to the United States, except those shipped on
Army transports, but, the Army, on request of the Navy, will render such assistance in per-
sonnel and material as may be necessary. It will readily be seen that it would be impos-
sible at the present time to estimate, for the different ports, the number of personnel and
character and amount of material that the Navy might require from the Army under the
provisions of the above article, but in order that the Army may be able to carry out its part
of the contract as far as possible, the following will be observed:
a. Base surgeons will investigate and determine the character and amount of material
(refered to under art. 1, par. C, of the above-mentioned agreement) that will likely be re-
quired by transports entering their respective ports, and they will make timely requisitions
therefor.
b. Whenever the Navy requests personnel under the provisions of the above-men-
tioned agreement, base surgeons will recommend to their respective base commanders, for
detail with the Navy, such assistance as is available in the different sanitary organiza-
tions of their respective base sections, without depleting the efficiency of any organization
to such an extent that its required work can not be satisfactorily accomplished. W' hen such
men are detailed with the Navy, a telegraphic report will be sent to the chief surgeon, A. E.
F., stating all particulars, in order that the men may be replaced as soon as practicable.
c. Should the personnel or material requested by the Navy not be available at the
time, base surgeons will take proper steps to retain ashore such cases as the transport sur-
geons would be unable tc roperly care for.
(e) When class D cases are evacuated to the United States on any vessel other than
naval transports or naval hospital ships, the surgeons of the base section from which the
vessel sails will, before patients are taken aboard, make the necessary preparations for proper
medical attention, supplies, and personnel for their care en route.
APPENDIX
953
(J) Surgeons of base sections will submit to this office lists of all patients evacuated
to the United States from the ports in their sections. In addition to giving name, rank,
organization, and diagnosis, the name of the ship will be stated, with a numerical summary
outlined as follows: Sitting cases; lying cases (insane requiring restraint; other mental
diseases); sick (tuberculosis; all others); wounded (received in action; all other injuries).
5. Instructions pertaining to prompt action of disahilittj boards and early disposition of
cases classified. — The attention of commanding officers of hospitals is called particularly to
the necessity for prompt action of disability boards, and for early disposition of cases that
have been classified. In order to determine the length of time that cases recommended to
disability boards for classification remain in hospital without being acted upon, commanding
officers of base hospitals will submit to the chief surgeon, A. E. F., Services of Supply, a
weekly report of all cases which have been recommended for the action of disability boards,
and which remain in hospital for two weeks without completion of board proceedings. This
report will be forwarded every Saturday, and will show in each case the name, diagnosis,
date of admission to hospital, date on which the case was recommended to be sent before
the board, and reason for delay in classification. This report will also show in each case the
name, diagnosis, and date of recommendation of disability boards, of all men who have been
classified by boards and who have not been disposed of within two weeks after the boards'
recommendation .
6. Instructions to disability hoards in regard to classification of mental cases at base ports. —
(a) For the information and guidance of surgeons of base sections, surgeons on transports,
liners, and hospital ships, disaVMlity boards at hospitals at base ports will classify all mental
cases destined for transfer to the United States into the following groups, making entry on
board proceedings in each case: "Close supervision"; "ordinary supervision"; "no special
supervision. "
(6) Cases designated for "close supervision" should be placed in compartments or
rooms on shipboard, being constantly guarded by reliable attendants, and not allowed to go
on deck.
(c) Cases designated for "ordinary supervision" can be placed in the sick bay, with
the same supervision as is given to ordinary sick and wounded.
{d) Cases designated for "no special supervision" can sleep in ordinary bunks.
Many cases of feeble-mindedness and nondepressed psychoneurotics may fall vmder
this class.
(e) The greatest care must be exercised in the classification of mental cases, and where
doubt exists in any case, the proceedings of the board will show the cntr\- "close supervision".
7. Letter from the Surgeon General of the Army. — The following letter from the Surgeon
General of the Army is quoted for the guidance of the medical officers of the American Expe-
ditionary Forces, and the information called for will be entered on the sick and wounded
card whenever known:
All medical officers are requested in the future to give the name of the causative organ-
ism in addition to the diagnosis of the kind of pneumonia and the type of pneumococcus
whenever known.
Thus, pneumonia, lobar, should, if practicable be reported as:
Pneumonia, lobar, pneumococcus, type 1.
Pneumonia, lobar, pneumococcus, type 2.
Pneumonia, lobar, pneumococcus, type 3.
Pneumonia, lobar, pneumococcus, type 3.
Pneumonia, lobar, pneumococcus, type 4.
Pneumonia, lobar, pneumococcus, type unclassified.
Also broncho-pneumonia should, if practicable, be reported as:
Broncho-pneumonia, pneumococcus, type 1.
Broncho-pneumonia, pneumococcus, type 2.
Broncho-pneumonia, pneumococcus, type 3.
Broncho-pneumonia, pneumococcus, type 4.
Broncho-pneumonia, pneumococcus, type unclassified.
Broncho-})neumonia, streptococcus, hajmolyticus.
Broncho-pneumonia, streptococcus, other types.
Broncho-pneumonia, streptococcus, unclassified.
Broncho-pneumonia, other organisms, unclassified.
954
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
8. The new plan of promotion in the Medical Reserve Corps and Dental Reserve Corpi.—
The following letter has been received from the adjutant general, A. E. F., which explains
clearly the recently approved plan for promotion of the medical reserve officers serving with
the American Expeditionary Forces. It has also been extended to the Dental Reserve
Corps, and the Surgeon General has been requested to adopt it for these corps in the United
States. The corrective promotions avithorized in the first paragraph will be made as rapidly
as the reports called for by Circular 36 are received, and then promotions will be made
according to the roster. Precedence in the ro,ster will be determined by age and length of
service, except that a value will also be given for distinguished service, including wounds
and decorations received and mention for conspicuous gallantry:
General Headquarters,
American Expeditionary Forces.
From: The adjutant general.
To: The chief surgeon, A. E. F. (through C. G., S. O. S.)
Subject: Promotions.
1. Referring to your memorandum of May 7, 1918, regarding promotion of Medical
Reserve Corps officers, you will submit recommendations for promotions to the grade of
major of all medical reserve officers above the age of 40, and to the grade of captain of all
the lieutenants above the age of 35, whom you may desire to recommend.
2. The following will be considered the policy that will govern in regard to the promo-
tion of officers of the Medical Reserve Corps in the American Expeditionary Forces:
Policy governing promotion of medical reserve officer. — (a) AH officers of the Medical
Corps in Europe will be placed on a roster according to age in each grade. An officer's age
will be determined by his actual age plus four months for each month of service.
(h) All lieutenants whose actual age is above 31, and who have completed one year's
service, shall be eligible for recommendation for promotion to captain.
(c) Promotion in general will be according to seniority, as determined by these rosters.
((/) Taking the number of first lieutenants of the Medical Reserve Corps in the American
Expeditionary Forces at any time as a basis, the number of officers in grade of captain and
major shall not be greater than that authorized by the proportion of one lieutenant to three
and nine-tenths captains to one and seven-tenths majors (approximately the proportion
between the same grades in the regular Medical Corps at the time of the passage of the
medical reserve law) .
(e) Recommendation on the part of the military superior of each officer, with a state-
ment that his services have been satisfactory, will be required in each case of recommendation
for promotion.
3. The policy with regard to promotion of officers in the Dental Reserve Corps shall
be the same as that outhned above for the officers of the Medical Reserve Corps. The chief
surgeon is authorized to forward at once any recommendations for promotions which he
believes should be made for the purpose of rectifying inequalities in grade due to mistakes
in original appointments.
By command of General Pershing:
(Signed) W. P. Barnett, Adjutant General.
9. Oxygen tanks. — The necessity of keeping tanks containing oxygen under covered
storage as much as possible is pointed out. Excessive heat causes the plug in the safety
valve to be blown out, thereby emptying the tank.
10. Appliances for fire protection.— Requests for apparatus of this character should
hereafter be made direct to the chief of the bureau of fire prevention, these headquarters, by
separate requisition. These items should not be included in requisitions made on the medical
suppl}' depots.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
Circular No. 39,
American Expeditionary Forces,
France, July 12, 1918.
light diets in base hospitals
1. The following menus for hospital light diets are sent out as suggestions for the guid-
ance of mess officers. They are based upon a series prepared for use in a base hospital in
the United States which proved by experience to work satisfactorily at that place. The
APPENDIX
955
same menus may be repeated each week indefinitely, as any one man is seldom on light diet
for more than two weeks. It is probable that the price of some of the articles mentioned
may be prohibitive and that some others may be unobtainable. Substitutes will, of course,
be made in such instances. ' '
2. By this system the mess officer knows in advance what items will be required and
■can take measures to keep his stock complete.
3. In preparing menus from Table 2 it should be borne in mind that the total number
of calories for each diet should be between 2,000 and 2,500. "Cup" has the same signifi-
cance in all tables.
4. It is believed that menus prepared from either Table 1 or Table 2 will conform to
the practices of the best civil hospitals in the United States.
Table I. — Menus for light diets for one week
Note.— In these menus "cup" means approximately one-half pint of material prepared ready to serve,
'slices of bread" refer to those of the 1-pound loaf or to the half slices of the large Army loaf.
The
SUNDAY
Breakfast:
1 orange, or equivalent in
fresh fruit
1 cup cornmeal mush with
sugar and milk
2 slices bread with butter
1 cup coffee, half milk
Dinner:
Chicken fricassee, medium
service
1 baked potato, medium
size
2 sHces bread with butter..
1 cup tapioca pudding
1 cup cocoa, half milk
Supper:
1 soft-boiled egg
1 cup Farina with sugar and
milk
% cup stewed peaches
2 slices bread with butter
1 cup coffee
Total
Calories
75
200
175
200
650
150
150
175
250
240
80
250
250
175
965
755
MONDAY — continued
Supper:
1 cup custard 300
1 cup rice with milk and
sugar 200
% cup stewed apricots 250
2 slices bread with butter... 175
Calories
925
Total 2, 330
TUESDAY
Breakfast:
1 baked apple
1 cup Farina with sugar and
milk
2 slices bread with butter...
1 cup coffee, half milk
Dinner:
1 cup creamed chipped l)eef.
2 slices bread with butter
}/2 cup ice cream
1 cup cocoa, half milk...
2, 370
Breakfast:
% cup stewed prunes 250
1 cup oatmeal with sugar
and milk 200
2 slices bread with butter 175
1 cup coffee, half milk 200
Dinner:
1 cuj) chicken soup 100
2 soda crackers 50
1 poached egg 80
3^ baked sweet potato 150
1 cup jelly 200
1 cup coffee
825
580
Supper:
1 poached egg on toast
1 cup hominy with sugar and
milk
2 slices bread with butter
% cup stewed pears
200
200
175
200
200
175
225
240
125
250
175
125
775
840
675
Total 2, 290
WEDNESDAY
Breakfast:
2 slices pineapple 200
1 cup oatmeal with milk and
sugar 200
2 slices buttered toast 175
1 cup coffee, half milk 200
775
956
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
WEDNESDAY — Continued
Dinner: calorics
Chicken fricassee, medium
service 150
1 medium baked potato 150
2 slices bread witli butter... 175
1 cup bread pudding 250
1 cup cocoa, half milk 240
965
Supper :
1 soft-boiled egg 80
1 cup rice with milk and
sugar 200
2 slices bread with butter.- - 175
1 orange 75
530
Total 2,270
THURSDAY
Breakfast:
% cup stewed prunes 230
1 cup hominy with milk
and sugar 250
2 rolls with butter 175
1 cup coffee 655
Dinner:
1 cup chicken broth with
croutons 100
1 egg as omelet 80
^ baked sweet potato 150
1 cup Farina pudding 250
1 cup coffee 755
Supper:
1 cup tomato spaghetti 100
2 slices bread with butter.. 175
2 slices pineapple 200
1 cup cocoa, half milk 240
715
Total 2, 125
FRIDAY'
Breakfast:
1 orange, or equivalent in
fresh fruit 75
1 cup oatmeal with milk
and sugar 200
FRIDAY — continued
Breakfast — Continued. Calories
2 slices buttered toast 175
1 cup coffee, half milk 200
650
Dinner:
1 cup creamed codfish 200
2 soda biscuits 50
2 slices bread with butter. 175
1 cup tapioca pudding 250
1 cup cocoa, half milk 240
915
Supper:
1 soft-boiled egg 80
1 cup Farina with milk
and sugar 200
2 slices buttered toast 175
% cup stewed peaches 250
705
Total 2,270
SATURDAY
Breakfast:
1 baked apple 200
1 cup Farina with sugar
and milk 200
2 rolls with butter 175
1 cup coffee, half milk 200
775
Dinner:
1 egg as omelet 80
1 medium baked potato.. 150
1 cup creamed carrots 100
2 slices bread with butter. 175
1 cup junket 150
1 cup cocoa, half milk 240
895
Supper:
1 poached egg on toast 125
1 cup corn meal mush with
milk and sugar 200
2 slices buttered toast 175
% cup apple sauce 150
650
Total 2,320
APPENDIX
^ o o 0)
O ^ O Oh O P3 piH
3 P
3 p fl a -2 . ® 9
^ tB o M a
+j C Q)
a> o 03
P-C
Et3 a ,
0^ o ,
o g-5 :
"^•3" ^ '
nog
■- a c« o
o
o'> >>
I- c
a S M 03 " a
o b, o o
."3 ."3 -o " O
I i >
nil If
.ti.-S.-ti" ^ a
a E 3 o o o
000^;feQ
958
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Table III.— Caloric values of small quantities of foods listed in Table II as prepared readij In
serve
[Note that these values can, in the nature of the case, be only approximate. They should, however, be of some sissistance
in helping the mess officer or dietitian to approximate the proper value for the day's rations]
Cereals:
1 cup of cereal with milk
and sugar
1 egg
Meats :
1 cup creamed chipped beef
or 1 cup creamed codfish —
1 cup creamed chicken
Beef, mutton, or chicken, small
service
Vegetables :
1 cup tomato macaroni
I medium potato, white
1 medium potato, sweet
1 cup tomato, canned spinach,
or lettuce
1 cup creamed carrots
1 cup creamed peas
Bread, 1 slice, or 1 roll, or }/2 slice
of Army loaf
Butter, 1 service (40 to pound)
Soups :
1 cup thin soup
Calories
200
80
200
400
100
100
100
200
50
100
225
50
85
50
1 cup thick soup 100-200
Desserts :
1 cup custard
1 cup ice cream
1 cup gelatine jelly
1 cup pudding
Fruits, raw:
1 apple, large
1 orange, large
Baked, 1 apple, large, with sugar, _
Canned or stewed fresh fruit:
1 cup apple sauce
3 large halves apricots with
juice
1 slice pineapple with juice
3 halves pears with juice
1 cup cherries (stewed)
1 cup stewed dried fruit
Drinks :
1 pint milk
1 cup cocoa
1 cup coffee, half milk
Calories
300
300
200
250
100
100
200
250
100
100
100
100
400
800
240
200
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
Circular No. 40.
American Expeditionary Forces,
France, July 20, 1918.
1. Circular No. 2, office chief surgeon, A. E. F., dated general headquarters, A. E. F.,
November, 1917, is amended in so far as it relates to the director of laboratories, A. E. F.
2. A division of the office of the chief surgeon, A. E. F., is herebv created, to be known as
the di vision of laboratories and infectious diseases. This division will be an integral part of
the office of the chief surgeon, A. E. F., and will be responsible to him through the chief of the
division of sanitation. The central organization of this division will consist of a director and
the necessary number of assistants. The office of this division will be located in the city in
which the central medical department laboratory, A. E. F., has been established (A. P. 0.
No. 721). Col. J. T. Siler, M. C, N. A., is designated as the director of the division and the
following-named officers are designated as his assistants: Lieut. Col. George B. Foster, jr.,
M. C, N. A., assistant to director section of laboratories; Maj. R. P. Strong, M. R. C,
assistant to director section of infectious diseases; Maj. Wm. J. Elser, M. R. C, assistant to
director section of laboratories; Maj. Hans Zinsser, M. R. C, assistant to director section of
infectious diseases; Maj. P. A. Shaffer, S. C, assistant to director section of food and nutrition;
Maj. Louis B. Wilson, M. R. C, assistant to director section of laboratories; Capt. Ward
J. MacNeal, M. R. C, assistant to director section of laboratories.
3. This division is charged with the following general duties:
Section of laboratories.— (a) Representative of the chief surgeon in all matters relating
to the laboratory service.
(6) Organization and general supervision of all laboratories and the assignment of
special personnel.
APPENDIX
959
(c) Advisor to the supply division, chief surgeon's office, in the purchase and distribution
of laboratory equipment and supplies.
(d) Publication of circulars relating to standardization of technical methods; collection
of specimens and other matters of technical interest to the laboratory service.
(e) Collection and distribution of literature relating to practical and definite advances
in laboratory methods.
(/) Collection and compilation of statistics on routine and special technical work done
in laboratories.
(g) Instruction of Medical Department personnel in general and special laboratory
technique.
(h) Distribution and replenishment of transportable laboratory equipment.
(i) Cooperation and coordination with the Chemical Warfare Service, A. E. F., in the
supply of personnel and equipment.
(j) Supervision of the collection of museum specimens and photographic records of
Medical Department activities.
Section of infectious diseases. — (a) Advisor of the chief surgeon in matters relating to
the prevention and control of transmissible diseases.
{h) Collection and distribution of literature and preparation of circulars relating to
methods of prevention and control of transmissible diseases.
(c) General supervision of laboratory research.
(d) Advisory supervision of all activities looking to the control of transmissible diseases
including direct liaison with division surgeon.
(e) Assignment of specially trained personnel and ecjuipment for the investigation of
epidemics or threatened epidemics.
(/) Experimental investigation of suggested prophylactic methods for tlie prevention
of infectious diseases and recommendations relative to their general adoption.
ig) Collection of epidemiological data on infectious disea.ses.
(h) Cooperation and coordination with the water supply service, A. E. F., in the super-
vision and control of water supplies.
Section of food and nutrition. — (a) Representing the chief surgeon in matters affecting
the nutrition of the troops.
(b) Investigating Army food requirements and consumption.
(c) Acting in an advisory capacity in the formulation of rations and dietaries for the
American Expeditionary Forces.
(d) Inspecting food supplies and mess conditions with troops, hospitals, and prison
camps.
(e) Giving instruction in food inspection and handling, mess management, and other
measures for the maintenance of nutrition and the conservation of food.
4. The laboratories for the American Expeditionary Forces will be of two general
types — stationary and transportable. The stationary laboratories will include the central
Medical Department laboratory, base laboratories for the sections of the Services of Supply
and for selected districts where necessary. Army laboratories where necessary, base hospital
laboratories for individual base hospitals, base laboratories for base hospital centers, and
laboratories for camp hospitals.
Transportable laboratories will be organized for evacuation and mobile hospitals and
for divisions. Their equipment will consist of standardized expandable units in chests, and
their personnel will be specialh' trained for the duties which they will perform.
5. Instructions concerning the laboratory service of general interest to all Medical
Department units functioning with the American Expeditionary Forces will be issued in
circulars from this office.
6. The director of the division of laboratories and infectious diseases is authorized to
issue special letters and circulars of instruction governing the organization and activities of
this division.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
13901—27 61
960
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
American Expeditionary Forces,
France, July 22, 1918.
1. Reports and returns— Commanding officers of base hospitals will forward reports
and returns relating to matters named below through the commanding officer of the hospital
center, and direct to the office of the chief surgeon, if the base hospital is not included in a
hospital center: Hospital fund statements; sanitary reports; personnel reports; return of
enlisted force, Medical Department; report of epidemic diseases; hospital construction and
repair.
Commanding officers of hospital centers will take appropriate action upon sanitary,
epidemic diseases, and hospital construction and repair reports. The other reports named
will be forwarded without action.
Reports of sick and wounded and weekly reports of venereal disease will be forwarded
by commanding officers of each base hospital direct to the office of the chief surgeon.
Copies of epidemic and of venereal-disease reports will be furnished to the surgeon of
the section in which the base hospital is located.
2. Gratuities to cooks. — In compliance with decision of the Judge Advocate General
(40, 200 J. A. G., October 13, 1916), effective August 1, no gratuities from the hospital fund
will be paid to soldiers of the Medical Department holding the statutory grade of cook.
Gratuities paid under authority obtained, both while in the United States and on duty with
the American Expeditionary Forces, will be discontinued.
3. Students. — Information has been received from the United States that it is not the
policy of the War Department to approve the application of any enlisted men for return
from overseas to the United States for the purpose of entering educational institutions.
This policy applies to medical, dental, and veterinary students.
4. Tobacco. — The attention of commanding officers of hospitals is invited to the fact
that tobacco has been added to the ration, and it becomes the obHgation of the mess officer
to furnish it to such patients in hospital as desire to smoke and are authorized to do so. The
commutation value of the ration has not been increased on this account, but is believed
be ample, if the proper steps are taken to secure good mess administration and prevent waste,
to stand this additional expenditure.
5. Salvarsan (arsenobenzol) . — On account of difficulties which have occurred in alkaliz-
ing and administering this drug under war conditions, the chief surgeon has directed that its
issue be confined to the base hospitals, all of which have the proper equipment and technique
for its administration. Xovarsenobenzol will be supplied to all other hospitals and units,
and it alone will be issued after the exhaustion of the present stock of arsenobenzol.
6. Clinical records. — Clinical records, temperature charts, and other detailed descrip-
tions of treatment will not be forwarded with monthly report of sick and wounded, by any
hospital. They are hospital records and will be retained as such.
7. Property accountability. — The attention of all medical officers, and especially those
who are accountable for medical property, is called to the following cable received at general
headquarters, A. E. F., June 12, 1918:
Pershing, AM EX FORCE:
Paragraph 4. Medical officers returning to United States should be provided with
certificates of nonindebtedness to the Government.
*******
Mc Cain.
8. Religion. — The religion of every patient admitted to a hospital ward should, as soon
as practicable, be ascertained by the ward medical officers and appropriate entry thereof
made on the patient's field medical card, such as Roman Catholic, Protestant, Jewish, etc.
9. Change in report of epidemic diseases. — Section XII of Sick and Wounded Reports,
effective June 15, 1918, calls for telegraphic or telephonic report of measles and German
measles. Report by wire of these two diseases is considered unnecessary, and report by
mail will be substituted.
10. Requisitions for antigas clothing and gas masks. — These items have been included
in some requisitions for medical supplies made upon advance medical supply depot No. 1.
APPENDIX
961
111 accordance with General Order 53, general headquarters, 1917, the same are supplied by
the Chemical Warfare Service, A. E. F., and should not be included in requisitions for medical
supplies.
11. Heating slaves. — The commanding officers of all base hospitals except type A (newly
constructed hospitals), camp hospitals, convalescent hospitals, and evacuation hospitals
will immediately submit to the chief quartermaster, through this office, requisitions for the
number of large, medium, and small size heating stoves required in addition to the ones now
on hand; also the requisite number of joints of pipe and elbows, with the necessary feet of
stove wire.
In arriving at the required numbers of each of these articles, commanding officers must
continually bear in mind the exceeding difficulty with which all articles of this nature are
secured, also the likelihood of extreme scarcity of fuel during the coming winter. In this
connection, stoves should be so located as to reduce the number of pipes and elbows neces-
sary to a minimum.
12. Expenditures. — Vouchers submitted for purchases made under the authority of
paragraph 4, Circular No. 15, office of chief surgeon, line of communications, which reads
as follows: "The commanding officer of each base hospital is authorized to expend from
Medical Department funds a sum not to exceed $100 per month for the purchase of equip-
ment and supplies properly chargeable under regulations against such funds," will bear the
signature of the commanding officer of the hospital either as a certifying officer or as the approv-
ing officer.
This allowance will be confined to the emergency purchase of articles on the supply
table and in amounts sufficient only to bridge over the period pending the receipt of supplies
from the depot. Supplies furnished by other departments will not be purchased, as such
are not properly chargeable against Medical Department appropriations. Authority to
purchase items which have been erased from the medical supply table or of any item in an
amount in excess of the immediate needs must be approved either by this office or the section
surgeon.
The reserve of medical supplies is now such that requisitions based upon future require-
ments can be filled, and many emergency purchases or requisitions can now be taken as evi-
dence of poor administration of the supply department of the hospital.
13. Papers for publication. — The attention of all medical officers is called to the follow-
ing memorandum which has been received from the Surgeon General. Papers for publication
should be sent through tlie office of the chief surgeon:
Attention is called to the memorandum quoted below, which was issued March 27, 1918.
In many instances paragraph 3 has been overlooked. It is essential that this office receive
in duplicate all professional papers submitted for authority to publish:
"1. Attention of medical officers is directed to the provisions of paragraph 423, M. M. D.
Medical officers will not publish professional papers requiring reference to official records or
to experience gained in the discharge of their duties without the previous authority of the
Surgeon General.
"2. Numerous scientific papers written by officers of the Medical Department have
recentlv appeared in the medical press without specific authority from this office. This
practice will be discontinued, and the above regulations will be strictly complied with.
"3. Officers desiring the publication of professional papers will submit two copies to
the Surgeon General, with request for permission to publish same. Upon approval, a copy
will be forwarded to the journal designated by the officer for pubhcation."
M. W. Ireland,
Brigadier General M. C, N. A., Chief Surgeon.
Circular No. 42:
American Expeditionary Forces,
France, July 27, 1918.
COLLECTION OF MUSEUM MATERIAL FOR MEDICAL EDUCATION AND RESEARCH
1. Object. — This circular is for the information of those branches of the service whose
cooperation and assistance are necessary to enable the Army Medical Museum to discharge
its duty of collecting all those things which may be used for medical education and research,
or which may be of historic interest. This material will consist of pathologic specimens,
962
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
bacteria, animal parasites, missiles, armor, instruments, apparatus, casts, models, paintings,
drawings, diagrams, charts, statistical tables, cinema films, photographs, radiographs, lantern
slides, and other things pertaining to the preservation of the health and the prevention and
treatment of the diseases of United States soldiers, or the history of the Medical Department
of the Army.
2. Scope. — In France all collections will be limited to those things which can not be
obtained readily in the United States, or which are necessary for studj' in the American
Expeditionary Forces. More specifically those will relate principally to war wounds, especially
lesions of bones and vital organs, gas poisoning, trench foot, gas gangrene, traumatic and
"shell" shock, to infections and parasitic diseases of special menace to the American Expe-
ditionary Forces, and to material of historic interest. Other material may be included if
obviously desirable. It is requested that all medical officers in the American Expeditionary
Forces cognizant of desirable museum material which they are not in position to direct into
proper collection channels, should notify the director of laboratories, A. E. F. (museum unit),
A. P. O. 721.
3. Responsibility. — It is the duty of each medical officer in the American Expeditionary
Forces to direct into proper channels all such desirable material coming to his notice. In each
medical unit the pathologist, or, in his absence, some other medical officer, will be responsible
or the collection, preservation, and shipment of all such material obtainable in the unit.
4. Use in American Expeditionary Forces. — Collected material required for investigation
in the American Expeditionary Forces will be shipped as early and as directly as possible to
the groups of officers conducting the investigations in such manner and quantity as they may
request through the director of laboratories, A. E. F. After serving the needs of the immedi-
ate investigation, this material, if still of value, will be preserved for use elsewhere.
Requests for material required for teaching in the American Expeditionary Forces
should be made to the director of laboratories, A. E. F., who will direct from what source it
shall be supplied.
5. Concentration points.— All other collected material will be shipped without unneces-
sary delay directly to concentration points as follows:
(a) To the central Medical Department laboratory from all hospitals in the south-
eastern portion of the zone of advance and from other hospitals to which the central Medical
Department laboratory is most readily accessible.
(6) To American Red Cross Military Hospital No. 2 from all hospitals in the middle
section of the zone of advance to which it is most readily accessible.
(c) To United States Base Hospital No. 4 (British Expeditionary Force No. 9 General
Hospital) from all hospitals in the northern portion of the zone of advance to which it is most
readily accessible.
(d) To United States base laboratory of base section No. 1 or to United States Base
laboratory of base section No. 2 from all hospitals to which either of the above points is
most readily accessible.
The local railway transport officer should be consulted as to the most accessible point
for concentration of packages at the time shipment is to be made.
6. Final disposition. — At the concentration points the museum unit wall take charge
of the further preparation of all material and its shipment to the Army Medical Museum.
There it will be catalogued and such portions of it as are necessary immediately redistributed
as loans in accordance with a recent decision of the Surgeon General's office, as follows:
(a) Teaching material to United States Army schools for medical ofl^cers.
(6) Teaching and certain research material to the under graduate medical schools of the
United States (all of which are now under the supervision of the Surgeon General's office.)
(c) All historic and surplus material will be held in the Army Medical Museum for
local use or further loans.
7. Pathologic specimens. — All pathologic specimens suggested in paragraph 2 from both
operations and autopsies should be preserved as follows:
(a) Gross specimens: These should be dissected enough to disclose the character of the
lesion and to permit proper fixation. The surface blood should be rapidly washed ofif with
weak formalin (1 per cent or previously used). Each should have securely attached to it
APPENDIX
963
a tag of starched cloth or thick tough paper on which is heavily written in black lead pencil
or typewriting the name, rank, and organization of the patient, the anatomical name of the
specimen, the diagnosis of the lesion, the hospital number, the serial number of the specimen
(if autopsy material, the autopsy number), and the date of collection. Each specimen should
he fixed, and preserved until shipped, in five to ten times its volume of Kaiserling No. 1
solution, the formula of which is as follows:
Potassium nitrate, 15 grams.
Potassium acetate, 30 grams.
Formalin, 200 c.c.
Water, 1,000 c.c.
These materials may be requisitioned.
Sodium salts may be used instead of potassium. If materials for other methods of
color preservation are at hand, they may be used, but the specimens kept separate from
others in shipping. If no salts are obtainable, 10 per cent formalin may be used. Hollow
organs, large intestines, etc., should be filled with the solution to their normal size and
caliber. Where time permits, the vessels of large specimens should be injected with the
solution.
The solution fixes very rapidly and rigidly, so that it is necessary to use care when
specimens are placed in it that they are not deformed by pressure. Soft organs (brains,
lungs, etc.) which may be injured by pressure should be fixed in individual containers (jars,
granite- ware pails, or pans, kegs, etc.). Other tissues may be fixed, several together, in
tubs, barrels, casks, etc.
Specimens should not be placed in containers in contact with metal nor in new wooden
vessels the walls of which may contain tannin. If new wooden vessels are used they should
be coated inside with paraffin. Large containers — earthenware jars, barrels, casks,
etc. — should be obtained locally. Wide-mouth bottles and small specimen jars may be
obtained by requisition.
After preliminary fixation, the specimens should be changed at least once to fresh
fluid, which may be reduced in strength to 10 per cent formalin. Delicate specimens such
as pieces of intestine or blood vessels need to be carried through the entire Kaiserling process
rapidly if a brilliant color is to be preserved. With all other specimens only the No. 1
solution need be used.
Where the specimen is a bone, the soft parts should be left attached and the specimens
treated similarly to lesions of soft tissues alone.
(b) Material for microscopic examination: Tissues intended especially for microscopic
examination should be cut with a sharp knife or razor into thin blocks (not over 0.5 cm.
thick) and placed immediately into twenty to fifty times their volume of fixative (Zenker's
fluid, formal Zenker, neutral Zenker, 10 per cent formalin, 95 per cent alcohol, or other).
Their source should be accurately noted, described, and sketched. Their subsequent
treatment should be that appropriate for the fixative. Special attention is called to the
necessity for fixing tissues intended for cytologic study as soon as possible (under two hours)
after circulation in the part has ceased. Wide-mouthed bottles or small glass jars tightly
closed should be used as containers for histologic material.
8. Shipment. — When pathologic specimens have been fixed for two weeks or more
they should be well padded with absorbent cotton wetted with the solution in which they
have been last immersed, then wrapped in waterproof paper (to be obtained by requisition)
and packed with paper, excelsior, hay, or similar material in a strong wooden or tin box
or a barrel and shipped to the most accessible point of concentration. (See pars. 5 and 6.)
Each package should he marked with the hospital number, the serial numbers of the specimens,
the autopsy number, if any, and date of shipment.
At the same time there should be forwarded by mail or courier an inventory of the
contents of each package, accompanied by abstracts of the clinical records of operation
specimens and of clinical and autopsy records of autopsy specimens. The name of the
pathologist or other medical officer who may be specially interested in the specimen should
l)e given.
964 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Army Regulations authorize transportation of all museum material by the Quarter-
master Corps. Packages of specimens weighing 7 pounds or less should be directed on a
penalty envelope marked official and delivered to an American post office of the military
postal express service, with explanations of their character and the importance of their prompt
delivery to prevent spoiling.
9. Bacteria. — Army Regulations provide that cultures of all pathogenic bacteria isolated
in the American Expeditionary Forces shall be sent to the central Medical Department
laboratory for confirmatory identification. The museum supply will therefore be drawn
from the central Medical Department laboratory,
10. Microscopic slides. — Microscopic slides containing data which can not readily be
duplicated in other material sent from the same source should be sent to the appropriate
concentration point.
11. Animal parasites. — Specimens of animal parasites — if possible living — such as lice,
fleas, mites, bugs, flies, mosquitoes, worms, etc., sho\ild be sent to the central Medical Depart-
ment laboratory for confirmatory identification. The museum supply will be drawn from
this concentration point.
12. Missiles. — For the psychic effect, a missile removed from the body of a wounded
soldier may be given to him if he wishes to keep it. However, he may be induced to relin-
quish his claim when the scientific value of the comparative study of such missiles and their
preservation in a museum is explained to him. The place and character of all missiles
in amputation material should at least be accurately described and, if possible, sketched.
All missiles and foreign bodies removed at autopsies should be carefully preserved, if pos-
sible in situ, with the pathological specimen. When it is necessary to remove them, their
location and wound effects should be minutely described, the description, if possible, being
accompanied by photographs or sketches.
13. Armor. — Armor, such as helmets, or other protective body covering showing the
effects of missiles, gases, etc., should, whenever obtainable, be preserved, with full data
concerning the incidents of their use, and shipped to the nearest concentration point.
14. Instruments and apparatus. — All instruments and apparatus of special value which
have been developed or materially modified in the American Expeditionary Forces should
be photographed, accurately described, and, if it seems desirable, models made and sent
to the nearest concentration point.
15. Casts and models. — The number of skilled cast and model makers in the American
Expeditionary Forces is extremely limited. When a medical officer has some specimen,
or series of specimens or cases, showing results of operations which he wishes to have illus-
trated in wax or plaster, he should make application to the director of laboratories, A. E. F.
(museum unit), A. P. O. 721, for the services of a model maker.
16. Paintings, drawings, diagrams, etc. — It is believed that in many hospital units
there may be found men capable of making diagrams and sketches furnishing graphic records
of teaching or historic value to the Medical Department. Well-trained medical illustrators,
on the other hand, are scarce and their services, to be utiHzed in an economical manner,
must be centrally controlled. Medical officers having material of scientific value, parti-
cularly in the fields noted in paragraph 2, and who are without the assistance of capable
medical illustrators in their hospital units, should apply to the director of laboratories,
A. E. F. (museum unit), A. P. O. 721, to have an artist assigned for temporary duty.
17. Cinema films.— There are few subjects (e. g., patients with "shell" shock, the tech-
nique of new operations, etc.) records of which it may be desirable to preserve in moving-
picture films. AppUcations for the services of a cinema camerist for this work should be
made to the director of laboratories, A. E. F. (museum unit), A. P. O. 721.
18. Photographs.— General Order No. 78, general headquarters, A. E. F., May 25, 1918,
amends previous orders as follows: "The Medical Department, A. E. F., is charged with
technical photography connected with the recording of photographic processes of surgical
and pathological matters." For the proper discharge of this duty each hospital unit should
have on its personnel, either in the laboratory or Roentgenographic department, at least
one man capable of taking good technical photographs of medical subjects. A standard
laboratory photographic outfit should be requisitioned by each base hospital not alreadv
APPENDIX
965
equipped. It is assumed that all developing will be done in the X-rav dark room, where
will be available a ruby light, and all necessary chemicals for development and fixation of
plates and prints.
In addition, the following expendable materials may be requisitioned:
Plates, Lumiere orthochromatique :
Series C, 13 by 18 cm.
Series C, 5 by 7 inches.
Series C, 4 by 5 inches.
Plates, Lumiere ordinaire, slow series C, 33^ by 4 inches.
Plates, Lumiere, autochrome, for color photography, 3}4 by 4 inches.
Printing paper, glossy:
Soft, 5 b}- 7 inches.
Soft, 4 by 5 inches.
Medium, 5 by 7 inches.
Medium, 4 by 5 inches.
Hard, 5 by 7 inches.
Hard, 4 by 5 inches.
Lantern slide covers, clear glass, 33^ by 4 inches.
Lantern slide gummed binding strips, 100 in package.
Lantern slide gummed labels, 100 in package, 1 by 10 cm.
Metol, or substitute therefor, 1 ounce bottles.
Hydroquinone, 3^ -pound bottle.
Metachinone, concentrated for Lumiere autochrome plates, r25-c. c. bottle.
Potassium bromide, xls 10 grams in bottle.
Sodium carbonate, bulk.
Sodium bichromate, 1 ounce bottles.
Sodium hyposulphite, bulk.
Sodium sulphite, bulk.
Acid, acetic, 1-pound bottles.
Acid, sulphuric, 3^-pound in ggs. bottle.
Alumen, 3^-pound bottle.
Alumen, chrome, 1-pound bottles.
Ammonia, 1-pound bottles.
Plate varnish, Lumiere gum damar, 50 c. c. in bottle.
Autochrome color screens, 2-inch.
Autochrome color screens, holders.
"Virida" paper for dark-room light for autochromes, 6 sheets in set.
Photographic records should be made of interesting lesions, particularly in the fields
noted in p&ragraph 2, and of those things of medical, surgical, or pathological interest in
the hospital which may be of value for teaching, research, or for their historical connection.
Copies of these should be forwarded by mail or courier to the central Medical Department
laboratory, (museum unit), A. P. O. 721, as soon as made, and the negatives reserved for
subsequent shipment to the most accessible concentration point.
19. Radiographs. — Radiographs, especially those in series or illustrating wound con-
ditions of their treatment which may be of value for teaching, should be copied in prints
or lantern slides which should be forwarded by mail or courier with full data to the central
Medical Department laboratory (museum unit), A. P. O. 721.
20. Original publication. — All pathological specimens, casts, models, paintings, draw-
ings, photographs, radiograms, etc., should be accompanied by the name of the medical
officer collecting them, and of the medical officer, if any specifically interested in their sub-
ject matter. This is important, not only for the occasional necessity for retracing them
back to their origin for additional data, but also that the privilege of original publication
of the data by the officer with whom they originated may be respected.
21. Supplies. — All requisitions for supplies will be prepared and forwarded by medical
supply officer of the hospital unit. Requisitions for laboratory supplies only will be made
966
ADMINISTHATIOX, AMERICAN EXPEDITIONARY FORCES
in quadruplicate, one copy being retained and three copies forwarded to the director of the
division of laboratories and infectious diseases, office of the chief surgeon, A. P. O. 721, and
it is desired that as far as possible requisitions be timed so as to permit shipment thereupon
to be included in larger shipments from supph' depots on ordinary requisitions. These spe-
cial requisitions, therefore, should be sent approximate!}' 10 days prior to larger requisitions
contemplated, and should bear notation that shipment should be held pending the receipt
of requisition of general supplies.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
Circular No. 43:
American Expeditionary Forces,
August 1, 1918.
1. Recommendations for promotions in the Medical Reserve Corps. — The attention of
commanding officers of hospitals and other senior medical officers is invited to the fact that
the form on the back of Circular 36 should not be used for the recommendation of majors,
M. R. C, because such promotions take these officers out of the Medical Reserve Corps
and into the National Army. Promotions of this sort must necessarily be limited to a small
class of specially capable officers, occupying positions of unusual aiministrative or profes-
sional importance. Such recommendations should, when made, be in the form of a special
report giving with great fullness all the reasons for the promotion. They should not be made
at the request of the officer interested, or except when such promotions are obviously to the
interest of the service. The blank form with Circular 36 should be used, therefore, only
for captains and for lieutenants about the age of 31 who are class A men.
The responsibility rests with officers making recommendations to see to it that elderly
men who have no administrative capacity, and no unusual professional accomplishments
which would fit them for the grade of major— in other words, men who belong to class B—
are not recommended for promotion as class A men. Lieutenants within the draft age
should only be recommended for promotion in unusual and exceptional circumstances, where
the individual has received a military decoration, or wound, or is a man of very unusual
professional ability and occupying a position of such importance as to make his promotion
of obvious advantage to the service.
2. Returning men to duty with 20th Engineers.— Attention of all medical officers is in-
vited to the fact that the 20th Engineers is a large regiment and the companies are desig-
nated by battalions. It is therefore necessary to always state the battalion number in con-
nection with the company letter whenever men from this regiment are returned to duty.
3. Messengers.— Vnder authority granted by the commanding general. Services of Sup-
ply, in the future when requisitions for X-ray tubes are made on any medical supply depot,
the organization making the requisition will, upon receipt of notification that the tubes
are available, send the necessary number of messengers to the medical supply depot in
question for the purpose of carrying back the tubes. Two tubes will be all that one man
can handle.
4. Repair of typewriters.— The question of the repair of tvpewriters has been taken
over by the Quartermaster Department. Hereafter all typewriters needing repair should
be shipped to the typewriter repair shop, Tours, notification of the fact of shipment being
made to the commanding officer thereof. Upon completion of repairs, machines will be re-
turned to the medical units who forwarded them.
5. Convalescent /iomes.— Arrangements have been made with the American Red Cross
that nurses for whom a period of change is desired for convalescence after illness may be
sent to the "American Red Cross convalescent home and vacation hotel," at Le Croisie
near St. Nazaire, during the summer months instead of to Cannes as formerly
It should be understood that in order to take advantage of this arrangement author-
ity should b^ requested from the chief surgeon, A. E. F., to send the nurse or nurses to this
convalescent home on a status of absent sick for convalescence with a statement as to the
physical condition which requires this change. Nurses for whom this authoritv has been
APPENDIX
967
granted should not be placed on a status of sick leave, no authority being granted for sick
leave to nurses.
It is not the intention to send nurses to the convalescent homes whose physical condi-
tion is such that they are in need of nursing care. Only those who are fully able to care for
themselves should be sent.
6. Charge for subsistence of civilians sick in hospital—Changes, Army Regulations
No. 69, provide that the charge of subsistence of civilian patients in hospital on the footing
of enlisted men will be an amount equal to the commutation rate prescribed for enlisted
patients plus 10 cents a day.
7. Prompt evacuation of class D patients.— Attention is directed to the policy of this
office with respect to the disposition of all class D patients. It is not intended to hold pa-
tients for prolonged periods of observation and study who are clearly destined to fall within
this class, no matter how much professional interest they excite.
Such cases should be placed before disability boards promptly for classification, and
as soon as they are able to travel by ordinary train they should be sent to Base Hospital
No. 8, at Savenay, with a view to their transfer to the United States. If not able to bear
travel upon ordinary trains, all such patients should be sent on the hospital train which
will be routed regularly to collect such cases as are able to bear the journey to the United
States.
Therefore, as soon as a patient is classified as of class D he should be considered as
destined for transfer to the United States, since the intention is to evacuate to the United
States all mutilated and disabled men for treatment, reconstruction, reeducation, and final
disposition. The necessity for this policy lies in the fact that the hospitalization program
in the American Expeditionary Forces is based upon a definite priority schedule of building
and of housing material, and also of tonnage space for medical supplies on ships from home
ports, in direct ratio to the number of troops in France. The hospitalization program in
the United States also contemplates the reception of a constant stream of evacuables from
the zone of operations.
8. Biological products. — The following biological products have been selected by the
chief veterinarian as all that are necessary for the American Expeditionary Forces. Supply
depots and base laboratories will carry these only in stock:
(a) Serum antitetanic.
(b) Serum antistreptococcic.
(c) Mallein intradermal.
9. Authority to authorize expenditures and approve vouchers on Medical Department funds. —
Authority to authorize expenditures and to approve vouchers for purchases properly charge-
able against Medical Department funds, in sums not to exceed $250, is granted to the com-
manding officers of all hospital centers and to the chief surgeons of armies.
The authority to authorize expenditures and to approve vouchers for purchases properly
chargeable against Medical Department funds, in sums not to exceed $100, is hereby granted
to chief surgeons of army corps.
10. Hospital trains. — When the commanding officer of a hospital is informed of
the arrival of a train of patients for his hospital he will send an experienced medical officer
and a sufficient number of enlisted men to unload patients from the train. This work is
not to be done by the train personnel except in emergenscy.
Commanding officers of base hospitals are authorized to issue expendable medical
and surgical supplies to the commanding officer of hospital trains, taking the memorandum
receipt of the commanding officer of the train as a voucher for property return.
11. Mail.— It has been reported to the chief surgeon's office that some medical officers
on duty in wards where there are mental cases are in doubt as to their power to prevent
the mailing of letters from mental cases of an obscene or abusive nature, or letters on trivial
subjects, to prominent persons. Commanding officers of hospitals should regulate this
matter and see that letters of this character are not placed in the mails.
M. W. Ireland,
Brigadier General , M. C, N. A., Chief Surgeon.
968
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 44.
American Expeditionary P'orces,
A ugust 3, 1918.
1. System of evacuation of wounded .—The following report of the system of evacuation
of the wounded adopted by the regimental surgeon, — th Infantry, is pubhshed for the in-
formation of regimental surgeons:
1. I made a reconnaissance the night of June — th of all roads and paths between
p road and B farm, including a personal reconnaissance of B , N ,
Bois la'M roads, etc., for suitable routes for ambulances; especial attention was
given to safety of ambulances, speed and comfort of wounded, and avoidance of traffic con-
gestion. , , . ,
2. OutUne the following system as the result of this study, which was very success-
fully followed during and after the attack: .
On June — th, 1918, an advance station was organized at M , including 3
medical officers, 8 Hospital Corps men, and 20 litter bearers. Ample supplies were stored
in the dugout in which this station was located. At T farm another dressing station
was estabhshed, with 3 medical officers, 8 Hospital Corps men, and 15 htter bearers, with
reserve supply of litter bearers and corps men and medical supplies always available for
forwarding to anv point where added assistance might be needed. An advance station
of the — d Infantrv was located at B . Their evacuation and operation of the station
was under my supervision. One surgeon, one sergeant, and one private went forward from
M with the assaulting waves, and they estabUshed a dressing station at V .
The stretcher bearers worked for this station, and the prompt need with which first aid
was given at the forward station undoubtedly saved a large number of lives. At La N
farm an advance medical supply depot was estabhshed and a reserve ambulance station.
This was in the hands of 1 medical officer and 1 noncommissioned officer in charge of ambu-
lance and medical supphes. The regimental infirmary included the regimental surgeon
and 3 assistants, with 5 medical officers in reserve to be forwarded to the point of greatest
need, and was located at B farm.
3. Thirty-five ambulances were in service for the evacuation of wounded from the
battalion aid station through the regimental infirmary to Field Hospital No. — . At the
time of our assault there were 2 ambulances in waiting at M station, 2 at B ,
and 2 at T farm. Four ambulances were at the intermediate station at La N ■ — •
farm. As soon as a loaded ambulance going to the rear passed La N ■ farm, the non-
commissioned officer stationed there sent an empty ambulance forward to replace it; in
this way there were always two, and no more than two, amVjulances at each battalion aid
station. As soon as the loaded ambulance reached B farm, another empty ambu-
lance was sent forward to replace the ambulance at the intermediate station at La N —
farm. This system cut down congestion on the roads and enabled us to have ambulances
always available and secured the greatest efficiency in the use of each ambulance.
4. Under the system of evacuation outlined, many wounded had reached the field
hospital at B — • within one hour after the first assaulting waves had left their lines
of departure. When the — d Infantry dressing station was demolished by artillery, kill-
ing one medical officer and wounding another, it was possible to replace them by two of the
medical officers held in reserve for this purpose within 15 minutes after the accident and
before there was any accumulation of wounded at the station.
Hospital Corps men held in reserve were forwarded to each of the battalion stations
as they were needed, and when the pressure relaxed they returned to the reserve station.
This arrangement allowed an elasticity which kept wounded from congregating at any station
and kept a stead}-, constant stream of evacuations to the rear. It enabled us to evacuate
the major part of approximately cases before midnight. At 3.30 a. m., excepting
straggUng cases, there were no wounded in any of the dressing stations or in the regimental
infirmary, all having been sent to the rear.
The cases handled included about Americans, about each of French and
Germans, each of which received hot drinks and additional medical aid at the regimental
infirmary before being sent to the field hospital at B . I left the regimental infirmarv
before being sent to the field hospital at B . I left the regimental infirmary in care of
a Medical Reserve Corps captain and in a motor cycle side car made the rounds of the for-
ward stations, apportioning the reserve surgeons and litter bearers according to the need of
the stations at that time, and supervised the forwarding of medical supphes as they were
needed.
2. Shortage of personnel. — Because of the shortage of Medical Department personnel
trained in the care of mental cases, it is directed that commanding officers of all base and
evacuation hospitals or other Medical Department units forward to this office the names of
any nurses or men who have had such training and who are not at present performing such
duties.
APPENDIX 969
3. Prisoners of war. — As soon as prisoners of war who have been under treatment in a
L'nited States Army hospital are ready to be evacuated to the C. P. W. E., the commanding
officer of the hospital should notify the provost marshal general, who will send the necessary
guard to escort them to the C. P. W. E. In order to economize on the number of escorts
sent to the hospitals, these prisoners of war should be evacuated from the hospital in groups
of five or more.
4. Livo vaccines. — The following letter from the Surgeon General is quoted for your
information :
I beg to inform you that the Army Medical School is now practically readv to begin
furnishing triple hpo vaccine in place of triple typhoid sahne vaccine. The lipo vaccine
has the great advantage over the saUne of being administered in a single dose. The oil
permits this, since it diminishes the rapidity of absorption, and a large dose can be adminis-
tered, which is absorbed gradually over a long period. It is expected in the course of a few
months to stop the manufacture of the saline vaccine altogether. The quantity of machinery
apparatus, necessary to this change in the method of manufacture is delaying the output
for a short time only. So far this month, 30 Uters have been issued, and we will soon be
in position to issue not less than 150 liters per month.
After the typhoid vaccine is well on the way a similar oil vaccine will be made to be
used against pneumonia, dysentery, cholera, plague, and perhaps streptococcus infections.
5. Medical war diaries. — Beginning with Jul}- 1, 1918, and in connection with medical
histories of camps, depot brigades, and base hospitals recently filed in the Surgeon General's
office, it is directed that medical war diaries be kept henceforth in these stations until the
close of the war. These diaries shall be regarded as the literary property of the division
of medical and surgical history of the war, Surgeon General's office, and must be entirely
disassociated from the ordinary military and medical records of camps and base hospitals.
Attention is called to the fact that these records are to be regarded as stationary; i. e.,
the medical records of the division surgeon of a mobilized division must not be confused with
the permanent medical history records of the camp or other stations in which the division
has temporarily been quartered or through which it passes. The latter records must remain
in the station until the end of the war as the ultimate property of the Surgeon General's
office, and should not be removed by any outgoing division surgeon.
It is requested, however, that each outgoing camp or division surgeon transmit to this
office (division of medical and surgical history) a carbon of his own individual contribution
to the war medical diary up to the time of his departure from the station.
Medical war diaries of camps and base hospitals shall be made up of brief but circum-
stantial entries of any events in the history of these stations which have influenced their,
sanitary status; e. g., outbreaks of epidemic diseases of major or minor importance, fires
or other accidents, important changes in personnel, medical administration, sanitation, new
therapeutic measures and sanitary devices introduced, new construction whether by enlarge-
ment of existing buildings or erection of new buildings, incidence of unusual diseases or
complications of disease, unusual surgical cases and operations performed, or any other
feature of like interest.
M. W. Ireland,
Brigadier General, Chief Surgeon.
Circular No. 45.
American Expeditionary Forces,
France, August 13, 1918
I. Circular No. 6 is amended to read as follows:
1. The attention of medical officers, A. E. F., is directed to the absolute necessity for
the prophylactic administration of antitetanic serum (A. T. S.) under the following conditions:
(a) Immediately after the receipt of a wound of whatever nature or severity.
(6) Upon the recognition of so-called trench foot, with or without skin abrasions.
(c) In cases of frost bite.
(d) During operations performed under conditions of unsatisfactory asepsis; e. g.,
emergency operations, operations for hemorrhoids, fistulse, or any conditions where fecal
contamination is a possibility.
970
ADMINISTRATION, A:MERICAN EXPEDITIONARY FORCES
(e) During secondary operations necessary in the course of the treatment of wounds
received seven or more days previously.
if) Following the manipulations incident to the reduction of com])ound fractures or
dislocations, after the removal of adherent drains, or any other procedure resulting in a
serious disturbance of the healing processes in a wound seven or more days old.
2. One prophylactic dose of 1,000 units of tetanus antitoxin will be given to all wounded
whatever the nature or severity of the wound, as promptly as possible after the infliction
of the wound if a battle casualty, preferaVjly at the battalion aid station. This dose should
be given subcutaneoush' preferably over the lower abdomen. A second dose of 1,000 units
will be given in every case after an interval of seven days.
3. In severe injuries where prolonged suppurative processes persist, especially when
fecal contamination of the wound per rectum or through intestinal fistula is present and
when much tissue necrosis occurs, three or even four doses may be indicated. The attend-
ing medical officer must bear this in mind and exercise judgment accordingly in the
individual case.
4. There is no objection to the use of 1,500 units for the initial and the second pro-
phylactic doses, but doses of 1,000 units each afford sufficient protection. (Note. — Tetanus
antitoxin from the United States usually contains 1,500 units to the dose.)
5. The serum should be administered by or under the immediate supervision of a medical
officer. If for any reason this is impossible, it should be given by some responsible member
of the Medical Department.
6. All injections, with amounts and dates, signed by the officer administering them,
will be entered on patient's field medical card, by the letters A. T. S. followed by the date
and hour. In the case of the freshly wounded the letter T should be marked plainly upon
the patient's forehead with an indelible pencil.
7. Absence of any records on the patient's card or face as indicated in the preceding
paragraph is to be accepted as evidence that the A. T. S. has not been given. The first
medical officer to assume subsequent control of a patient thus neglected should administer
the serum immediately.
8. Medical officers who are thus compelled to administer A. T. S., because of the failure
of any medical officer or officers previously responsible for this administration to carry out
the above instructions, must make an immediate report of such ommissions to the chief
surgeon, A. E. F., through the director of general surgery, with sufficient data to establish
the time and circumstances of the omission.
II. Patients dying on hospital trains. — Commanding officers of base hospitals will receive
from hospital trains the remains of any patients dying en route, and will arrange for their
burial and render the necessary reports called for by existing orders.
III. Civilian emplojjees for hospital centers. — Authority is hereby granted to commanding
officers of hospital centers to authorize the employment of such civilian employees as may
be necessary for the administration of the base hospitals under their command. The employ-
ment of these civilians must be in accordance with existing regulations; and attention
is invited to Bulletin No. 14, headquarters, line of communications, February 13, 1918,
and General Order No. 7, headquarters, services of supply, March 11, 1918.
IV. Address of director of professional service.— Attention of all medical officers is invited
to the fact that the address of the director of professional service is A. P. O. 706, and that
of the consultants is A. P. O. 731. Considerable mail is coming to this office for these services
and addressed to post office 717. These cause a delay and unnecessarv work in this office.
V. Transportation of wounded in trucks. —Trucks can be used to' great advantage for
transportation of wounded where the distances are not too great. Twelve litter cases can
be earned in a 3-ton truck. In loading, 3 litters are first placed transverselv in the upper
tier, with handles resting on the edges of the sideboards of the truck box; then 3 longitudi-
nally in the bed of the wagon; then 3 more transversely in the upper tier; and finally 3
more on the floor of the truck longitudinally. The tailboard of the truck remains open,
ihe stirrups of the 3 rear litters in the lower tier fit into the opening between the bodv of
the truck and the tailboard. In order to keep the rear patients from rolling out one open
litter is placed on edge at the back of the truck, with its lower handles resting on the side-
APPENDIX
971
boards and the upper handles supported by the rear bow of the truck. It requires 12 minutes
for 4 men to load 12 patients. Where there is a bank beside the road, it can be conveniently
used for loading the upper tier.
VI. Promotion and demotion of enlisted men, Medical Department. — The commanding
officers of hospital centers are authorized to promote and demote enlisted men of the Medical
Department between the grades of private and sergeant, first class, inclusive. They will
sign warrants "for the chief surgeon" for men promoted under this authority. The number
of men promoted will not exceed the percentages authorized by law. Recommendations for
promotions of soldiers of the Medical Department to the grade of master hospital sergeant
and hospital sergeant will be forwarded to this office for approval.
VII. Visits of French ladies to American wounded. — Authority has been granted the
Association of French Homes (Foyers Francais) to issue to ladies who are members of that
society permits which will entitle them to visit American wounded in military hospitals of the
American Expeditionary Forces. The society has been informed, however, that these visits
can, as a rule, be only made during the regular visiting hours prescribed by the commanding
officer of the hospital or hospital center.
VIII. Anthrax. — The following letter from the Surgeon General, of July 6, 1918, is
quoted for your information:
1. I am directed by the Surgeon General to inform you that the number of cases of
anthrax being reported to this office is sufficient to attract attention at this time. Anthrax,
so far as reported, has without exception appeared on the face or neck, and shaving brushes
have fallen under suspicion, and in some cases anthrax organisms have been isolated from
them. For this reason, it is necessary that each case of anthrax coming to your attention
be examined critically; that the man's shaving brush, talcum powder, and other shaving
accessories be obtained; that the organism be sought for with great thoroughness. For the
purpose of testing brushes, it is recommended that inoculations of bristles from the brush be
made into rabbits, guinea pigs, and rats; nothing short of this may give conclusive results.
Report should be made to this office of each case, giving the clinical history, the etiology,
the results of the examination of supposedly infected material. The shaving brush or other
article from which the anthrax bacillus may be isolated must also be forwarded to this office,
with full information as to its source, name of the maker, and other data to facilitate its
identification.
M. W. Ireland,
Brigadier General, Chief Surgeon.
Circular No. 46.
Americ.w Expeditionary Forces,
France, August 16, 1918.
1. Upon the recommendation of the chief consultant in surgery, and with the approval
of the director of professional services, the following instructions are published for the informa-
tion and guidance of all concerned:
INSTRUCTIONS CONCERNING THE TREATMENT IN ORTHOPEDIC CONDITIONS, INCLUDING
FRACTURES AND JOINT INJURIES
2. The work of the division of orthopedic surgery in the medical organization of the Army
divides itself quite clearly into two parts, one having to do with the preparation of the men for
the expected combat, and the other assisting in their recovery if wounded. The first endeav-
ors to see that they are so trained that there will be the greatest possible vigor for the combat,
and that physical defects which might have rendered them ineffective are corrected The
second has to do with the treatment of the men if injured, so that there will be the least possible
ultimate crippling or interference with function. The first has to do with saving men for
service who would otherwise be discharged as physically unfit and also, as the result of careful
training, increasing the number of days that should be expected of the men for active duty.
The second has to do with the saving for service of men who but for such work might not
have lived, or, had they lived, been so crippled as to be of no use to the Army.
972
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
3. Without such methods of treatment available for those needing such care in the pre-
combat or training period, large numbers of men will be lost for active duty, as the ordinary
medical measures can only give temporary relief.
4. Without such methods in cases of combat or other injury there will be much unneces-
sary loss of function and much of the acute surgical treatment will be purposeless.
5. In each of the large hospital centers, a base hospital with special personnel and equip-
ment for caring for such cases will be installed, while in the detached base hospitals special
services will be established so that there will be the least possible transferring of cases from
one hospital to another.
6. Consultants in orthopedic surgery will be assigned to groups of hospitals, whose
function it will be to keep in touch with the orthopedic work of the given group. These
consultants should be freely used by the staff of the respective hospitals and can be reached
through the commanding officers of hospital centers.
7. To best accomplish the purposes of the division and to make the services of its mem-
bers available the following instructions will govern:
AMPUTATIONS
8. Cases of amputation of either extremity will be assigned as soon as possible to the
orthopedic service for the needed special treatment. A guillotine amputation, for instance,
without other injuries, can usually be moved without risk in one week, and with suitable
measures rapid closure of the wound is usually possible so that the artificial leg can be fitted
and the man get about without crutches many times in from four to five weeks from the time
of injury. It is desirable that transfer to the orthopedic service take place as early as pos-
sible before contractures have taken place so that the temporary artificial limb, in case that
is desirable, can be most favorably fitted and the muscles used to the best advantage.
TENDON INJURIES OR INFLAMMATIONS
9. The cases of injury to the tendons or inflammation in or about the tendons should
be assigned as soon as the primary wound healing is well established, or as soon as the acute
inflammatory reaction has subsided to the orthopedic service. Early transfer to these
special services is important in order that the treatment having to do with the full restoration
of function in the part that has been injured or inflamed may be established at the earliest
possible moment and before adhesions have formed or become organized.
FLAT FEET, WEAK FEET, OR PRONATED FEET
10. Cases of fiat, weak, or pronated feet associated with pain, swelling, or inflammation,
when admitted to a hospital should be assigned to the orthopedic service. As soon as the
acute symptoms have passed, the cases should be transferred to the nearest convalescent
camp. From here, in keeping with the degree of difficulty, the cases should be transferred
for full duty or to the orthopedic training camp, depot division, for training to fully overcome
the weakness, or for noncombat duty under class C classification.
11. No cases of uncomplicated flat foot should be exempted from service or recom-
mended for transfer to the United States, as all can be made useful for military service.
SPINAL STRAINS, WEAK BACKS, CHRONIC BACKACHES
12. The cases of weak, painful, or lame backs, or of sprain of the spinal or sacro-iliac
joints, should be assigned to the orthopedic service. From here they should be transferred
to the nearest convalescent camp as soon as the acute symptoms have passed, and from there,
after a reasonable time, they should be transferred either for full dutv or for noncombat
duty under class C classification.
GENERAL BAD POSTURE
13. Cases of general bad posture, which is commonly associated with lack of vitality
or general endurance as well as being part of the condition leading to weak feet and weak
backs, should be sent for training in the orthopedic training camp, depot division
APPENDIX
973
FRACTURES
14. For all cases of fracture of bones other than of the head or face, or of extensive
muscle injuries, it is of the utmost importance that proper splints be applied at the earliest
possible moment so that the transfer of the patients to the hospital in which treatment is to
be given, is associated with the least possible damage to the tissue adjacent to the injured
bone. The Thomas leg splint, the hinged half-ring splint, the Thomas hinged arm splint
(Murray modification), the Cabot posterior splint, and the ladder splinting are the appliances
most needed for such work.
15. In case the fracture is compound, the wound treatment at the evacuation or other
hospitals should follow the principles outlined by the chief consultant of surgical services.
16. After the primary wound treatment has been given, these cases should be trans-
ferred to the orthopedic service, in which the most approved methods for the early restoration
of function to the injured part will be available. An effort should be made to transfer the
cases to such services, wherever possible, within a week or 10 days of the time of injury,
this being the most favorable time as regards bone repair. All fracture cases which, for any
reason, can not or should not be transferred to one of the services as indicated above, should
be reported to the senior consultant in orthopedic surgery, or to the orthopedic consultant
of the special area.
17. Simple fractures should not be converted into open fractures except under very
exceptional conditions or after consultation with one of the orthopedic consultants. A
result which may not be as perfect anatomically as might have been obtained by open opera-
tion may, nevertheless, be functionally good. This is so commonly the case that the risk
of infection, which is greater under the war conditions than in civil life, should be avoided
whenever possible.
JOINT INJURIES
18. All injuries of the joints should be protected with the same care for transport to the
hospital in which the treatment is to be given as has been indicated for fractures. Suitable
splints should be applied immediately, and the standardized list of splints of the Army
provides types that will meet all the needs.
19. In case the injury is associated with open wounds, the principles of the wound
treatment are those which have been laid down by the chief consultant of general surgery.
20. Since in all such injuries ultimate function of the joint is the chief requisite, treat-
ment having for its purpose the restoration of function should be instituted as soon as possible,
and for this purpose it is desirable that cases of such injury be transferred, as soon as the
primary wound treatment has been given, to the orthopedic service. It is important that
such transfer be made before unnecessary adhesions have formed so that the restoration of
function can be obtained with the least possible loss of time. In all such functional restora-
tion it should be clearly understood that while motion is to be encouraged at the earliest
possible moment, it should consist entirely of active motions performed by the patient, in
which case the reflex muscular contraction will protect the joint from undue injury. All
passive motion should be avoided.
21. Operations upon the joints that are not emergency in character should not be
performed until after consultation with one of the consultants in orthopedic surgery.
TRANSFER TO UNITED STATES
22. It will be the policy to send to the United States, as soon as transportable, all
cases that are of class D type, or cases in which prolonged treatment will be required for
restoration to dutv.
M. W. Ireland,
Brigadier General, M. C, N. A., Chief Surgeon.
Circular No. 47.
American Expeditionary Forces,
August 28, 1918.
I. The following memorandum from general headquarters, American Expeditionary
Forces, is published for the information of all medical officers concerned. Strict observ-
ance of the instructions that only class A men, fit for immediate combat duty, be sent to
replacement battalions is enjoined:
974
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
1. Complaints are reaching these lieadquarters that hospitals are sending men to
replacement battalions who are not fit for class A or immediate combat duty. The com-
manding general of the First Corps reports this matter to these headquarters and is advised
in substance as per the telegram being sent out to-day:
"Following furnished for your information and guidance. Commanding general,
First Corps, recently forwarded these headquarters complaint that men other than class A
were sometimes being sent to replacement battalions, and requested authority to send all
class B, C, D men to depot division for disposal. Our indorsement .\ugust 19 approved
this request, with statement men sent to replacement battalion must be class A, fit for
immediate assignment to combat duty, and was never contemplated that class B, C, D
men be sent those battalions. Chief surgeon has been directed to circulate this information
to medical officers concerned.
" MOSELEY."
II. Discharge of civilian patients from hospitals. — In a recent case a civilian employee
of the Army was admitted to hospital as a soldier, was transferred to another hospital as
such, and upon discharge from the hospital for duty was issued the uniform of an American
soldier. He was later arrested on the charge of illegally wearing the uniform. Commanding
officers of hospitals should take every possible precaution in issuing imiforms to patients
being discharged from hospital that they are only given to those entitled to wear them.
III. Appliances. — Requisitions for all appliances which require heat or power should
show in the column "Remarks" whether gas or electricity is available; and, if the latter^
the type of current, voltage, and cycle will be designated. This applies in particular to
X-ray,, dental, and laboratory equipment.
IV. Prolonged active hospital treatment. — Patients have recently been evacuated from
the front to Services of Supply hospitals "For continuation of antisyphilitic treatment."
General orders and circulars issued on this subject provide that "Only cases presenting
complications indicating the necessity of prolonged active hospital treatment will be trans-
ferred back from the regimental lines." In this connection, attention of all medical officers
is called to paragraph 5, section 1, General Order 34, general headquarters, 1917, and para-
graph 5, Circular 15, office of chief surgeon, 1917.
V. To registrars of all hospitals. — The copies of Form 22, A. G. O., received in this
office are in many cases so illegible as to be unavailable for use. Unless better copies are
sent, it will be necessary in a large proportion of the reports to require that new sets be made
out and forwarded. To obviate this necessity it is suggested that first and third, or second
and third, copies of the original impressions be forwarded to this office.
VI. Evacuating officers and soldiers from hospitals. — There have been frequent com-
plaints that orders governing the evacuation of officers and soldiers from hospitals were
not being complied with. Commanding officers of hospital centers and hospitals are charged
with the duty of seeing that all the officers of their command concerned with the evacuation
of patients from hospitals are thoroughly familiar with the orders governing this subject.
In this connection attention is called to section 7, General Orders 111, general headquarters
1918; section 2, General Orders 11, Services of Supply, 1918; section 1, General Orders 41,
general headquarters, 1918; and Circular Letter 6-A, office of chief surgeon, 1918.
VII. Records to accompany patients on evacuation from hospitals. — 1. Attention of all
medical officers is called to the instructions on the field cards, which state that these cards
are to be securely fastened to the patient's clothing. These instructions are not being
carried out, and as a result patients and their cards are becoming separated and there is a
great confusion of records. In some cases when patients are being evacuated bv hospital
trains the field cards are turned over in bulk to the train commanders. This method of
transfer of field cards is not authorized, and train commanders are hereby instructed not
to accept field cards in this manner.
2. Many patients are being received at hospitals in base ports for evacuation to the
United States without adequate records of previous condition. Attention is called to the
requirements of General Orders 41, general headquarters, 1918; section 1, paragraph 8;
and to the Manual of Sick and Wounded Reports, sections 6 and 7, and section 9, paragraph 12
3. In making report, disability boards wiU use card Form No. 25, statistical section,
A. G, O.
VIII. Personal property of patients.— It has been reported that articles of value have
been turned in, without receipt, by great numbers of wounded soldiers at field, evacuation.
APPENDIX
975
and other hospitals and that on their being evacuated to other hospitals these articles have
not been returned to them. Commanding officers of hospitals should give this matter
their attention and endeavor to see that personal property belonging to their patients
accompanies them upon evacuation.
IX. Fire protection. — The following suggestion is made to this office by the bureau
of fire protection:
In hospitals where different types of construction have been used, commanding officers
should keep in mind in making assignments of patients to wards that on account of diffi-
culties of evacuation in case of fire the more serious bed patients should, whenever practicable,
be placed in less inflammable wards.
X. Ordnance equipment. — Commanding officers of hospitals in and adjacent to Paris
are informed that all ordnance equipment, with the exception of guns and ammunition,
should be shipped to the American salvage depot, St. Pierre des Corps. All firearms and
ammunition should be shipped to the advance ordnance depot No. 1, at Is-sur-Tille. Guns
should be securely packed in boxes or tied together and well wrapped so that they may
arrive in as good condition as possible. All salvaged clothing which is not required can
be turned in to the American salvage depot, 110 Boulevard de Hospital, Paris.
XI. Requisitions for X-ray supplies. — A Roentgenologist has been attached to inter--
mediate medical supply depot No. 3 for the purpose of acting upon requisitions for X-ray
supplies. Hereafter requisitions for X-ray supplies will be listed separately as heretofore
but will be sent direct to the intermediate medical supply depot No. 3, A. P. O. No. 737.
XII. Emergency medical teams. — The medical teams heretofore known as "gas teams,"
■or "shock teams," will be known in the future as "emergency medical teams." They are
to be used in emergencies for the medical cl.'"* of the wounded (especially chest wounds)
and for those suffering from surgical shock as well as gas.
XIII. Front-line packages. — It is directed that commanding officers of Services of Supply
hospitals stop the practice of making requisitions for the "front-line packages" prepared by
the Red Cross. There dressings are expensive and not specially suited to regular hospital
work. They are intended for use at the front only.
XIV. Rest rooms for nurses. — The building of Red Cross amusement rooms and rest
rooms for nurses has unfortunately been much delayed at many base hospitals on account
of the demand for more beds for patients and the necessity for using all available material
and labor to provide the additional room needed for the sick and wounded.
M. W. Ireland,
Major General, M. C, Chief Surgeon.
Circular No. 48:
American Expeditionary Forces,
September 9, 1918.
I. Official relations between medical and veterinary personnel. — (1) The veterinary service
of the American Expeditionary Forces is by special order now placed under the authority
of the chief surgeon, and the Veterinary Corps will in the future function under Special
Regulation 70, dated Washington, December 15, 1917.
This special regulation is not to be interpreted as placing individual veterinary officers
or veterinary organizations under the authority of medical officers. On the other hand,
it is to be interpreted as placing all detachments of veterinary personnel in an independent
status with reference to other Medical Department personnel.
The senior veterinary officer of any organization or station, therefore, would bear the
same relationship to the commanding officer thereof as does the senior medical officer, and,
as a detachment commander, he has the same responsibility for the care, instruction, and
discipline of his men.
(2) Senior veterinary officers are not to be considered as assistants or subordinates
to corresponding medical officers. It is not contemplated that correspondence, reports,
or returns emanating from or pertaining to the Veterinary Corps will pass through the office
of medical officers as part of the routine channel of communication.
13901—27 62
976
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(3) Requisitions for veterinary supplies will be forwarded as follows: (a) Organizations
with divisions through division veterinarian, and upon his approval, in the manner as laid
down by General Order 44. (b) Officers commanding veterinary hospitals and othor
independent units direct to proper supply depot.
(4) Although the independence of action outlined herein is expected to govern official
relations between the medical and veterinary services, it should not be forgotten that the
activities of both are in contact at several points and that frequently occasion arises when
the medical officer, by reason of longer service and broader experience, can be of material
assistance to the veterinary officer. This is particularly true as regards army, corps, and
division surgeons and veterinarians.
Senior medical officers will therefore cooperate with veterinarians and assist them by
counsel and advice in the handling of duties newer to many of them. While the veteri-
narian should welcome such assistance, he should at the same time cultivate independence
and authority in his department and avoid submitting himself to such supervisory action
as would tend to destroy his initiative and sense of responsibility.
II. Telegraphic reports. — Commanding officers of hospitals in making telegraphic
reports to the British authorities of deaths of British officers and soldiers should indicate
in the report the number or name of the hospital from which the report is being made.
III. Inspection. — It has been brought to the attention of this office that isolated detach-
ments connected with divisions, and with the Services of Supply, sometimes fail to undergo
the regular inspections for venereal disease. The attention of all responsible medical officers is
called to this oversight.
IV. Treatment of Y. M. C. A. personnel. — The requirements of Circular 37, paragraph 8
calHng for reports to be submitted to Y. M. A. headquarters for Y. M. C. A. personnel
treated in American Expeditionary Forces medical formations are not being observed.
In many cases diagnoses are not given or anything indicating the condition of the patient on
discharge from hospital. These reports should be addressed to medical section, Y. M. C. A.
headquarters, No. 12 Rue D'Aguesseau, Paris, which change of address will be noted.
V. Rating of enlisted men. — Commanding officers of hospital centers are authorized
to rate enlisted men under paragraph 1420J/^, Army Regulations. Report of any ratings
made under this authority will be forwarded to this office.
VI. Carrel-Dakin tubing. — There is great difficulty in meeting the needs for Carrel
Dakin tubing. Every effort must, therefore, be made to conserve the supply. The com-
manding officers of hospitals will give such instructions as to insure that the tubing after
use will be cleansed and sterlized and again used, and that all received at the hospital in
excess of the needs of the hospital will, after cleaning and steriUzation, be returned to the
nearest supply depot.
VII. Nurses. — Any member of the Army Nurse Corps who marries while on active
service in France will be returned immediately to the United States for duty and will not
be discharged in France. Report of the marriage of any nurse will be immediately reported
to this office by the proper commanding officer.
VIII. Ordnance equipment. — Decision has been rendered that mess equipment and
canteens should be issued to patients upon discharge from hospitals, whether patients are to go
to replacement organizations or to convalescent camps. The commanding officers of
hospitals are instructed to maintain a sufficient supply of this ordnance equipment to issue
to patients upon discharge.
IX. Reports of issues of ordnance to patients discharged from hospital. — Circular letter
No. 6-A, from this office, requiring that ordnance property issued to patients leaving hospitals
be dropped on a monthly abstract of issues showing the quantity of each kind of article
issued during the month and giving the names of the soldiers to whom such uniform equipment
has been issued, is with the consent of the chief ordnance officer amended so that the names
of the soldiers to whom these articles are issued will not be required.
X. Conservation of supplies. — The necessity for the utmost economy in all surgical
dressings and supplies is obvious. Not only the hmitations imposed by the tonnage situation,
but the enormous increase in the burden thrown upon the manufacturer, makes this essential.
Gauze and bandages should be repeatedly w^ashed and sterilized. Rubber gloves should be
APPENDIX
977
cleaned and tested. Wastage in catgut should be avoided by insistence upon an economical
method of tying. Ether should be conserved. Only by the cooperation bv the entire surgical
staff of each hospital can the desired conservation of supplies be brought about, and the im-
portance of this subject should be repeatedy impressed upon all concerned. The Surgeon
General reports some most satisfactory results in the United States through efforts at conser-
vation and suggests the following method:
While the varying equipments of different hospitals mav modify the method used for
the reclaination of gauze and bandages, the following method is suggested: Each surgical
ward and dressing room should be equipped with two galvanized-iron buckets with a cover
Imed by a paper bag m one of which should be put all blood-stained and slightlv soiled
dressmgs; m the other, pus-stained dressings. These buckets should be taken twicedailv—
oftener if necessary— to the room where dressings are washed. If no laundrv equipment
or laundry machinery, is available, the gauze and bandages can be washed by hand using
heavy rubber gloves for this purpose. Previous to washing, the slightlv stained and blood-
stained dressings should be soaked for 12 hours in cold water containing one-tenth per cent
of chloride of lime; the pus-stained dressings in a solution containing one-tenth of 1 percent
^u^"7^^u^ u^'M^^^'^r"^ one-half of 1 per cent washing soda. If washed bv hand, these dressings
should be boiled for at least one hour. When laundry machinerv is available or in the larger
hospitals which are now being furnished with equipment for the reclamation of re-use knittted
gauze, ordinary gauze and bandages may also be reclaimed. The gauze and bandages should
be put in mesh bags, soaked for 12 hours as directed above, boiled for 1 hour, transferred to the
washing machine, and, if a rotary tumbler is available, can be dried in the bags in this tumbler.
If this is not available, gauze and bandages can be passed through a wringer and hung on lines
to dry. After drying dressings should be sorted, folded, put in packages, and sterilized in the
ordinary way for 30 minutes at 15 to 30 pounds pressure, on two successive days. Careful
bacteriological tests should be made from time to time to test its sterility.
M. W. Ireland,
Major General, M. C, Chief Surgeon.
Circular No. 49.
American Expeditionary Forces,
September 18, 1918.
I. Preparation of gum-salt solution. — Prepared solution of gum-salt for intravenous
infusion in cases of hemorrhage and shock will be hmited to field, mobile, evacuation, and
advanced base hospitals really functioning as evacuation hospitals, where, during active
periods blood transfusion may be impossible of accomplishment. Such hospitals may obtain
gum-salt solution from the nearest Army medical dump or from the central Medical Depart-
ment laboratory. The solution is issued in 500 c. c. automatic stoppered bottles, 12 bottles
to a case. Both cases and bottles are obtained with great difficulty, and empty bottles and
cases must be returned in order to receive replenishments.
In base hospitals, generally, blood transfusion should be the procedure of election and
intravenous infusion of gum-salt solution resorted to only in emergency. The small stock
of gum-salt solution necessary to meet those emergencies should be prepared locally, by each
base hospital for its own use. Directions for the preparation of the solution may be obtained
from the director of laboratories, A. P. O. 721.
In order that all the acacia that is available may be conserved for use in the preparation
of gum-salt solution, its issue from supply depots for dispensary use is interdicted.
Requisitions for acacia in small quantities, not to exceed 5 pounds in the instance of
base hospitals, will be honored, provided the notation: "For preparation of gum-salt solution "
is entered opposite this item in the column of remarks.
II. Transfusion sets. — On several occasions requisitions for transfusion sets have been
received from base hospitals with the explanation that the transfusion set formerly on hand
had been taken to an advanced field, evacuation, or mobile hospital b}' some member of the
staff on detached service with a "shock team."
The impression has been gathered, apparently, that transfusion sets issued to individuals,
upon completing the course in resuscitation at the central Medical Department laboratory,
were for their j)ersonal use. This impression is erroneous, as each set was destined for use
in the hospital to which the individual returned, and should have been turned over to the
supply officer of the hospital.
978
ADMINISTRATION, AMERICAN EXPEDITTOXARY FORCES
All transfusion sets now in the possession of individuals will be turned in to the supply
officer of the hospital to which they are permanently attached. Transfusion sets have been
issued to advanced hospitals, and reserve supplies have been placed in Army medical dumps.
These supplies are adequate for the use of "shock teams" serving temporarily at advanced
hospitals.
III. "Shock teams." — It is directed that emergency medical teams ("shock teams"),
when once formed, be left intact by commanding officers of Medical Department units unless
specific authority to change personnel of these teams is obtained from the office of the chief
surgeon or from the director of professional services.
IV. Purchase of foodstuffs. — The following letter from general headquarters is quoted
for the information of all concerned:
We are in receipt of information from the French mission, general headquarters, A. E. F.,
stating that in certain localities American troops are offering prices for foodstuffs in excess
of the prices fixed by the French authorities. This practice is obviously bad in whatever
wav considered.
Please take necessary steps to have the troops under your command pay no more for
their open-market purchases of foodstuffs than the price fixed and pul:)lished by the French
authorities.
V. Coast Artillery casuals. — All Coast Artillery casuals discharged from hospitals as of
class A shall be sent to Angers.
VI. Epidemic disease. — The attention of surgeons of all organizations and command-
ing officers of all Medical Department units is again called to the necessity for prompt report
to the local French civil and military authorities of all cases of epidemic disease. This
report should give the name and organization of patient.
VII. Clinical records. — It is desired that the clinical records of patients treated in Serv-
ices of Supply hospitals be as complete as circumstances will permit. Form 55, Medical
Department, will be used for this purpose. Form 55-A will be made out for all patients,
but only such other parts of Form 55 will be used as are of interest or value in the individual
case. The clinical record for completed cases will be filed in the hospital in which the case
is completed. When patients are transferred from one Services of Supply hospital to another.
Form 55 will be placed in the envelope with the field medical card.
VIII. Construction at base hospitals and hospital centers. — Many cases have occurred
recently where patients were evacuated from one hospital to another without sufficient
rations. In travel of this sort there are many and unexpected delays. In addition to the
cooked rations issued for the expected length of the journey, a reserve of cooked or travel
rations for at least 36 hours over and above ordinary schedule time should be issued for each
patient. The number of such travel rations issued can be noted on the travel order and
patients required to turn in rations unused on arrival.
IX. Reports. — Circular No. 28, section on allied patients in American Expeditionary
Forces' hospitals, is modified to read as follows:
"Par. 2. When French military patients are admitted to, discharged from, or die in,
American miUtary hospitals in the French zone of the armies, notification of the fact will
be sent within 24 hours, on Form 52, Medical Department, to American statistical section,
10 Rue St. Anne, Paris."
"Par. 7. A separate daily Ust of casualties and changes of patients in hospitals, Form
22, A. G. O., S. D., A. E. F., will be made out for all British patients; two copies will be for-
warded to the deputy adjutant general's office. Third Echelon, British Expeditionary Force,
France, and another to medical communications, British Expeditionary Force, France. No
copy will be sent to the chief surgeon, A. E. F., the monthly report called for in 1-b being
sufficient."
X. Patients to be examined by board of officers. — It is desired that in the future no patients
be transferred from hospital, either to duty or convalescent camp, without having been
examined by a board of medical officers. In most cases disability boards already appointed
can act upon all such cases. Where the time of disabiUty boards is fully occupied with class
D cases, a board, to consist of the chief of service and ward surgeon, can act upon cases
going to duty or convalescent camp. Complete physical examination will not usually be
required in such cases, and no formal record of the proceedings of the board other than a
note by the senior member on the patient's clinical record.
APPENDIX
979
XI. Hospital fund. — In view of the fact that irregularities in the hospital fund of a
base hospital have been discovered, the following recommendations have been made by the
officers conducting the investigation will be carried out in all base hospitals:
The commanding officer of each base hospital in the American Expeditionary Forces
w ill appoint an auditing committee for the hospital fund, with instructions to make a care-
ful examination of the hospital fund accounts from the time of the establishment of the hos-
pital in France, with a view to determine if funds due from all sources have been collected
and accounted for, and also to take necessary steps to see that the fund is carefully and
methodically audited each month hereafter.
A cash book will be kept by the custodian of the hospital fund in every hospital in such
manner as to show the daily receipts and expenditures from the hospital fund.
Patients who are charged board in hospitals should, if they are not able to pay their
mess bills, sign an acknowledgment showing their indebtedness. The accounts of pay
patients should be checked against the daily lists of patients received and discharged so as
to show that the full amounts due are paid.
Arrangements will be made to secure the services of skilled accountants who will from
time to time be sent to base hospitals to investigate their hospital fund accounts.
M. W. Ireland,
Major General, M. C, Chief Surgeon.
Circular No. 50:
American Expeditionary Forces,
October 4, 1918.
I. (1) Instructions regarding hospitalization and evacuation of patients with disease
or injury of the eye, ear, nose, throat, and maxillo-f acial region. — In general, the policy as
regards hospitahzation and evacuation of these cases is as follows:
(a) Simple cases should> whenever possible, be retained for treatment with their organi-
zation or be treated in near-by camp, field, or evacuation hospital.
{h) Cases not suitable to be retained with organizations but which will be fit for return
to duty in the American Expeditionary Forces within a reasonable time should be trans-
feilred to the nearest camp or base hospital.
(c) Cases which are permanently unfit for duty in the American Expeditionary Forces,
or which will require prolonged treatment to render them fit for duty, should be classified
as "D" and evacuated as soon as safely transportable to the United States. Class D cases,
in which healing might be materially retarded by delay or interruption of treatment incident
to evacuation to the United States, or which have unsightly wounds of the face or neck
that could be materially helped within a reasonable time, should be retained for primary
treatment in the American Expeditionary Forces.
The treatment of cases retained in France must involve the least possible amount of
transportation from one hospital to another, and facilities will be provided in each hospi-
tal center and in the larger base hospitals not connected with hospital centers for the
treatment of this class of cases. Base Hospital No. 115, located at Vichy, has more elab-
orate equipment for this class of cases.
Consultants in the different specialities will be located at certain hospitals, whose
services can be called upon by neighboring hospitals. Addresses where these consultants
can be reached will be published from time to time.
(2) Ophthalmic cases. — Routine refractions and vision examinations for troops should
be done in the nearest hospital serving these troops. Ophthalmic cases which require more
elaborate treatment than can be given in isolated camp or base hospitals and which do
not come within the provisions of paragraph 1 (c) above, should be transferred to the near-
est hospital center, or upon recommendation of the local or senior consultant in ophthal-
mology be transferred to Base Hospital No. 115, Vichy.
(3) Ear, nose, and throat cases. — Cases of disease or injury of the ear, nose, or throat
which require more elaborate treatment than can be given in isolated camp or base hospi-
tals and which do not come within the provisions of paragraph 1 (c) above, should be trans-
980
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
ferred to the nearest hospital center, or, upon recommendation of the local or senior con-
sultant in oto-laryngology, be transferred to Base Hospital Mo. 116, Vichy.
(4) Maxillo-facial cases. — Cases evacuated to the Paris district will be treated at the
American Red Cross Military Hospital No. 1. Other cases that can not be treated in the
hospital in which they are situated may, on request of the local or senior consultant in maxillo-
facial surgery, be evacuated to a base hospital or hospital center where there is a maxillo-
facial service, or to Base Hospital No. 115, Vichy.
Maxillo-facial cases requiring only occasional surgical or dental supervision may be sent
from the base hospitals to convalescent camps to await further examination or operation.
No maxillo-facial case should be evacuated to the United States until the patient can
open his mouth sufficiently and has the pharyngeal muscle control necessary to obviate the
danger of aspiration during seasickness.
Cases that have been recently repaired should be retained in hospital until the sutured
wound is safely healed.
II. British soldiers in American hospitals. — Pursuant to recommendation from the
British authorities, the following instructions will govern visits of relatives to dangerously
ill British soldiers in American hospitals:
(a) In all cases requests for relatives to visit British soldiers dangerously ill in American
hospitals should be sent to the A. D. M. S., Paris, and not direct to the relative of the patient.
{b) When the American hospital is located outside of Paris or its near vicinity request
should be made to the A. D. M. S., Paris, and at the same time there should be a statement
as to whether suitable accommodations for the relatives of the soldier exist at the place
where the American hospital is situated. In those cases where it is not possible to accommo-
date relatives it is not proposed to make arrangements for the relative to visit.
III. Evacuation of orthopedic cases. — -Some confusion has resulted from apparent
conflict of instructions in Circular Letter A-1 and Circular 46, Office of Chief Surgeon
All instructions regarding evacuation of this class of cases, issued prior to Circular 46, are
revoked.
IV. Pail collection system. — Reports have been received at this office that in certain
of the hospitals where the pail collection system is used, urine and other human excreta has
been dumped into the sewer system. Attention of all responsible officers is called to the
fact that where the pail system is used the sewer system is provided for sink waste only and
that there is no purification system adequate to care for human excreta. Steps should be
taken at once to prevent a recurrence of this faulty method of using the sewer system.
V. Ordnance property. — The following information, received from the chief ordnance
officer, is repeated for all concerned:
It has come to the attention of this office that the "pouch for small articles, model
1916," which is furnished the Medical Department by the Ordnance Department, has
been incorrectly called "pouch for adhesive tape and foot powder. " The supply division
of the Ordnance Department has been notified to discontinue the use of this name, "pouch
for adhesive tape and foot powder."
VI. Reports.— The following revisions in the Manual of Sick and Wounded Reports
for the American Expeditionary Forces, revision of September 15, will be noted, effective
October 1:
Section IX, paragraph 11 (p. 9), sentence "Cases transferred to convalescent camps
will be considered completed as far as the records are concerned, " is revoked.
Section XXI, paragraph 2 (p. 51), is revoked.
In the future all convalescent camps will report as do base hospitals carrying patients
on sick report. Hospitals will not consider that cases are completed when the patients
are transferred to convalescent camps.
VII. Promotions. Since the issue of Circular 36, of this office, explaining the gen-
eral principles of the system of promotion by roster in the Medical Department, two very
important orders have appeared which, while not upsetting this scheme, have modified it to
a certain extent. The first of these was Bulletin 59, general headquarters, dated August 16,
which abolished distinctions between the Regular Army, National Army, National Guard,
and Reserve Corps, merging all of these in the United States Army. It also announces that
the principle of selection will govern for promotions.
APPENDIX
981
General Order 162, general headquarters, dated September 24, gives the rules under
which promotions are made and states that they will be temporary appointments made by
the commander in chief, pending approval by the War Department.
The general effect of these orders is to give greater importance to the factor of special
qualifications in determining the roster number. The value of this factor is determined by
the chief surgeon and is based upon the reports received of the officer in the "Report of
character of services and qualifications" on the form published in connection with Circular
36 (known as C. S. and Q. report). General Order 24 has been revoked, and at least half
of the data required thereby have been eliminated. If the Form C. S. and Q. is accurately
made out, it furnishes all the data necessary. Attention is, however, invited to the impor-
tance of its being signed, with date and station, by the officer making the report. Attention
is also called to the fact that a statement of the physical condition is required which, however,
need not be the elaborate report upon the prescribed form heretofore required. The require-
ment is simply:
(d) A certificate that the officer has been examined by a medical officer and found
physically fit to perform the duties of the grade to which he is recommended for promotion
will be forwarded with the recommendation.
If an officer is temporarily disabled by wounds or sickness, a careful statement of the
nature of the disability and the length of time which it will probably prevent him from per-
forming his duty should be given, with a statement that the officer is with the exception of
the disability noted physically fit to perform the duties of the grade to which he is
recommended.
M. W. Ireland,
Major General, M. C, Chief Surgeon.
Circular No. 51 :
American Expeditionary Forces,
October 12, 1918.
Pneumonia, Its Prevention and Management
THE prevention OF PNEUMONIA
The present epidemic of respiratory infection in the American Expeditionary Forces is
largely influenzal in character, with a rather high incidence of secondary pneumonia due
usually to pneumococci or streptococci and occasionally to influenza baciUi and possibly to
meningococci. The mortality has been in the neighborhood of 30 per cent. As primary
pneumonia is likely to increase with the advent of colder weather, medical officers are reminded
that the prevalence of pneumonia, as well as of other respiratory infections, in armies in the
field depends particularly upon:
(1) Overcrowding,
(2) Exposure to wet and cold.
(3) Fatigue, whether induced by overwork, a long journey, loss of sleep, or nervous
exhaustion from worry.
Crowding forces the occupants in barracks or billets into close personal contact, and
the greatest danger from it in relation to the occurrence and spread of respiratory infections
is obviously in the increased opportunity furnished for droplet infection of the healthy inmates
from those who already harbor pathogenic micro-organisms in their noses or throats.
In epidemics of pneumonia or of influenza, the disease is undoubtedly usually spread from
man to man through the secretions or discharges from the mouth, nose, or other parts of
the respiratorv tract, and an individual who harbors virulent pneumoccoci or streptococci or
influenza bacilli is obviously very likely to infect his cosleepers by coughing or sneezing, or
even speaking loudly in close proximity to them.
In the present epidemic, the great majority of the cases of pneumonia are secondary to
influenza— the natural resistance of the individual having been first broken down by this
disease, secondary infection of the respiratory tract with pneumococci or streptococci has
occurred.
982
ad:ministration, American expeditionary forces
In Panama, where climatic conditions were not severe, pneumonia was prevalent,
particularly on account of overcrowding, and the same was found to be true among the
workers in the South African mines. Prevention consisted particularly in scattering the
individuals and giving them separate dwellings in place of barracks.
Overcrowding. — In relation to overcrowding. Medical War Manual No. 1, for 1917,
authorized by the Secretary of War under the supervision of the Surgeon General ai>d Council
of National Defense, states that whenever possible the floor space per enhsted man should be
80 square feet, affording 960 cubic feet, and should never be less than 10 by 6 feet, or 60 square
feet, which with a ceiling 12 feet high would afford 720 cubic feet. This manual furtlier
states that should an epidemic occur and should the soldiers be overcrowded, it may be
assumed axiomatically that the epidemic can not be checked by other sanitary measures
alone, but must be combined with measures to reheve the overcrowding. Owing to the
shortage of lumber and materials, it was thought necessary in the American E.xpeditionary
Forces to reduce the space per man to 1 linear foot, or 20 square feet — one-third of the
minimum amount recommended. The order directs that bunks shall be 2 feet 8 inches
wide by 6 feet 6 inches, double tier, in sets of four, 2 feet 8 inches apart, giving 1 linear foot
of Adrian barracks per man. It is hoped that conditions will soon be such that this allowance
maj' be increased. In the meantime, an effort must be made to prevent droplet infection
by other means between the men sleeping side hy side in barracks. A board partition 2 feet
high may be built between the two adjoining bunks. Until this is done, wires may be run
2 feet above the bunks and the shelter tents suspended upon them between the adjoining bunks.
Similar precautions should be taken in billets and tents. This is a more practical arrange-
ment than placing the head to the feet of the adjacent sleeper. In cases where the over-
crowding is excessive and the weather fine, the advisability of bivouacing the men in the
open air under shelter tents, or other canvas, should be considered. If this is done, addi-
tional blankets obviously should be supplied. Rehef from the dangers of overcrowding should
be the first important consideration in connection with the checking of the present epidemic.
Distance between beds is the important factor, not cubic space, in the prevention of the
spreading of pneumonia infections. Crowding in recreation rooms at cinematograph enter-
tainments, etc., should at present time be prevented as much as possible.
Wet and cold. — Wet and cold are also important predisposing factors in pneumonia
epidemics. A lowered condition of vitality from cold favors particulary the development
of such infectious diseases as pneumonia and influenza, by lowering the resistance of the
bronchial and pulmonary tissues to infection. Experiments suggest that infections with
these diseases are favored by cold and chilling through the stimulation of the mucous glands
with resulting closure of the small bronchioles with plugs of mucus. It is well known that
the functions of the leucocytes are disturbed by cold, and it seems likely that phagocytosis
may play an important role in connection with the mechanism of immunity in pneumonia,
and that immunity is in this disease particularly related to the functions of the leucocytes.
The movements and phagocytic action of the leucocytes occur most favorably at about the
temperature of the normal body. Exposure of the skin to cold and wet leads to chilUng of
the leucocytes during their repeated passage through the skin capillaries, which may diminish
their functional activity, and thus lower resistance to a point at which infection may occur.
It should be borne in mind that cold wet feet produce a general reaction of the bodv and not
only a local one, and that this condition also predisposes to infection. Cold and wet have
less unfavorable action when accompanied by energetic muscular exercises, if a condition
of fatigue is not reached. Additional efforts should be made to provide for the prompt
removal and drying of the wet clothing of the soldier, and additional blankets at night must
be insisted upon.
Fatigue.— 1\ should be borne in mind that fatigue induced bv overwork and also bv
lack of sleep and worry in connection with wet and cold has been one reason for the excessive
mortahty from pneumonia in armies in the field. It is well known that normal resistance
to mfection may be broken down by fatigue.
Early detection.— Greater attention should be paid bv medical officers to the early
discovery of cases of colds, cases of influenza, and other respiratory infections, and to prompt
isolation and treatment of such cases. Carriers undoubtedlv play an important role in
disseminating pneumococci, streptococci, and influenza bacilli as well as meningococci
APPENDIX
983
Warning against spitling. — Men should be specifically instructed at this time against
expectorating in ciuarters, and the danger of sneezing and coughing and of speaking in close
proximity to the face explained.
THE MANAGEMENT OF PNEUMONIA
1. Pneumonia, especially as it occurs among troops, and as it is now present in the
American Expeditionary Forces, must be regarded as a highly contagious disease, and it
must be managed with the same precautions as are taken in the care of other contagious
diseases.
2. The epidemics of influenza now prevalent in many widely separated parts of France
have at least one point in common; i. e., the occurrence of pneumonia as an incidence of the
disease, a complication, or a sequel. The pneumonia is usually of a patchy type, different
slightly in its characteristics in different regions, but characterized by rapid progress, great
respiratory distress, frequency of early collapse, and high mortality. The causative organ-
ism may not always be the same; pneumococcus, streptococcus, and the influenza bacilli
and occasionally the meningococcus all seem to contribute their share.
3. Early isolation and hospitalization of pneumonia as well as of influenza and similar
respiratory infections will do much to prevent the spread of the disease and lower the mor-
tality. Cases should be hospitalized, when possible in medical formations where they may
remain until recovery, even though the initial trip by ambulance may be somewhat length-
ened. Cases of pneumonia in the earliest stages withstand transportation fairly well, but
later in the disease after they are hospitalized, they are greatly injured by moving. Numer-
ous cases of respiratory infections have been evacuated by train or by motor, to arrive at
their destination some hours later in profound collapse, to die within a very short time.
Moving a case of pneumonia to make room for a battle casualty may kill the pneumonia
patient and not aid the wounded, and the practice should not be tolerated.
4. Isolation or segregation should be practiced in all cases of respiratory infection and
such isolation should start in the field. Upon arrival at the hospital the cases of respiratory
infection should be received in wards devoted to the observation of cases with respiratory
infection; or if it is possible to make an absolute diagnosis on admission to the hospital,
the case may be sent directly to the ward designated to receive cases suffering from that
particular type of infection. The observation ward for respiratory diseases should be
cubicled, a sheet or other partition being placed between adjacent beds. It is desirable
that an accurate diagnosis be made as soon as possible of cases in this ward so that they
may be transferred immediately to those wards designated to receive cases suffering from
the different types of respiratory infection. All cases of uncompHcated influenza should be
isolated in separate wards as rigidly as if they were cases of measles, and all beds should be
cubicled. No cases of pneumonia should be sent to these wards, and should a patient with
influenza develop pneumonia he should be immediately removed to a pneumonia ward.
Cases of pneumonia should be segregated in wards set aside for this purpose. These wards
should be cubicled. The reason why such rigid isolation and employment of the cubicled
system is imperative is due to the fact that, first, cases of influenza are highly susceptible
to pneumonia and may be infected with great readiness by a pneumonia patient in the near
proximity, and, secondly, that the lobular type of pneumonia may be caused by several
varieties of organisms, and should a patient with a pneumococcal pneumonia be placed
next to one with a streptococcus pneumonia either one or both patients might readily contract
a double infection. The course of the disease in such double infections is much more serious
and the mortahty much higher than in single infections. Cross infections will, therefore,
be less common and the mortality reduced by cubicle isolation for all respiratory infections.
The practice of receiving respiratory infections of unknown origin in wards with other
medical or surgical cases is reprehensible and is responsible for many fatal cases of pneumonia
in individuals who might otherwise have been returned to duty within a short time. Cubicle
isolation may most readily be carried out by screening with sheets. This can be done by
j)osts and the use of wire and can be adapted for tents as well as for wards. It is only neces-
sary that the screen should reach midway between the foot and head of the bed, halfway
l)etween the bed and the floor, and 2}/2 to 3 feet above the level of the patient. It is, however,
highly important that the screen should extend several inches beyond the head of the bed.
984
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
5. Protection of medical officers, nurses, and personnel with gowns and fresh and
clean gauze masks is important, both to prevent spread of infection among them and to
prevent their transmitting infection to others. Attendants should he examined with the
view to finding carriers: When found, these should be disinfected. Masking ot all individuals
who come in contact with cases of respiratory infection and fever, except in case of extreme
urgency, and then only with precautions to prevent the transmission of the disease to others.
Patients should be masked while being moved.
6. Special attention must be paid to all cases of respiratory infection, with fever
with relation to the development of signs of pneumonia. It is often impossible at the out-
set to distinguish between cases of influenza, without consolidation, and actual pneumonia.
All cases, with fever and with symptons referable to the respiratory tract, must be viewed
with suspicion and hospitalized, and the physical signs must be carefully watched.
7. Bacteriological examination in order to determine the infecting organism is impor-
tant, not only from the standpoint of specific therapy, but also to facilitate the management
of cases of different etiology. It must be remembered that pneumonia is really a group
of diseases, with certain common signs and symptoms. The promiscuous mingling of cases
of pneumonia, without determination of the infecting organism, is as harmful as the mingling
of measles, scarlet fever, and smallpox.
8. Specific therapy, when possible, is advisable. This will at present be limited to
cases of pneumonia due to pneumococcus, type 1. The indiscriminate use of serum, with-
out proper type determination, is ill-advised, not only on account of the fact that it subjects
the patient to unnecessary inconvenience, discomfort, and possibly danger, but on account
of the fact that serum is scarce, and must be saved for the cases in which it is actually indi-
cated. The polyvalent serum may be used in type 1 cases, as its titer for the type 1 organism
is as high as that of the monovalent type 1 serum. The use of polyvalent serum in cases
other than those due to pneumococcus, type 1, is not advised.
9. General treatment should be directed toward sustaining the patient and guarding
against collapse. Under no circumstances should a patient with pneumonia, or suspected
of having pneumonia, be allowed to walk, and after he is put to bed he should not be per-
mitted to sit up for any reason whatsoev'er. He must l^e kept warm, but must be assured
a continuous supply of fresh air. Fluids should be given freely from the start, and the
patient should be induced to take them frequently and in considerable amounts. Sponge
baths should be used to combat high temperatures.
10. Early cyanosis and collapse are characteristic of the present form of pneumonia.
Treatment aimed to prevent and to combat circulatory failure should be instituted promptly
on making the diagnosis of pneumonia. The early use of digitalis has heen shown to reduce
mortality, and is advised. It may be given in the form of a standard tincture, of which a
total amount of 30 c. c. (1 fluid ounce) should usually be given. The following schedule
may be followed.
If seen on the first or second day :
Day of digitalis therapy. _ _ _
1
2
3
4
5
6
7
8
9
Total amount of standard tinc-
ture to be given in divided
doses on the days indicated...
Minims-
5
Ixxv
5
Ixxv
0
5
Ixxv
5
Ixxv
0
0
5
Ixxv
5
Ixxv
If seen on the third day, or later :
Day of digitalis therapy
1
2
3
4
5
6
7
Total amount of standard tincture to be given in divided doses
(c. c.)
10
el
10
cl
0
5
Ixxv
0
0
5
Ixxv
Minims
The hospitals should supply themselves with a standard tincture of digitalis. Do
not use pills which are insoluble. Other stimulants, notably citrated caffeine and cam-
phorated oil, may be used by hypodermic injection when collapse occurs or is imminent.
The use of strychine has not been shown to be of value.
APPENDIX
985
11. Morphine is of great vahie to control severe coughing, to relieve the pain of pleu-
ritis, and to secure rest for the patient. It should be used without hesitation. For the
troublesome tympanites that frequently occur, turpentine stupes, given while a small
catheter is inserted in the rectum, are of value.
12. Most careful attention must be paid to the physical signs, particularly with rela-
tion to spread of the consolidation and to fluid in the chest. When the physical signs suggest
fluid exploratory puncture, the microscopic and bacteriological examination of the fluid
obtained should be performed promptly. Exploratory respiration is a simple procedure,
with little danger or discomfort to the patient. Local anesthesia may be induced by freez-
ing or by intracutaneous and subcutaneous injection of cocaine or novocaine. When clear
or even slight turbid fluid is obtained, even when the infecting organisms are demonstrated
in the fluid, treatment by repeated aspiration with the Potain aspirator is followed by the
best results. When purulent fluid is found, or in cases where fluid previously clear becomes
purulent, operation is advised, with postoperative measures necessary to insure free drainage.
13. Convalescence must be managed with care, both as to the condition of the patient
and as to his transmitting the disease to others. Development of pleural exudate late in
the disease, or during convalescence, is not uncommon, and frequent physical examination
must not be neglected. Relapse or spread may also occur after the temperature has been
normal for several days, and the patient should not be permitted to sit up or move about
until 7 to 10 days have elapsed. During this period isolation should be practiced as during
the acute stage of the disease. The use of mildly antiseptic solutions in the mouth and
nasal passages is of value in reducing the number of carriers. Patients should not be allowed
to mingle with other patients, and should not be evacuated until all signs of infection of
the respiratory tract have disappeared.
14. Recovery and return to duty will be slow. The final stages of recovery will best
be provided for in convalescent camps. No patient who has had pneumonia should be
evacuated to a convalescent camp until his temperature has been normal for at least two
weeks, and in cases where the infection has been severe or prolonged this period will be
materially increased. The patient should be free from cough and other physical signs
should be normal.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 52.
American Expeditionary Forces,
October 22, 1918.
I. Recommendations for appointments. — The following paragraphs of a letter, adju-
tant general's office, is quoted:
1. With reference to the cases of * * * and * * * action has been taken
to withdraw the recommendation contained in courier letters from these headquarters to
The Adjutant General of the Army, that these men be appointed as officers in the United
States Army. ^ , . , ,
2. Chiefs of staff departments and other services are expected to take the necessary
steps to insure that onlv persons fullv quahfied are recommended by them for appointment,
and it is desired that greater care be exercised in the future that recommendations from the
office of the chief surgeon conform to the above requirements.
II. X-ray therapij. — The following hospitals are designated as being the only ones
quahfied, at present, to administer X-ray therapy: Base Hospitals Nos. 15, 28, 32, 20, 18,
9, 6, American Red Cross MiUtary Hospital No. 1.
When it becomes necessary to administer X-ray therapy, either because it is imme-
diately indicated or in the event that a patient requiring it need not be evacuated to the
United States, and he is in some other hospital, he will be transferred to one of the above-
designated hospitals. .
III Base Hospital No. ^.—Hospital trains and detachments of patients hitherto or-
dered to Base Hospital No. 8 will hereafter be directed to report to the commanding officer
hospital center, Savenay. , , , i- i
IV List of B and C class personnel.— The commanding officer of each Medical Depart-
ment unit will forward to this office, with the least practicable delay, a nominal list, show-
ing all B and C class personnel,' with branch of service, now on duty with his unit, with
statement of the number returned to duty reclassified as class A.
986
ADMINISTRATION, AMEEICAX EXPEDITIONARY FORCES
Attention is invited to tke fact that paragraph 5, section 1, General Order No. 41,
c. s., requires reexamination of all class B officers and soldiers at least every two months.
This order is apparently not being complied with.
V. Soldiers qualified as opticians. — The commanding officer of each Medical Depart-
ment unit will report by mail to this office, with the least practicable delay, the names of
all Medical Department soldiers belonging to his command who are qualified as opticians.
VI. Telegrams to he numbered serially. — The adjutant general informs this office that
telegrams are frequently received from base hospitals, especially at hospital centers, in which
the particular unit sending the telegram can not be identified. In order to avoid this, each
base hospital should number its telegrams serially and state immediately after the serial num-
ber the numerical designation, as, for example, the first telegram of Base Hospital No. 25
under this system, would begin "1 BH 25 AUerey."
This would not be necessary, however, where the commanding officer of a hospital
center preferred to send all telegrams through his office and signed with his name. Only
one serial list for the center would be kept in such case, and the telegrams would begin,
"1 HC AUerey."
VII. Nurses' names. — Commanding ofl^cers of all medical units to which nurses are
attached will, if they have not already furnished this information, forward to this office the
name in full of all nurses of the Regular Army Corps, and the places from which they were
assigned, as given in original letters of appointment. Special attention will be given to
the correct spelling of the names of nurses and places.
VIII. Change of station of nurses. — When making a change of station, either for tem-
porary or permanent duty, the letter of appointment of the nurse, with the required infor-
mation as to pay, etc., indorsed thereon, should be carried by her and delivered to the com-
manding officer or chief nurse at her new station. Failure to carry out this procedure in
the past has caused difficulties in the matter of the pay of the nurse.
In order to avoid delay in the receipt of baggage, nurses who are traveling under orders
should be instructed to give it their personal attention when changing trains.
IX. Amendment to Circular No. 45. — Paragraph 8, Section I, Circular 45, office of chief
surgeon, c. s., is amended to read:
Medical officers, who are compelled to administer antitetanus serum by reason of the
failure of medical officers through whom the patient has passed to administer the same, will
make immediate report of said failure, with sufficient data to establish the circumstances of
the omission, directly to the surgeon of the division from which the case came, or in case the
patient belongs to a higher or separate organization to the senior medical officer of that or-
ganization.
X. Requisitions for medical supplies. — ^AU organizations in base section No. 1, other
than base hospitals and hospital center depots, will submit their requisitions for medical
supphes to the surgeon, base section No. 1, A. P. O. No. 701, and will hereafter submit none
direct to intermediate medical supply depot No. 3, Cosne.
Upon the approval of the section surgeon, the requisitions will be sent to the medical
supply depot, base section No. 1, for issue.
XI. Address of American statistical section. — The address of the American statistical
section, to which reports of French military patients hospitalized in American mihtary
hospitals in the French zone of the armies are sent, has been changed from No. 10 Rue Saint
Anne, Paris, to No. 7 Rue Tilsitt, Paris. Hereafter all American Expeditionary Forces
hospitals in the French zone of the armies will send reports to the latter address.
XII. Identification tags.~The removal of identification tags from the persons of pa-
tients during the process of evacuating them from the front, especially from groups of patients
who have been bathed as an antigas measure or as a routine to admission to hospital, has
caused the erroneous return of soldiers' identification tags to others. In one recent instance
a soldier's tags were erroneously placed on another who subsequently died and was buried
and reported as dead under the name of the former. This one mistake gave rise to much
needless grief and administrative difficulties.
The removal of identification tags as a routine while bathing patients either, as an anti-
gas measure or on admission to hospitals, is prohibited. When for any reason, other than
the above, it becomes necessary to remove a soldier's identification tags the utmost care
will be exercised in preventing the possibility of their being placed on another.
APPENDIX
987
XIII. Base Hospital No. 66. — Base Hospital No. 66 is hereby detached from hospital
center, Bazoilles, and will operate as a base hospital directly under the chief surgeon,
A. E. F.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 53:
American Expeditionary Forces,
October 29, 1918.
I. The following extract from assistant chief of staff, G-4, is published for information
of all concerned:
1. A serious situation has arisen with regard to the telegraph and telephone systems
of the American Expeditionary Forces, and attention is directed to the necessity of exercis-
ing the most rigid economy in their use, particularly the long-distance telephone service.
During the past three months, the use of the long-distance telephone service has increased
70 per cent, and during the same period it has been possible, through the most strenuous
efforts, to increase the telephone and telegraph services only 25 per cent. Until recently,
there has been a margin of safety in the facilities, but this has now been entirely absorbed
by the tremendous increase in the number of telegrams and long-distance telephone calls.
If this increase continues, a very serious congestion will soon result.
2. It is not desired to issue any hard and fast rules to restrict the use of the long-dis-
tance telephone and telegraph. It is believed, however, that a reading of paragraph 1 above
explains fully the present situation, and the necessity of some action to reduce the number
of long-distance telephone calls and telegrams sent. It is desired that this reduction be
made by the chiefs of the services, themselves.
3. The following means of communication are now available, and are arranged in the
order in which they should be used:
(a) Mail.
(6) Courier and messenger service.
(c) Telegraph.
(d) Long-distance telephone service.
4. It is desired that each chief of a service prepare and put into operation at once a
system which will reduce the number of long-distance telephone calls and telegrams in use
by his service. It is desired that a memorandum be sent to this office (G-4), giving an out-
line of the system devised and the means adopted for its execution.
It is desired that every effort be made to use the mail, courier, and messenger service
wherever possible among the Medical Department units, and it is thought that, except in
immediate emergency, any message which can be delivered within 24 hours should be sent
by this service rather than by telegraph or telephone. There will be certain exceptions to
this rule, such as the weekly report on Form 211, which must be consoHdated in one office
and then forwarded on to another office for consolidation, thereby consuming three days for
delivery to this office instead of one. In cases such as this the telegraph will be used.
II. Daihj and weekly telegraphic bed report. — With regard to daily telegraphic bed report
from base hospitals and the weekly telegraphic bed report from camp hospitals, constancy
with reference to personnel should now be eliminated. This refers to item E. Hereafter
item E will be designated to indicate the total number of beds which can be utilized in the
event of emergency, consideration being given to bed space in tentage, halls, and corridors
of the hospitals.
III. Unloading of freight cars. — The French railways are taxed to their utmost to meet
the demands made upon them. Facility of transport is vital to the American Expeditionary
Forces. Reports have been made that cars containing medical supplies have been delayed
at destination pending unloading.
It is desired that all Medical Department organizations having to do with such supplies
take the necessary steps to prevent the least delay in the unloading and release of cars.
Orders require that this be done within 24 hours.
IV. Commissions in the Sanitary Corps.— With reference to Bulletin No. 30, c. s., these
headquarters, the attention of all medical officers is invited to the fact that the Medical
Department, within the next few months, will have urgent need of large numbers of well-
(lualified soldiers at present in the Medical Department who may be suitable for commission
in the Sanitarv Corps. It is desired that, before recommending a soldier for commissionjn
anotlier deiiartment, the commanding officer of a Medical Department unit satisfy himself
that tlie soldier recommended is better fitted for cojnmission in some other branch of the
service than in the Sanitary Corps.
988
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
V. Nurses. — With reference to paragraph 7, Circular 48, the i)oUcy outlined thoreiu
has been changed and following adopted:
"Nurses marrying in France will be sent to base section No. 3 for duty, and no leave
to visit France will be allowed after they shall have reported in England."
VI. Vocational education. — There is some misunderstanding among disabled soldiers
affecting the matters of vocational education. It is important that erroneous ideas be cor-
rected, and medical officers are urged to set the men straight. The terms of the following
letter should be understood and communicated to disabled soldiers by medical officers and
the facts in the letter should be placed on the bulletin board in each hospital.
Subject: The vocational rehabilitation act (Smith-Sears Act) to provide vocational educa-
tion for disabled persons discharged from the military or naval forces.
Question 1. What is the vocational rehabilitation act?
Answer. It is an act of Congress appropriating the funds and providing the means for
giving every disabled person discharged from the military or naval forces a vocational educa-
tion free.
Question 2. Who is entitled to a vocational education under the provision of this act?
Answer. Every war-disabled person whose physical disability entitles him to any com-
pensation under the regulations of the Bureau of War Risk Insurance.
Question 3. Will the person who elects to secure vocational training under the provi-
sion of this act receive a monthly compensation during the period of time he is pursuing his
vocational training?
Answer. Yes. He will receive a monthly compensation equal to the amount of his
monthly pay for the last month of his active service, or the amount of his monthly com-
pensation allowed by the Bureau of War Risk Insurance, whichever amount is the greater.
His family will receive the family allowance in the same manner as if he were an enlisted man.
Question 4. Will the fact that he has secured a vocational education, and thereby
increased his earning power, in any way change the amount of compensation he should
receive from the Bureau of War Risk Insurance?
Answer. No. The compensation he will receive from the Bureau of War Risk Insurance
is calculated on the basis of his physical disability and not on the basis of his economic
efficiency. A vocational education will not lower his compensation from the war risk
insurance.
Question 5. Under whose supervision and administration will the vocational training
be given?
Answer. The Federal Board for Vocational Education, of Washington.
Question 6. What types of vocational education will the Federal Board for Vocational
Education provide for these men?
Answer. Training for every vocation will be provided. Any vocation in the fields
of industrial, commercial, agricultural, technical, and professional education is open for him.
His past vocational experience, his physical disabiUties, his own desires and aptitudes
will determine the vocation he elects, in which to take his training. He will be given scien-
tific information concerning the economic advantages of the different vocations by technical
experts.
Question 7. Where will the training be given?
Answer. In the vocational and technical schools, colleges, and universities of the United
States. All courses will be under the supervision of the Federal Board for Vocational
Education.
(Signed) Edwin L. Holton,
Special agent, Federal Board for Vocational Education.
VII. Change in paragraph II, Circular No. 52, office of chief surgeon.
The list of hospitals designated in Paragraph II, Circular 52, office of chief surgeon,
October 22, 1916, as being the only ones qualified, at present, to administer X-ray therapv,
has been changed as follows: Base hospitals Nos. 6, 7, 9, 15, 20, 28, 30, 32, 38, 115, 116,
Mars hospital center, American Red Cross Military Hospital No. 1. ' ' ' '
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No, 54.
American Expeditionary Forces,
November 9, 1918.
I. Data necessary for promotion.— Attention is called to the requirement of General
Order 162, A. E. F., 1918, that a statement of the current physical condition of an officer
^all be made as an accompaniment to any request or recommendation for promotion.
This IS mandatory, and if the certification is not made it must involve annoying delay to
everyone concerned.
APPENDIX
989
Papers covering promotions must be acted on by superior local medical authority
prior to submission to this office.
Recommendations for promotion of officers of tlie Sanitary Corps will be made on the
blank for character of service and ciualifications, as in the case of medical, dental, and
veterinary officers. The only citation which recpiires omission in this blank is the fourth,
which specified the medical school from which graduated. However, should the officer be
a graduate of a high school, college, or university, the citation may be made under this
paragraph.
II. Travel orders. — Complaint has V^een made that hospitals evacuating patients to
other hospitals have failed to furnish attendants accompanying them with sufficient copies
of travel orders to get commutation of rations and return transportation. In order to avoid
unnecessary duplication of work at the liospital where these patients are received, hospitals
will furnish attendants the necessary copies of orders for commutation and return trans-
portation.
III. Claims for damages to French property. — Claims made for damages to French
property have been erroneously paid out of hospital fund. Such payments are not to be
made in the future, either out of hospital fund or out of Medical Department appropriations.
In this connection, attention is invited to section 4, paragraph E, General Orders,
No. 50, general headquarters, A. E. F., dated March 30, 1918, which establislies a renting,
requisition, and claims service for the American Expeditionary Forces and outlines pro-
cedure for handling damage claims; and attention is also invited to section 4, General Orders,
No. 78, general headquarters, A. E. F., dated May 25, 1918, which quotes an act of Congress
appropriating specific sums for the payment of such damages.
IV. Middle initial or number to be given in reports. — Attention is invited to the following
letter from the chief paymaster. United States Marines. Care will be taken to follow the
instructions as requested in this letter:
1. Numerous cases have arisen in which we are unable to distinguish certain men on
account of no middle initial being given in your reports to this office of men returning to
the United States on account of disability.
2. It is requested that whenever possible the middle initial be given, or in the absence
of such information that the man's number be given. Whenever it is impossible to give
either the number or the initial, it is requested that the company organization be designated
instead of regimental organization.
V. Property of French soldiers. — The chief of the French mission states that the provi-
sions of Circular 31, office chief surgeon. May 23, 1918, regarding the personal property of
French soldiers who die in American hospitals, are not being carried out. The attention
of all Medical Department organizations is called to this circular, and the directions
contained therein will be carefully and strictly followed in the future.
VI. Religion of patient to be entered on field medical card. — Attention is invited to
paragraph 8, Circular 41, office chief surgeon, July 22, 1918, which provides that, as soon as
practicable, the religion of every patient admitted to a hospital ward will be ascertained
by the ward medical officer and appropriate entry thereon made on the patient's field
medical card. These instructions will be carefully followed, as it has been reported that
this is very often neglected.
VII. Reporting of French military patients. — The attention of all commanding officers
of American hospitals in the zone of the interior is again directed to instructions governing
the reporting of French military patients to the Franco-American section of the region and
not to the American statistical section. No. 7 Rue Tilsitt, Paris.
VIII. Nurses and civilians.— In many cases the number of nurses and civilians assigned
to duty have not been entered on weekly strength return of hospitals. In future, care will
be exercised to have these returns complete in every respect.
IX. Nurses' uniform.— The uniform of all nurses, including the cap, must conform in
all respects to that of the Army Nurse Corps. The use of the Red Cross cap will be dis-
continued bv the reserve nurses of the Army Nurse Corps.
X. Sick leave for nurses, Army Nurse Corps.— Bulletin 43, War Department, July 22,
1918, states that nurses shall be entitled to sick leave with pay not exceeding 30 days m
any one calendar vear in cases of illness or injury incurred in the line of duty. Nurses while
so absent are entitled to commutation of rations at rate fixed by Army Regulations. When
990
ADMINISTRATION, AMERICAN EXPEDITIONARY P^ORCES
sent to convalescent homes or hotels provided by the American Red Cross, nurses will be
charged for subsistence at the same rate as will be paid to them by the Government as
commutation of rations.
XI. Original papers on the surgenj of the u-ar.— The editor of The Military burgeon is
anxious to secure original papers on the surgery of the war, especially reports on regional
surgeries. Medical officers of the American Expeditionary Forces are requested, when
forwarding papers to this office for publication in the United States, to state if they wish
them to be published in The Military Surgeon. This will also apply to professional papers
other than surgical. • a.t i i
XII. Requisitions for medical supplies. — All organizations in base section No. 2, otlior
than base hospitals and hospital center depots, will submit their requisitions for medicLl
supplies to the surgeon, base section No. 2, A. P. O. No. 705, and will hereafter submit none
direct to intermediate medical supply depot No. 3, Cosne.
Upon the approval of the section surgeon, the requisitions will be sent to the medical
supplv depot, base section No. 2, for issue.
XIII. Applications for transfer. — In order that applications for transfer from one
branch of the service to another, forwarded by officers and soldiers wdiile sick in hospital,
may be acted upon inteUigently, the following information will be indorsed upon all such
applications forwarded to higher authority for action:
(a) Whether the applicant is a patient; and if so,
lb) The nature of his disability, whether wounds or sickness, with a brief description
thereof.
(c) Probable date when applicant will be returned to duty.
(d) The class in which he will probably be discharged from the hospital.
XIV. Alphabetical list of officers on duty in the office of the chief surgeon showing
rank, department, and telephone number:
Officer
McCaw, Walter D..
Olennan, James D..
Winter, Francis A _
Fife, James D
Fisher, Henry C
Oliver, Robert T..__
Shaw, Henry A
Whitcomb, Clement
C.
Aitken, John J
Clarke, Howard
Culler, Robert M ._.
Harmon, Daniel W-
Johnson, Thomas H.
McDiarmid, Nor-
man L.
Shepard, John L
Thearle, William H .
W'elles, Edward M.,
jr.
White, David S
Weed, Frank W
Bemis, Harold E
Dickson, Robert A__
Emerson, Haven
Fielden, John S.C.,
jr.
Rice, William S
Williams, Linsly R..
Thompson, Richard
K.
Whitcomb, Walter
D.
Barney, James E
Berry Eugene J
Bolton Ray
Colonel
Brieadier
general
Colonel
do
do.
do
do
do..
Lieutenant
colonel.
do
do
do
_...do
....do
._..do
.-.-do
...-do
....do.
....do.
Major.
-...do.
....do.
do.
do
do
Captain
do
Firstlieu-
tenant.
do
do
Department
Tele-
phone
No.
Chief surgeon.
Hospital
Assistant chief
surgeon
Hospital
Inspection
Dental
Sanitation
Supply
Veterinary.
Transportation.
do
Sick and
wounded.
Hospital
Supply
Hospital
Personnel
do
Veterinary
Hospital
Veterinary
Administration-
Sanitation
Supply
Dental
Sanitation
Dental
Finance and
accounting.
Transportation
Finance and
accounting.
Veterinary
549
51-1
57
55-1
57
50-1
57-1
261-2
252- 1
256-1
256- 1
524-1
468-1
257- 1
569-1
253- 1
253-1
252-1
569-1
252-1
255
59-2
257-2
50-1
59-2
50-1
538
50-2
538
533
Officer
Rank
Brown, John D
Calder, J. W
Douglas, Malcolm C
Evans, John E
Emerson Bertrand,
jr.
Fenton, W illiam J _ .
Foster, Elliott O ...
Goodyear, Russell
W.
Hanford, Harry C
Mael, Jesse H
Mannix, Daniel E.
Mims, Martin D..-
Mueller, Frederick
W.
Murray, Joseph E _
Ross. Frank A
Yohe, Edward L
Russell , George E - - -
Rich, Harold
de Grange, Garrett
S.,jr.
Skelly, Patrick J
Engel, William E...
Bibby, Henry L
Delafleld, Robert H.
Duffield, Thomas J.
Powell, George E . . .
McComb, Robert P,
Proctor, Arthur W. .
Scott, Ernest E ......
Benett, Lowell
Bissonette, Geo. A ..
Nelson Arthur E
First lieu-
tenant
....do
.-..do.
1 Tele-
Department jphone
I No.
Dental.
Transportation.
do
.do ' Hospital .
-do Supply.
...do--
.--do...
.do.
256
50-2
50- 2
51- 2
257-2
Det
Finance and
accounting. !
do 538-1
448-2
538-1
.do I Hospital ..
.do I Personnel.
.do. i do
.do Hospital-.
.do do
-do.,
.do..
.do
.do.. ..
-do
.do.-.-
....do
...-do
Captain
Second lieu-
tenant.
do
do
do
do
.-...dO--....
Second lieu-
tenant.
do
do
Transportation.
Sick and
wounded
Dental
Hospital .-
----do. _.
....do
Sick and
wounded.
Records
Prom
Sick and
wounded.
Sanitation
Veterinary
do
Supply
Hospital
Reference li-
brary.
Transportation.
Sick and
wounded.
51-2
253-1
246-2
51-2
55-1
256-2
524-1
256
51-2
51-2
51-2
524-1
59-1
448-1
524=1
59-2
533
533
261-2
269-1
50-2
524-1
Walter D. McCaw%
Colonel, Medical Corps, Chief Surgeon.
APPENDIX
991
Circular No. 55:
American Expeditionary Forces.
December 12, 19 IS.
distribution of medical supplies in the AMERICAN EXPEDITIONARY FORCES OUTLINING
LINES OF SUPPLY AND DECENTRALIZATION OF BOTH REQUISITIONS AND SUPPLIES
I. The following outline of medical supply department activities from front to rear
will obtain in the future operations of this department.
(a) Divisional medical s upply dumps.- — On a basis of one to each division.
Activities: To supply divisional troops and to stock only such items as are needed
by combat divisions. Items of stock carried to be identical in all divisional supply dumps
the amount of each item to be carried and controlled by a maximum stock list.
(6) Army -park medical supply dumps. — On a basis of one to each army corps.
Activities: To supply divisional medical supply dumps and in emergency to surround-
ing medical units. Stock items to be the same as those carried by divisional medical supply
dumps. The amount of stock to be carried on items to be based on the number of combat
divisions concerned in the sector supplied.
(c) Army medical supply depots. — On a basis of one to each Army.
Activities: To supply army park medical supplj- dumps, evacuation hospitals, field
hospitals, ambulance companies, mobile hospitals, mobile surgical units, veterinary field
units, and such other imits as specially designated. Stock items to be carried should meet
all the requirements of the units concerned and should also be based on a maximum stock
list.
(d) Services of Supply medical supply depots. — Number prescribed by the chief surgeon,
A. E. F.
Activities: To supply army medical supply depots and designated Services of Supply
medical units. The stock in these Services of Supply depots in advance positions to fully
cover all the items carried at army medical supply depots, as well as the surrounding Services
of Supply medical units.
(e) Controlled stores. — Includes all medical supplies in storage at base ports or other
designated Services of Supply depots, the issues from which are under the direct control
of the chief surgeon, A. E. F.
Activities: To furnish supplies to all depots and initial equipment to new units being
installed.
(J) Medical supply depots at hospital centers. — Number prescribed by the chief surgeon
A. E. F.
Activities: To furnish supplies to the hospitals of the group concerned to any other
units specially designated by the chief surgeon, A. E. F. Hospital centers not having depots
should consolidate requisitions and forward same direct to the chief surgeon, A. E. F., A. P. O.
717.
Depot control. — While the chief surgeon, A. E. F., controls all activities of the Medical
Department, the imm ediate control of the army dumps and army medicll supply depots
is vested in the chief surgeon of the army concerned. The immediate control of all other
medical supply depots being under the chief surgeon, A. E. F.
II. Decentralization of requisitions. — Hereafter all requisitions, except those specially
exempted below originating in the Services of Supply will be acted upon by the chief surgeon
of the section concerned, who will modify the requisition and forward same to designated
depot for issue.
This modification will be final and any question thereto should be taken up by the
depot concerned with the surgeon of the section approving the requisition.
Exceptions. — Requisitions from medical supply depots and medical supply depots
at hospital centers and for initial equipment of medical units will be sent direct to the office
of the chief surgeon, A. E. F., A. P. O. 717, for his action.
Requisitions for laboratory supplies, except from medical supply depots, will be sent
direct to the director, central laboratory, A. P. O. 721, Dijon, for his action; same will
then be forwarded to the designated depot.
13901—27 63
992
ADMINISTRATION, A:MERICAN EXPEDITIONARY FORCES
Requisitions for X-ray supplies covering initial equipment — i. e., base hospital X-ray
outfits, portable X-ray outfits and bedside units— will be forwarded to technical consultant,
Roentgenology, A. P. O. 702.
X-ray supplies such as plates, chemicals, etc., will be included in requisitions for medical
supplies and referred to the section surgeon, but they must appear under separate heading,
X-ray supplies.
Requisitions for veterinary supplies follow the course of medical requisitions except
for initial equipment of units, which will be forwarded to the chief surgeon, A. E. F., direct.
Requisitions for dental supplies follow the course of medical requisitions except for
initial equipment of base hospitals; i. e., base dental outfits, which will be sent direct to
chief surgeon, A. E. F.
III. Pending the installation of additional depots, the following sections will be supplied
by medical supply depots as follows:
Base section 1, 4, 5, by base medical supply depot No. 1, St. Nazaire.
Base sections 2, 6, 7, by base medical supply depot No. 2, Bordeaux.
Intermediate section and Paris district by intermediate medical supply depot No.
3, Cosne.
Advance section. Services of Supply, by advance medical supply depot No. 1, Is-sur-
Tille.
Surgeons of sections will take the necessary steps to notify the unit now in their sections
and new units arriving as to the proper channels for medical supply requisitions as above
outlined.
IV. This circular does not modify the method of handling requisitions in combat sectors.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 56.
American Expeditionary Forces,
November 19, 1918.
I. Made-up surgical dressings. — -Because of the immense amount of devoted labor given
by the women of America, through the American Red Cross, there is now available in France
a sufficient supply of made-up surgical dressings to warrant the issue to and use in all hos-
pitals of these prepared dressings.
It is desired therefore that requisitions be submitted for these dressings and that reqiii-
sitions for gauze, plain, be consequently reduced. These dressings are of two classes:
First, already sterilized. — The supply of this type is limited, and issue will be made to
field and evacuation hospitals, and they should be used only in times of stress or where oppor-
tunities for sterilization are inadequate. Requisitions for these dressings should call for
"Dressings for evacuation hospital use, sterilized."
In ordinary times dressings of the following type should be used:
Second, prepared and wrapped ready for sterilization but not sterile. — These supplies are
stocked in all medical supply depots and dumps and in Red Cross storehouses. They should
ordinarily be obtained from the medical supply depot by original requisitions. Case lots
should be asked for. For the initial stock, requisition should be submitted to this office.
The attached Hst approximates 10 carloads, and requisition may be submitted in the form
of a request for 10 carloads, or a specified portion thereof. (In this case the shipment
will be prorated.) Subsequent requisitions should call for case lots of dressings needed:
APPENDIX
10-carload lot of assorted surgical dressings
[To be used as basis for requisitions by medical supply depots, A. E. F.)
993
Dressing used as:
Sponges —
Qauze wipes—
2 by 2
4 by 4
Gauze finger sponges.
Gauze squares, 9 by 9
Folded gauze strips_.
(^oinpresses—
Sterile dressing pads, 8 by 4.
Gauze compresses —
4 by 4
9 by 9
Packing and padding —
Gauze rolls, S yards by 4J^2
Gauze rolls 3 yards by iH.
Laparatoiny pads —
12 by 12
6 by fi
4 by 16 _
Absorbent —
U. D. pads, type 1—
Cotton, 8 by 12
Oakum, 8 by 12
U. D. pads, type 1—
Cotton, 14 by 20
Oakum, 14 by 20
U. D. pads type 1, cotton, 12 by 24 _
Split irrigating pads, 21 by 16.
Bed pads —
U. D. pads, type 2—
WA by 18
18 by 23
Drains— Gauze packing, 2 by 1 yard, {2 by 1 yard-
Body bandages:
Abdomen —
Many-tailed bandages, 48 by 12- —
Abdominal bandages-
Muslin, 48 by 18 - - -
Flannel, 52 by 12
Scultetus, flannel
Perineal, T bandages, 53 by 7
Head and chin, four-tailed bandages, 36 by 8-
Arm and various slings
Eyes—
Double-eye bandages
Single-eye bandages.
Pneumonia jackets
Accessories used with splints:
Supports —
Support slings-
No. 1,8 by 21 ----
No. 2, 5M by 16. -
No. 3,7 by 23 ^-riv-vr
Rubber cloth support slings (wooden ends), 8 by 24.
Canvas support slings (wooden ends), 8 by 24
Canvas swathes, 18 by 22 ---
Straps and buckles —
I'/i by 4 yards -
IH by 2 yards..
Heel rings - -- -
2
3, 200
2
5, 000
1
1,400
250
y2
250
100
1
4,000
1
2, 400
1
630
17, 230
994
ADMINISTRATION', AMERICAN EXPEDITIONARY FORCES
10-carload lot of assorted surgical dressings — Continued
[To be used as basis for requisitions by medical supply depots, A. E. F.]
Num-
ber of
cases
Accessories used with splints — Continued.
For traction —
Anklets, _
Elbow traction bands
Traction bands, flannel, 10 by 5, 16 by 7, 23 by 7-
Adhesive plaster
Shot bags " --- ---
Ctnvas weight bags
Accessories used with plaster:
Sheet wading, 5-inch
Crinoline-
s-inch ---
Bolts
Felt, 100 yards
Canvas hammocks, 20 by 42.
Bandages:
Gauze bandages, 3 inches by 5 yards.
Muslin bandages, bias —
3- inch, _ , -
4- inch ,,,
5- inch
6- inch
Muslin bandages, straights —
5 by 5,- ,
4 by 5.. ,,
5 by 5,.. ,,
Flannel bandages, straights—
3by 5...
4 by 5.,,
Jackinette, 500 yards
30
Dressings
500
1,000
5,000
500
22,000
1,820
28,820
4, ,500
10,000
290
14,890
37,500
1,200
1,200
600
3,200
8,000
4,800
600
3,000
1,600
61,700
" In stock, but not being replaced.
II. Reconstruction aides. — Reconstruction aides are civil employees under contract with
the Surgeon General. They are subject to the orders of the commanding officer of the units
to which assigned and will be under the direct charge of the chief nurse. They are entitled
to such pay and emoluments as are set forth in contracts.
Their especial function is to carry out the instructions of the medical staff in the rehabili-
tation of wounded in methods of physical and occupational therapy.
When assigned to duty at hospitals they are subject to the same regulations which
govern nurses, and when their services are not required in their special work they may be
temporarily assigned to duty as nurses' aides.
The necessary reports will be made by the chief nurse and forwarded through regular
channels.
III. Expendable property. — The following articles of medical property will be considered
expendable property: Crutches, canes, and splints of all kinds.
To expedite the evacuation of patients, commanding officers of hospitals and hospital
trains are authorized to exchange bath robes (convalescents' gowns), blankets, liters, pajama
coats, and pajama trousers on a numerical basis except where it is found to be more prac-
ticable to transfer the property by exchange of invoices and receipts.
Walter D. McCaw%
Colonel, Medical Corps, Chief Surgeon.
Circular No. 57.
American Expeditionary Forces,
November 20, 1918.
I. Duties of professional consultants.— {!) The duties of the professional consultants
will be to supervise the clinical work of the American Expeditionary Forces. Thev will
be assigned to hospital centers, districts, armies, army corps, and divisions, as the necessity
demands, on recommendation of the chief consultant of their respective services bv the
proper military authority. '
APPENDIX
995
(2) In order that the individual consultant may perform his duties effectively, he
will make frequent visits to the hospitals or other medical organizations in his territory,
as may be required. He shall spend so much time in each hospital as in his judgment
may be necessary in order to acquaint himself thoroughly with the character and quality
of the work done therein.
(3) It is the duty of the consultant to supervise the professional w'ork, as to his depart-
ment, of the organization or organizations to which he is assigned. He will give advice,
instruction, and actual demonstrations as to the best and most efficacious methods of treat-
ment in order that the w'ork of his department may conform to the recognized and accepted
standards of the best civil and military practice.
He will make recommendations to the commanding officer as to the abilitj' and pro-
fessional fitness of individual medical officers of his department. The commanding officer
will take the necessary steps to carry the recommendations of the consultant into effect.
A copy of the recommendations of the consultant will be forwarded to the senior consultant
for his information. In case of difference of opinion between the commanding officer and
the consultant, the decision rests with the commanding officer on whom, in all military
organizations, the ultimate responsibility rests. This does not interdict the right of appeal
to higher military authority.
(4) In order that the supervision and direction of the clinical care of the sick and
wounded may be consistent throughout, consultants will recommend to commanding officers
of hospitals in their respective areas the names of those suitable for appointment as chiefs
of clinical services and specialists in those hospitals.
(5) Consultants will render regular monthly reports of their activities. These reports
will embody the nature of the clinical work of the organizations in their jurisdiction, the
character and quality of the work, and fitness of individual medical officers in their depart-
ments. These reports will be submitted to the senior consultant, through the command-
ing officer of the hospital center, or in base hospitals operating separately, the commanding
officer of the hospital, or through the surgeon of the unit to which they are assigned.
(6) The commanding officers of units in the district assigned to a consultant will afford
proper and necessary facilities to the consultant in the performance of his duties.
(7) The consultant will report to the commanding officer immediately on his arrival
at, and before his departure from, any unit which is within the sphere of this action.
II. Assignment of personnel. — Commanding officers of hospital centers may make
such changes of assignment of personnel on duty with units belonging to their centers as
may be necessary or desirable. This authority will not be construed to cover personnel
belonging to units, such as field hospitals or ambulance company which are not permanently
assigned to the center. All changes of assignment made under this authority will be promptly
reported to this office.
III. Class B men. — Men of class B held at hospitals in accordance with telegraphic
instructions, chief surgeons's office, October 25^ 1918, will be held as classified men, after
disability boards have acted upon them, and not as patients.
IV. Artificial eyes. — Four centers have been established where men requiring arti-
ficial eyes can best have them fitted. Base Hospital No. 115 at Vichy is the principal center.
The others are base optical unit. Medical Department repair shop, Paris; Base Hospital
No. 8, Savenay; and Base Hospital No. 29, London. Cases requiring plastics on the eye-
lids or orbit prior to the fitting of an artificial eye should be routed to Base Hospital No.
113 if practical. Such cases appearing in Paris may be sent to American Red Cross Military
Hospitals Nos. 1 or 2.
V. Trachoma. — Cases of trachoma which occur among the troops can be treated in the
base hospitals, but precautions should be taken to prevent any danger of spread of the disease.
Special care of towels and handkerchiefs is jnost necessary. Severe cases likely to require
long treatment with resulting impairment of vision should be classified "D" and routed
accordingly.
VI. Civilian employees.— (l) Supplementing paragraph 3, Circular No. 45, chief sur-
geon's office, dated August 13, 1918, commanding officers of hospital centers are directed to
report to the office of the chief surgeon (F. and A. Division), all authorities for the employ-
996
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
ment of civilians granted by them to date to commanding officers of base hospitals under
their command, and also to forward to the same office copies of all similar authorities here-
inafter granted by them. Attention of commanding officers of hospital centers is invited
to section 3, paragraph 2, General Order No. 32, general headquarters, A. E. F., dated Feb-
ruary 13, 1918, and also to section 5, General Order No. 131, general headquarters, A. E. F.,
dated August 7, 1918, which regulates employment of civilian personnel.
(2) Supplementing section 2, paragraph 1, Circular 16, chief surgeon's office, dated March
28, 1918, and section 1, Circular 23, chief surgeon's office, dated April 22, 1918, commanding
officers of hospitals and other units functioning as such, are directed to have payment of
civilians, whenever possible, made from the hospital fund and reimbursement to such fund
secured in the method provided in section 2, paragraph 1, Circular No. 16, chief surgeon's
office. Payment of civilians should be made by Quartermaster Corps disbursing officers
only when sufficient balance is not on hand in the hospital fund. Whenever civilians are paid
from the hospital fund, the original pay roll, properly signed and executed, with memorandum
voucher attached, should be sent to the disbursing officer. Medical Department, office chief
surgeon, A. P. O. 717, for reimbursement by one check drawn to the order of the hospital
fund. These original rolls should bear the following properly signed certificates:
(a) I certify that I have witnessed the payment of this roll and that the amount i)aid
each employee was such as is set opposite their respective names.
Signature.
(6) I herebv certifv that payment of this roll was made from hospital fund. Base Hos-
pital No. and hereby request that said hospital fund be reimbursed the amount of
francs
Custodian, Hospital Fund.
VII. Surgical instruments. — Any surplus instruments held by medical units will be
turned in at once to the instrument repair shop, 11 ter Rue de La Revolte, Paris, France.
The same procedure will obtain where medical units are discontinued. All instru-
ments shipped in compliance with the above instruction will be properly invoiced to com-
manding officer of the instrument repair shop.
VIII. Paragraph 3, Circular 28, office of chief surgeon, c. s., is amended by substituting
the following:
When French and allied military patients are admitted to, discharged from, or die
in, American military hospitals in the French zone of the Interior, notification of the fact
will be sent within 24 hours to the Franco-American section of the region (Service de Sante),
on Form 52, which will contain: Surname, Christian name, regiment, serial number, place
of enlistment (if possible), nationality, date of admission, source of admission, nature of
wound or disease, and, if in line of duty, complications, mode and date of discharge, or
date of death and place of burial, name of hospital in which patient is being treated.
IX. Patients remaining in hospital December 31, 1918. — A remaining card. Form 52,
will be made out for each patient in hospital on December 31. It will be identical with
Form 52 as used for completed cases except that in space 16, "Disposition," the entry
"Remaining in hospital" will be made, and in space 17, "Date of disposition," the entry
"December 31, 1918," will appear.
A nominal check list of these will be made with the word "Supplemental" appearing
on the form at the top. The sheet, together with the cards, will be submitted with the
regular monthly report for December.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 58:
American Expeditionary Forces,
December 2, 1918.
I. Collection of museum material for medical education and research {supplement to Cir-
cular No. 4^) . — The cessation of hostilities makes necessary the following additional direc-
tions concerning the collection, preservation, and shipment of specimens for the Array
Medical Museum:
APPENDIX
997
Par. 2. Scope. — Since opportunity is past for obtaining pathologic material showing
recent war injuries, efforts will now be made to obtain material showing such injuries in all
stages of healing. Serial graphic records by photographs and drawings will be made of
typical or otherwise interesting cases. Amputated and resected material will be preserved.
Also all lesions from war injuries in cases coming to autopsy. It is believed such specimens
will be of inestimable value in the study of the treatment of wounds, gas burns, trench foot,
etc.
Par. 7. Pathologic specimens. — (a) To prevent overhardening during long delays
which may occur in transporting specimens to the United States, all gross pathologic speci-
mens, after short preliminary fixation in Kaiserling No. 1, if not carried through the entire
Kaiserling process, will be placed in fresh KaiserHng No. 1, which contains only 10 per cent
of formalin.
Par. 8. Shipment. — To avoid loss during long delays in transit in France, when pos-
sible specimens will be shipped by motor transport to concentration points. (See par. 5,
Circular 42.) If rail transport must be used, pathologic specimens will be well padded with
waste absorbent cotton, moss dressing, or paper, packed closely in kegs, barrels, or casks,
which will then be headed and filled with half-strength Kaiserling No. 1 and shipped by
"Grand Vitesse." Where large numbers of specimens have been collected and capable
packers are not available, application for assistance will be made to the director of labora-
tories, A. E. F. (museum unit), A. P. O. 721.
Par. 18. Photographs. — By authority first and fourth indorsements, O. C. S. -jV/r
C. S. O., the Medical Department, through the Signal Corps, now has full authority to make
photographs of subjects pertaining to the Medical Department. Commanding officers of
liospitals will take immcfliate steps to procure photographs for illustrating the history of
their organizations.
II. Proceeds from sale of garbage. — (1) Decision of the judge advocate states that pro-
ceeds from the sale of kitchen refuse at hospitals belongs to the hospital funds of the
organizations.
(2) Commanding officers are therefore instructed to make contracts locally for the
sale of same, and place proceeds therefrom in the hospital funds.
(3) If proceeds previously received have been turned over to the Quartermaster Corps,
effort should be made by commanding officers of hospitals to secure refund, either from the
local disbursing quartermaster or by sending claims with all details to this office (F. and
A. Division).
III. Camphor. — Due to the difficulty of obtaining camphor, it is desired that every
effort be made to conserve it.
IV. Return of buildings occupied for hospital purposes. — No agreement should be made
between commanding officers of hospitals and local French authorities for the return of build-
ings occupied for hospital purposes, as this office has been repeatedly informed by the
French central authorities that local authorities are not competent to act on the premises.
This transfer should be only done after receiving directions from the chief surgeon of the
American Expeditionary Forces in the case of base hospitals, and the section surgeons of
the Services of Supply in the case of camp hospitals.
It has been reported to this office that a number of base hospitals have evacuated
patients who should not have been moved, with a view to demobilizing the hospitals.
Action such as this will not facilitate the departure of Medical Department units to the
United States, but will in fact retard it. Greater care than ever must be exercised in treat-
ment and evacuation of patients. This office will make proper recommendation, when the
time arrives, as to ordering the units to the United States.
V. Medical Department property. — All officers accountable for Medical Department
property who are carrying Red Cross property on their returns are instructed to drop this
property from their returns, making a certificate to this effect to the chief surgeon, F. and A.
Division, giving the number of the voucher on which the property was dropped.
Although there is no formal accountability for Red Cross property (see par. 3, Circular
3, B. G. and L. O. C, August 28, 1917), responsibility, however, for this class of property
rests with the commanding officers of hospitals and other organizations who should be pre-
pared at all times to give and account of the use to which this property has been put.
998
ad:ministeation, American expeditionary forces
VI. Medical journals and 6ooA:s.— Standard medical journals and books arc available
in the medical supply depots and the medical research and intelligence department of the
Red Cross, Hotel Regina, Paris. Application for such books should be made through the
usual channels. Base hospitals will be supplied from the Army stock, and camp and
evacuation hospitals from the Red Cross stock. If nonstandard books arc not available in
one stock, request will be referred, if approved, to the other.
The medical research and intelligence department of the Red Cross, Hotel Regina,
Paris, will be glad to review the literature on any special subject in which a medical officer
is interested, and to furnish him an abstract of the results. Correspondence may be made
direct.
VII. Repairs or installation of X-ray apparatus.— In case of repairs needing the attention
of an X-ray officer of the Sanitary Corps the commanding officer of the hospital should wire
the office of the technical consultant in Roentgenology, A. P. O. 702, who wUl direct the
proper officer to make the repair. A brief, explicit statement of repair needed will expedite
service.
In case of portable or bedside transformer, wire the above office for a replacement
and send damaged part to medical repair shop No. 1, X-ray division, 11 Bis Avenue de la
Revolte, Neuilly, Paris.
No officer for the installation of new equipment will be sent unless the telegram to the
above office states that machine is on hand and that current is available.
VIII. Personnel available for transfer. — Commanding officers of Medical Department
units and detachments will report, by mail, to this office on the 15th and the last day of
each month the names of any officers, nurses, or men who can be spared for return to the
United States or for duty elsewhere in the American Expeditionary Forces.
IX. The following information will be furnished this office, when units are sailing for
the United States:
The immediate commanding officer of each medical department formation will make
a final return showing all members of the Medical Department present for duty with his
organization, on date of departure to the United States.
Division surgeons will make a separate return of all members of the Medical Department
serving in their divisions and not included on other returns.
Separate return will be made of all personnel, present for duty, in the following order:
Officers of the Medical Corps; officers of the Dental Corps; officers of the Veterinary Corps;
all to be listed alphabetically according to grade.
Separate return will be made of all enlisted personnel, present for duty, alphabetically
according to grade, the soldier's serial number, name, and rank will be recorded in the follow-
ing manner:
Serial No.: Surname: Christian name: Rank:
14278 Brown, William E.
Separate return will be made of all civilian employees and members of the Army Nurse
Corps.
The return will be prepared on letter or cap paper (typewritten). The return will
then be forwarded to the chief surgeon, A. E. F., through the base surgeon, who will take
such memoranda therefrom as he may require, and will without delay transmit it by informal
indorsement to this office.
X. Sick leave of absence. — In granting sick leaves of absence under paragraph 2, General
Order 7, Services of Supply, c. s., attention of all commanding officers is invited to para-
graph 9, General Order 6, General Headquarters, c. s. In this connection, Paris is in the
French zone of the armies, and leave should never be granted to visit Paris except in very
exceptional cases.
XI. Travel orders. — Reports have been received at this office that the commanding officers
of base hospitals, in sending men to depot divisions and casual camps, are not complying
with the requirements of General Order 111, General Headquarters, c. s. In order that
there may be no mistake, the travel orders of officers and soldiers evacuated from hospital
not only as of classes B and C, but also of class A, will state clearly the classification to
which the officer or man belongs. Especial attention will be given the fact that sufficient
APPENDIX
999
number of orders must accompany each group in order that the commanding officer of the
depot division or casual camp may have the proper records immediately on receipt of a
man or group of men.
Walter D. McCaw,
Colonel Medical Corps, Chief Surgeon.
Circular No. 59:
American Expeditionary Forces,
December 9, 1918.
I. pneumococcus lipo-vaccine
1. The following directions for vaccination against lobar pneumonia and for making
the necessary records are published for the information and guidance of medical officers of
the American Expeditionarj^ Forces.
2. Each cubic centimeter of the pneumococcus Hpo-vaccine contains 15,000 miUion
pneumococci of Type I and 15,000 million of Type II. On standing in the cold, some of
the fats may separate and cause a precipitate. This will disappear on standing a short
time at room temperature.
3. A single dose of 1 c. c. of this vaccine is sufficient. It is especially important that
it be given subcutaneously, not intravenously, intramuscularly, or under the fascia. In
order to insure this, you will pick up a fold of skin and inject into the subcutaneous tissue of
that fold. Practically all the severe reactions that have been reported have been due to
neglect of this precaution. The deep injection of this vaccine may lead to fat embolism
and defeats the object of the inoculation.
4. No person should be vaccinated who is not perfectly healthy and free from fever.
The temperature will be taken before vaccination is begun and, in doubtful cases, the urine
should be examined; if fever or any other symptoms of illness are present, the procedure
should be postponed. This precaution is necessary to avoid vaccinating men who may be
in the incubation stage of a fever. Neither beer nor alcohol in any form should be drunk
on the day of treatment. It is advisable to give the vaccine about 4 o'clock in the afternoon,
and the men should be required to remain in quarters for 24 hours after the injection.
5. A sick and wounded card is to be made out for each person vaccinated, giving the
type of vaccine employed, batch number for its identification, and the dosage. This card
is to be marked "For vaccination record only" and sent direct to the office of the chief
surgeon, A. E. F., A. P. O. 717. Enter on the service record, date, type, and dose of
vaccination.
6. The pneumococcus lipo-vaccine may be obtained by requisition from base labora-
tories in accordance with paragraph 10, Memorandum No. 21, office chief surgeon, division
of laboratories and infectious diseases, September 18, 1918.
7. Vaccination against lobar pneumonia is not compulsory, and the use of pneumo-
coccus lipo-vaccine in the American Expeditionary Forces must be made only with the
consent of the patient.
II. TYPHOID lipo-vaccine
1. The following information is furnished for the guidance of the medical officers of
the American Expeditionary Forces.
2. As rapidly as the supply of triple hpo-vaccine is increased it will be sent in filling
requisitions for triple typhoid saline vaccine. Requisitions should be made to the nearest
base laboratory in accordance with paragraph 10, Memorandum No. 21, office of chief sur-
geon, division of laboratories and infectious diseases, September 18, 1918.
3. Triple typhoid hpo-vaccine contains in each cubic centimeter 2,500 milUon Bacillus
typhosus, 2,500 milhon Bacillus paratyphosus A; and 2,500 million Bacillus paratyphosus B.
On standing in the cold some of the fats may separate and cause a precipitate. This will
flisappear on standing a short time at room temperature.
4. A single dose (not three) of 1 c. c. of the lipo-vaccine is sufficient. It is especially
important that this vaccine be given subcutaneou.sly and not intravenou.sly, intramuscularly,
1000
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
or under the fascia. To insure this, a fold of skin is picked up and the injection made into
the subcutaneous tissue of that fold. Practically all the severe reactions that have been
reported have been due to neglect of this precaution. The deep injection of the lipo-vaccine
defeats the object of its use and in addition may lead to fat embolism.
5 The precautions to be taken regarding the absence of temperature or disease are
the same as are given for the typhoid vaccine in Circular No. 16, War Department, office
of the Surgeon General, March 20, 1916. It is advisable to give the vaccine about 4 o'clock
in the afternoon, and the man should be required to remain in quarters for 24 hours.
6 After the injection, the record of the vaccine should be kept on Form No. 81, that
form being modified bv writing "Lipo" after "Triple vaccine," and by striking out "First"
in the "Dose" column, and by striking out all columns in the "Second" and "Third" doses.
The batch number of the vaccine should always be entered on the card.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 60.
American Expeditionary Forces,
Chief Surgeon's Office, Services of Supply,
December 16, 1918.
DIPHTHERIA AND DIPHTHERIA CARRIERS IN THE ARMY
I. Bacillus diphtheria;.— (a) True diphtheria bacilli when freshly isolated and examined
in young cultures (24 hours on Loeffler's blood serum) have fairly typical morphology and
staining reactions which usually serve to differentiate them from other organisms.
(6) Their positive identification may be made upon morphology and staining reac-
tions plus cultural characteristics.
(c) B. diphtheriie may be divided into two groups — virulent and avirulent — which are
indistinguishable from each other morphologically, tinctorially, and culturally, but may be
positively differentiated by guinea-pig inoculation.
(d) Practically speaking, an avirulent strain of diphtheria bacilli never acquires vir-
ulence, and a virulent strain retains its virulence with great tenacity.
II. Etiology. — Clinical diphtheria is produced only by virulent diphtheria baciUi.
III. Diphtheria bacillus carriers. — (a) Single throat cultures from healthy individuals
of various ages reveal B. diphtheria; in 1 per cent to 30 per cent. The average incidence
appears to be 3 to 4 per cent.
(ft) Among the bacillus carriers the per cent of carriers with virulent bacilli varies
greatly, but is commonly found to be 10 to 15 per cent of carriers.
(c) The carrier stage may be temporary or chronic. Sometimes diphtheria bacilU
disappear from the throat of a carrier within a few days after they find lodgment there; in
other cases they persist for weeks, months, or even years.
(d) If daily cultures are taken from the throats of chronic carriers, very interesting
and instructive results may be obtained; (1) Positive cultures may be obtained for a number
of consecutive days extending perhaps over weeks. (2) A majority of the cultures may be
positive, with occasional negatives interspersed among the positives. (3) A majority of
the cultures may be negative, with occasional positive cultures. (4) A carrier who has
been giving regularly positive cultures for a number of days may show irregular results for
a time and then give entirely negative cultures for a number of successive cultures, to be fol-
lowed still later by regularly positive cultures, and this condition of affairs may repeat itself
many times. (5) The growth of diphtheria bacilli is not confined to the surface of the mucous
membrane; colonies have been demonstrated in the depths of the tonsillar tissue, and the
condition described under (4) above is probably to be explained by the successive coming
to the surface of these deep colonies as the superficial layers of the tonsils are gradually
exfoliated. (6) Virulent and avirulent bacilli are rarely, if ever, found in the throat of a
carrier at the same time.
APPENDIX
1001
IV. Sterilization of carriers. — To free carriers of virulent diphtheria, a great number
of methods have been tried. The only one which has met with any considerable degree of
success in chronic carriers has been tonsillectomy. This will not prove universally success-
ful, as in some cases the nidus may be elsewhere than in the tonsils, as, for example, in the
accessory siimses.
V. The role of carriers in the spread of diphtheria. — The role of carriers who have not
been in close contact with an active clinical case of diphtheria in the spread of diphtheria
does not seem to be important. This is obvious when it is recalled that 85 to 90 per cent of
all carriers harbor only nonvirulent bacilli, and that infection does not readily occur from
the remaining 10 to 15 per cent who constitute a possible source of infection for susceptible
individuals.
VI. The detection of carriers. — single throat culture from any large number of people
would probably reveal less than half the actual number of carriers present. Two cultures,
taken with an interval of a week or two between, would probably reveal twice the number of
carriers found on a single culturing. If six or seven cultures were taken with an interval
of a week or two between cultures, the number of carriers remaining undiscovered would
probably be very small. Nasal cultures might show a few additional carriers, but very
few.
Isolation of healthy carriers is impracticable because (1) of the labor involved in detect-
ing all the carriers. (2) If all the carriers among any large group of persons were detected,
their number would be too great. (3) The only method of sterilizing chronic carriers (ton-
sillectomy) that has met with much success could hardly be recommended as a routine
procedure, and without this many of them will remain carriers indefinitely. (4) They do
not constitute a menace serious enough to justify any of the above procedures. (5) Finally,
if for any reason an attempt is made to detect and isolate carriers, virulence tests should be
performed and the carriers of avirulent organisms should be disregarded.
VII. The diphtheria patient. — While the healthy carrier of even virulent diphtheria
bacilli does not constitute a serious danger to persons in contact with him, the same can not
be said of the individual suffering from clinical diphtheria. The disease is readily transmis-
sible, both by direct contact and by moist discharges from the nose and mouth. Strict
isolation of all cases should be carried out and thorough disinfection of all clothing, bedding,
and other articles that have been used by the patient subsequent to his infection. It is pos-
sible that persons who have recently become carriers by contact with a diphtheria patient
may be a greater source of danger in the spread of the disease than the ordinary healthy
carrier who has not been recently in contact with the disease; therefore, all those who are
in intimate contact with a person at the time of, or just prior to, his development of diph-
theria should be isolated until the incubation period of the disease has passed or until they
can be shown to be free from the infection by at least two negative throat cultures. All
nurses and orderlies in attendance upon cases of diphtheria should be isolated during the
whole of the time that they are in charge of such patients and for a period thereafter equal
to the incubation period of the disease, or until they are shown free from the infection by at
least three successive negative throat cultures at intervals of three days.
VIII. The incubation period.^The incubation period of diphtheria is from 2 to 5 days,
oftenest 2 days, and under experimental conditions has been found to be short as 24 hours.
IX. Treatment with diphtheria antitoxin.— Biphtheria antitoxin given m adequate doses
sufficiently early in the diseases will effect a prompt cure in practically 100 per cent of cases.
There should be no mortalitv where antitoxin is given within 24 hours of the development
of symptoms. For adults weighing 90 pounds or over, the amount of antitoxm required
in the treatment of cases is as follows: Mild cases, 3,000 to 5,000 units; moderate, 5,000 to
10,000 units; severe,'' 10,000 to 20,000 units; mahgnant, 20,000 to 40,000 units.
Cases of laryngeal diphtheria, moderate cases seen late at the time of the first injection
and cases of diphtheria occurring as a compHcation of the exanthemata should be classified
and treated as "severe" cases. , > i •
In all cases a single dose of the proper amount, as indicated in the schedule, is recom-
\nended. .
•I When given intravenously, '^ne-hnlf the amounts stated.
1002
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
It is recommended that the methods of administration be as follows:
Mild cases, subcutaneous or intramuscular.
Moderate cases, intramuscular or subcutaneous.
Severe cases, intramuscular or subcutaneous or intravenous.
Malignant cases, intravenous or intramuscular.
Some point on the surface of the body should be chosen for the injection, as where
there is an abundance of subcutaneous cellular tissue — the abdomen or infrascapular region
Before the remedy is administered, the skin should be sterilized at the point of injection
with tincture of iodine or other disinfectant. The syringe should be thoroughly sterihzed.
It is better not to emploj- massage over the point of injection.
THE EARLY ADMINISTRATION OF ANTITOXIN
The earlier the remedy is administered the more certain and rapid is the effect. In
cases of any severity where diphtheria is suspected, it is far better to administer the remedy
at once, making a culture at the same time, than to delay the treatment until a diagnosis
has been made by bacteriologic examination. The first injection should be large enough
to control the disease. One large dose given early is far more efficacious than the same
amount in divided doses. Severe cases and those in which the administration of antitoxin
has been delaj'cd, or cases which are progressive because of an insufficient first dose, should
receive a large intravenous injection whenever feasible. In this way the full value of anti-
toxin is obtained at once, whereas the absorption from the subcutaneous injection is so slow
that many hours must elapse before anj^ great amount of antitoxin has found its way into
the genera^ circulation. It must be warmed to the body temperature and given verj' gradually.
X. Anaphylaxis. — While it must be admitted that anaphylactic shock may follow
the administration of diphtheria antitoxin serum and that this danger is slightly greater
when the serum is given by the intravenous route than when given subcutaneously or intra-
muscularly, instances of serious consequences from therapeutic use of diphtheria antitoxin
are so rare that there is no justification in withholding antitoxin in clinical diphtheria.
Desensitization may with advantage be attempted in cases of known sensitiveness to horse
serum.
XI. Immunity. — (a) Natural immunity: Experience has shown that approximately 50
per cent of mankind are naturally immune against diphtheria. This immunity is due to
the presence, naturally, of a small amount of diphtheria antitoxin circulating in the blood.
This immunity once established apparently lasts throughout life. The Schick test: The
presence of natural or artificial immunity may be determined by the Schick test. This
test consists in the intradermal injection of a small amount of diphtheria toxin: if antitoxin
is present (natural immunity) the toxin injected will be neutrahzed and no reaction will
follow. If no antitoxin is present (as in a susceptible individual) the toxin will give rise to
an inflammatory reaction at the site of inoculation, a positive reaction. Technique of the
Schick test. The test consists in the intracutaneous injection of one-fiftieth M. L. D. diph-
theria toxin in volume of 0.1 c. c. The M. L. D. (minimum lethal dose) of toxin is that
amount which will kill a 250-gram guinea pig in 4 to 5 days. For the injection, alec,
hypodermic syringe with very small sharp needle is necessary, and the injection may con-
veniently be made into the skin of forearm.
(fe) Susceptibility.--It seems highly probable that people who give a negative Schick
test may be exposed freely to diphtheria without danger of their contracting the disease,
while persons giving a positive Schick test so exposed are likely to contract the disease.
(c) Active imtnunization.Susceptihle individuals may be activelv immunized against
diphtheria by the injection of toxin-antitoxin mixtures, and such immunitv is probably
fairly lasting, in some instances persisting throughout life.
id) Passive immunization.— SnsceptiUe individuals mav be passively immunized
against diphtheria by the injection of antitoxin. Such immunitv reaches its maximum
degree immediately, if the antitoxin is injected intravenouslv, and after about 48 hours
foUowmg subcutaneous injection. Passive immunity following the usual prophvlactic dose
of 1,000 units of antitoxin gives the individual a temporary immunitv against natural infec-
tion, but the immunity is transitory, diminishing rapidly and usuallv lost in ten davs or
APPENDIX
1003
two weeks. Rarely persons may retain some demonstrable degree of immunity as long
as three weeks. Subsequent use of antitoxin for passive immunity in the same individual
develops even a briefer protection.
(e) Prophijlactic use of antitoxin. — E.xperience has abundantly demonstrated the almost
absolute power of a prophylactic injection of antitoxin in preventing the development of
diphtheria in persons who have been exposed to the disease. It probably has no effect in
preventing the lodgment and growth of bacilli in the throats of such persons, and it is con-
ceivable that the bacilli which have lodged in the throats of such persons might persist
and give rise to the disease after the transient immunity conferred bj' the antitoxin has
disappeared. That this frequently happens is not borne out by experience. It is evident,
however, from what has been said about natural immunity, that in approximately 50 per
cent of persons there is no need of giving prophylactic injections of antitoxin, since this
proportion of humans are naturally immune. If prophylactic injections are to be given,
it is worth while to perform a preliminary Schick test and give antitoxin only to those who
are thus shown to be susceptible by a positive reaction.
XII. Prevention of spread of diphtheria. — Undoubtedly the most important measure in
preventing the spread of diphtheria is the prompt recognition of cases as soon as thev de-
velop, and effective isolation of them. It is undoubtedly true that many cases are not imme-
diately recognized and that they give rise to a spread of the disease among their associates.
At a time when diphtheria is prevalent, frequent throat inspections should be made of
all individuals exposed, or who may have been exposed, and any person having a throat
that looks at all suspicious shoul be isolated and regarded as having diphtheria until nega-
tive cultures prove that the suspicion is unfounded. This measure alone, if efficiently
carried out, will probably serve to prevent any spread of the disease.
XIII. A typical case of diphtheria. — It should be borne in mind that not infrequently
cases of diphtheria occur in which the typical appearance of the throat is lacking, and the
symptoms may be so mild that they may be overlooked. The pharynx in these cases maj'
present a beefy red appearance, with perhaps a few pinhead-sized patches, and the symp-
toms consist in little more than a feeling of malaise on the part of the patient. The ther-
mometer will usually reveal a slight elevation of temperature, and it is these cases that may
escape isolation and by freely mingling with their associates give rise to a spread of the
disease.
XIV. Wholesale measures in dealing with epidemics illogical and valueless. — There are
certain measures that have become so well established in dealing with epidemics of diph-
theria that to question them is sure to arouse the antagonism of those whose ideas have become
fixed by tradition. These are the wholesale taking of throat cultures and the prophylactic
administration of antitoxin. A knowledge of the practical limitations of application of
wholesale culturing to organizations or groups among which diphtheria has appeared, and
the poverty of actual results in detecting the insignificant incidence of carriers of virulent
B. diphtheria, should suffice to forbid the practice. Similarly, the uselessness of administer-
ing diphtheria antitoxin to insusceptibles and the temporary character of the protection
given to susceptibles by passive diphtheria immunization will serve to put an end to the
routine use of diphtheria antitoxin without Schick reaction control for prophylactic purposes
in an organization where diptheria has appeared.
XV. Selective immunization. — We may next consider the advisabiUty of determining the
susceptible individuals, either in a camp or among those who presumably have been most
exposed to the danger of infection, and of giving prophylactic doses of antitoxin to those
of persons or of applying other precautionary measures to them. The susceptible individuals
may be discovered by means of the Schick test. The results may be known at the end of
48 hours. If a camp of 5,000 men be tested, 25 per cent, or 1,250, may be found susceptible,
and these are the only ones who run any risk of developing diphtheria and to whom the
prophylactic injection of antitoxin could be of any use.
If the Schick test is applied to a small group (those who have been more intimately
exposed to the disease), one will have to deal with a proportionately smaller number of
individuals.
1004
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
XVI. Principles for management of diphtheria outbreak. — In all preventive measures
the two main objects to be accomplished should be kept clearly in mind: (I) the protection
of the individual; (II) the protection of the community. We should also keep clearly in
mind what we consider constitutes the danger to the individual and what, to the community.
I. The danger to the individual is that he may develop diphtheria.
II. The danger to the community, as usually considered, is that diphtheria may be
spread by: (a) Diphtheria bacillus carriers; (6) the failure properly to isolate recognized
cases of diphtheria; (c) contact with persons who are in the incubation period of the disease;
(d) unrecognized cases of diphtheria with which healthy persons are allowed to come in free
contact.
I. The danger to the individual that he tnay develop diphtheria. — Among adults there is
a 75 per cent factor of safety to start with, represented by natural immunity. This is
further increased by the chance that of the 25 per cent of susceptible adults exposed to
diphtheria not all of them will have diphtheria bacilli implanted in throats — a chance,
however, that for the sake of safety we will not consider. Of any group of individuals
exposed to diphtheria, the susceptible ones may be determined by the Schick reaction.
It is obviously unnecessary to give a proph3dactic dose of antitoxin to any but the susceptible
persons. The time necessary to determine the result of the Schick reaction is 48 hours
and during this period all the contacts should be kept in isolation. The incubation period
of the disease is given at "from two to five days, most often two," so that by the time the
result of the Schick test is known most of those who are going to develop the disease will
already have manifested signs of symptoms. The Schick test has therefore been unnecessary.
Antitoxin given in the first 24 hours of the disease is curative in practically 100 per cent of
cases. Therefore, if isolation and observation only of the contact is employed without
the prophylactic use of antitoxin or the Schick test, the occasional individual who develops
the disease under the conditions has lost little if anything, and the large majority of contacts
have experienced no inconvenience other than a very short isolation.
II. Danger to community. — (a) From carriers: There is no danger from the carrier
of nonvirulent bacilli, and the danger from the ordinary healthy carriers of virulent
bacilli is so slight that it does not seem practical to take any measures against it.
(6) The necessity of carefully isolating all recognized cases of diphtheria is so universally
acknowledged and practically carried out that no further discussion of this point seems
necessary.
(c) That persons in the incubation period of the disease constitute a distinct danger
is certain, and the prompt isolation of persons who are in contact with diphtheria cases is an
important measure. Fortunately the short incubation period of the disease makes necessary
only a very brief isolation. If these contacts are isolated and a daily observation made of
their throats and symptoms, no other measures are necessary unless suspicious symptoms
arise. In such cases cultures should be made and antitoxin given according to the nature
of the developments.
(d) Unrecognized cases of diphtheria: It is probable that these cases are the most
potent agents in giving rise to the spread of the disease. At a time when diphtheria is
prevalent, the most important measure, other than the isolation and treatment of the recog-
nized cases of diphtheria, is the search for the mild cases which might otherwise escape
detection. Daily inspection of throats, with an inquiry as to symptoms, will serve to discover
all suspicious cases. If these are isolated as they are discovered, a culture taken, and in
sufficiently suggestive cases antitoxin given, no serious spread of the disease need be feared.
The taking of cultures may be hmited in these cases, and to the routine procedure covered
by Army orders for the discharge of patients convalescent from diphtheria and to those
who have been in attendance on diphtheria.
The Schick reaction may be of value in eliminating 75 per cent of the individuals con-
stituting any group as naturally immune and therefore unnecessary to be kept under observa-
tion as possible subjects of diphtheria. It may further be of use in selecting naturaUy
immune persons to serve as attendants on diphtheria patients, and, finallv, if active immuni-
zation against diphtheria should be undertaken, it will discover those persons who stand
in need of immunization.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
APPENDIX
1005
Circular No. 61:
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
December 18, 1918.
I. The following salient points are noticed in a recent report, based on actual obser-
vations, of the nutritional officer, chief surgeon's office;
mess service to patients
1. Mess lines of soldiers are to be avoided if possible. Two systems of avoiding this
are in operation in American Expeditionary Force hospitals:
First. Tickets with different times for presentation at the mess hall are issued to the
various groups of men.
Second. Patients are conducted by noncommissioned officers to the mess hall in squads.
In either case the men must be checked to see that their number corresponds with
that called for by the diet slips. Patients in pajamas and slippers must not be allowed in
lines and exposed to the weather.
DIETITIANS
2. Attention is again directed to Circular 27, office of chief surgeon, c. s., which has
evidently not been carefully read. Dietitians are not cooks. Their duties may be defined
as follows:
(a) The dietitian. — It is her duty to prepare menus for all patients in the hospital.
She is to see that the food is properly prepared and served. She should see that the menus
are served as written.
(6) She should be present in the kitchens during the preparation of meals. How-
ever, during the service she should divide her time between the wards and mess hall in such
a way that she may know whether the food is being properly served throughout the hospi-
tal. She, or her assistant, is responsible for the issuing of the food to the wards. She
should also report to the commanding officer defects of service found in the wards, that
these may be corrected through proper channels. Defects of preparation or service found
in the mess hall or kitchen should be reported to the mess officer.
(c) She is directly responsible for the preparation of special diets and for special items
or modification of the three listed diets. She should, however, be supplied with sufficient
help to relieve her from all the details of preparation of these items. It is her duty to advise
with the hea^is of the services, ward surgeons, or nurses, as may be necessary, to insure
the patients getting food that is adapted to their needs, while at the same time the kitchen
may be relieved of preparing unnecessary specials.
3. In the absence of regularly qualified dietitians, Circular 39, office of chief surgeon,
c. s., should prove invaluable, attention particularly being invited to Table II, page 4. Two
corrections, as follows, are to be made in Table III: (1) the caloric value of a pint of milk
is about 300 calories; (2) one cup of coffee, half milk, contains about 150 calories.
CHIEF MESS officer
4. Large centers should include a chief mess officer as a part of the administrative
personnel for the center. Among others, his duties should include the following for the
entire center:
(a) Purchaser and distributor of articles of mess.
{b) Inspection of all messes.
(c) Consultant for unit mess officers.
{(i) The organization of schools for cooks, bakers, and mess sergeants.
(e) Acting, for a short term, as hospital mess officer in any unit in the center where
the regular mess officer is temporarily incapacitated.
Where an officer running one of the hospital messes in a center has acted as purchaser
for the center, the results have proven entirely unsatisfactory. One hospital gets fed; the
others go without.
1006
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
II. Long-distance telephone calls. — A report from the chief signal officer shows that
long-distance telephone calls originated by the Medical Corps were in November, 21.7 per
cent more numerous than the average for the previous three months. Attention is called
to Circular No. 53, and it is directed that long-distance calls be not made for communi-
cations of a trivial nature.
III. Nurses to pay their own expenses. — Commanding officers will direct the attention
of all nurses to the fact that when passing through Paris under orders they must pay their
own expenses and request reimbursement later from the quartermaster and must not call
upon the Red Cross for lodging. The Red Cross up to the present time has had arrange-
ments with the Continental Hotel in Paris to take nurses as guests and render the bill to
the Red Cross. The Red Cross has notified this office that this arrangement will be
discontinued immediately .
IV. Medical supplies.— In case of shortages of medical supplies received, General
Order No. 57, headquarters Services of Supply, November 21, 1918, will be consulted and
the procedure therein outhned followed.
V. The instrument repair shop.— The instrument repair shop is now located at Pare
des Princes, Porte St. Cloud, Paris.
VI. Medical Department property of organizations changing station.— Officers account-
able for Medical Department property are directed, upon change of station of their organi-
zation, to submit to this office, by letter, a brief report showing the status of their Medical
Department property, what disposition has been made thereof, under what authority, etc.
VII. Salvage medical field supplies. — Salvage medical field supplies will be shipped
to officer in charge, medical supply depot, Montierchaume, Indre, properly invoiced.
VIII. Disposal of records of hospitals. — (1) The attention of all hospital commanders
is called to Circular 73, War Department, November 18, 1918, which prescribes methods
for the disposal of the records of organizations which are being disbanded.
(2) In addition, it is directed that each hospital upon final closing of its work as an
organization in the American Expeditionary Forces, shall send its final report of sick and
wounded, including (a) final report of sick and wounded for the period since last report,
per Section XI, Manual Sick and Wounded Department, A. E. F., dated September 15,
1918; (b) retained file of copies of Forms 22, 647, and 648; (c) retained register index cards
Form 52, to the office of the chief surgeon, A. E. F., Tours, in the personal charge of he
registrar and such personnel as he may deem necessary in addition. After examination
of these records and the making of the necessary corrections in them the registrar will be
given a clearance receipt.
(3) In the case of medical units (infirmaries, etc.) other than hospitals, which function
as hospitals and are required to render sick and wounded reports, the final report and records
may be forwarded in charge of a responsible soldier, preferably one who has had to do with
the preparation of the records and reports.
(4) Such records as are to be sent to Washington in accordance with Circular 73 may
be sent by postal express. Such records, relating to Medical Department work or personnel,
as Circular 73 designates to be left at camp headquarters should instead be sent to the office
of the chief surgeon, to be kept until checked against by Washington.
(5) The supply of Circular 73 is limited, but as soon as sufficient quantities are received
they will be distributed.
IX. Property. — Medical officers accountable for property, when returning to the United
States, should report their departure by letter to this office (finance and accounting division).
Statement of property charged against them will be forwarded to the office of the surgeon
general for settlement. In case transfer of property is made to another accountable officer
in the same unit, clearance of departing officer's accountability will be expedited if the officer
before his departure submits a final return to this office (finance and accounting division)-
If a unit is disbanded and property turned into salvage or supply depots, transfer should be
made in the usual manner. When vouchers covering above are forwarded to this office,
certificate that all property has been disposed of should accompany the last voucher. In
this case also clearance of departing officer's accountability will be expedited if he submits
before his departure final return to this office (finance and accounting division). Medical
Department officers responsible for but not accountable for property should clear their
responsibiHty to accountable officer before their departure.
APPENDIX
1007
X. Lice. — A recent inspection of patients received from base hospitals at classification
camps shows that 12 per cent are infested with lice. This appears due to the fact that pubic
and axillary' hairs are not carefully inspected for presence of nits.
In future, in addition to usual manner of disinfestation, the pubic and axillary hairs
will be clipped.
XI. Advance medical supply depot No. 2. — ^Advance medical supply depot No. 2 has
been estaVjlished by the Services of Supply at Treves, Germany, to furnish medical supplies
to armies and all other medical units in Germany.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 62.
American Expeditionary Forces,
Chief Surgeon's Office, Services of Supply,
December 23, 1918.
epidemic cerebro-spinal meningitis (cerebro-spinal fever)
The following bulletin is published to ampUfy and modify the instructions relative to
the handling of epidemic cerebro-spinal meningitis heretofore issued from this office, more
particularly those incorporated in the bulletin on transmissible diseases and the use of thera-
peutic sera.
Clinical manifestations. — The early signs and symptoms of cerebro-spinal fever are
those common to many other acute infections. Headache is almost always present. Vomit-
ing is often an early manifestation. Fever is almost invariably present. Constipation is a
fairly constant symptom. The pulse is relatively slow in relation to the temperature.
Changed mental activity, varying from a slightly increased delay in cerebation, marked
apathy, drowsiness to restlessness or even violent delirium, is generally present. A petechial
rash about the shoulders, arms, and pelvis occurs in about a fifth of the cases. When such
manifestations as these are present, cerebro-spinal fever should be considered in the differen-
tial diagnosis, and, in case of doubt, a blood culture should be taken and the advisability
of spinal puncture weighed.
More characteristic manifestations include stiffness of the neck, tending to increase
upon continued movement of the examination, retraction of the head, sluggishness and
inequahty of the pupils, stiffening of the hamstring muscles (Kernig's sign), incontinence or
retention of urine, and sudden deafness, total or partial. Such manifestations, unless ade-
quately explained as due to a cause other than meningitis, are imperative indications for
spinal puncture.
Specific diagnosis.— Diagnosis depends upon the recognition of the meningococcus m
the fluids derived from the patient. Meningitis, with all its clinical manifestations, may be
caused by any one of several other organisms without the meningococcus being present.
Such forms of meningitis do not possess the epidemic tendencies of the meningococcus men-
ingitis, a fact which renders their bacteriological differentiation very important.
For diagnostic purposes the meningococcus is sought in the nasopharynx, in the
circulating blood, and in the cerebro-spinal fluid. In specimens from the nasopharynx
many other bacteria are Ukely to be met with. In the circulating blood and in the spinal
fluid the bacteriologv is ordinarily simple.
Cerebrospinal fluid is obtained by lumbar puncture in the median line between the fourth
and fiftli lumbar vertebra. This point is on a line joining the summits of the ihac crests.
The fluid should be collected in a series of sterile tubes. The normal fluid is water clear
and contains less than 10 leukocvtes per cubic millimeter. In meningitis the fluid is usually, but
not alwavs, under increased pressure and more or less turbid, and the number of leukocytes
is greatlv increased. Cultures should be made at once by spreading a drop of the fluid
over the surface of a suitable medium in a Petri dish. Gordon's trypsin agar' to which has
. Gordon's trypsin agar may be obtained from the central Medical Department laboratory or from the nearest base
laboratory.
1.3901—27 64
1008
ADMINISTRATION, AIMERICAN EXPEDITIONARY FORCES
been added ether-laked blood is recommended, but glucose agar mixed with blood or with
laked blood msLV be used. A portion of the fluid should be mixed with an equal volume
of plain broth and incubated, and a portion should be incubated without the addition of
anj^ other medium. All media should be incubated before use, should be warm when inoc-
ulated, and kept at 37° thereafter. The sediment should be smeared on slides, stained
with Wright's or Leishman's stain, and examined with the oil immersion objective, observing
the numerical relations of red blood cells, various types of white cells, morphology and position
of the bacteria present. A second smear should be stained by Gram's method. The presence
of Gram-negative intracellular diplococci in the spinal fluid warrants a provisional diagnosis
of meningococcus meningitis. Identification of the organism in cultures will be considered
subsequently.
If clinical diagnosis of cerebrospinal fever has been made, a dose of polyvalent anti-
meningococcus serum should be given at once through the same needle that is used for
obtaining the specimen of spinal fluid, without waiting for the bacteriological report. The
prompt introduction of this first dose of serum is of utmost importance to the patient. It
is best run in by gravity, very slowly, 2 c. c. per minute, the total dose being 15 to 40 c. c,
or two-thirds of the volume of fluid removed.
Blood culture may give positive results in cerebrospinal fever before clinical mani-
festations of meningitis are evident, especially in fulminant cases. At least three agar
plates and two broth cultures should be made with a total quanity of 10 c. c. of blood. Gram-
negative diplococci appearing in pure culture in these media warrant a tentative diagnosis
of cerebrospinal fever. The final identification of the organism will be subseciuently con-
sidered.
Cultures from the naso-pharynx give positive results in the large majority of cases
of cerebrospinal fever but, on account of the admixture of other micro-organisms in the
specimen, material from this region is less suited for rapid diagnosis of the active case of
meningitis than is the cerebrospinal fluid. However, may individuals are infected with
meningococcus in the upper respiratory passages without the infection extending to the blood
stream or to the meninges. Such individuals ma}^ show no clinical evidence of the infection.
Their detection, segregation, and treatment constitutes an important part of the procedure
for restricting the spread of cerebrospinal fever. As a general rule the examination of the
naso-pharynx for meningococci should be resorted to only in active or convalescent patients
and in persons who have been very closely associated with such patients. General surveys
of entire regiments or brigades by this method in a search for carriers are, as a rule, unwar-
ranted.
The specimen should be obtained from the mucous membrane of the naso-pharynx
without contamination from the mouth or palate, because the presence of saliva and of
the normal buccal or pharyngeal bacteria interferes with the subsequent detection of men-
ingococci in the specimen. A considerable degree of technical skill is essential in getting
the specimen. In some cases a protected swab (West swab) will be of service. The material
from the naso-pharynx should be placed at once on the surface of heemoglobin agar plates
and kept warm. It may be spread at once or after a brief interval, if more convenient. The
medium is prepared by mixing ether-laked blood with Gordon's trypsin agar. Rabbit's
blood or human blood (10 c. c.) may be used, laked by the addition of ether ( 5 c. c.) and
distilled water (90) and added (1:50) to the melted agar, previously cooled to 45° C. The
mixed medium is then poured into Petri dishes, allowed to harden, and w^armed to 37° before
use. After inoculation the plates are kept warm until transferred to the incubater at 37° C.
Identification of the meningococcus. — Gram-negative diplococci found in cultures from
the cerebro-spinal fluid or from the circulating blood should be subcultured to trypsin
agar without blood enrichment, for testing against specific agglutinating sera. Colonies
of Gram-negative diplococci found on the plates inoculated with pharyngeal mucus require
more critical scrutiny because other Gram-negative cocci are frequently met with on such
plates. The colonies should be examined after 16 to 24 hours incubation, first with the naked |
eye and then with a lens magnifying about 10 diameters. The meningococcus colony presents '
a glistening appearance and has a bluish-gray tint by reflected light (black background),
it is transparent, colorless, or very slightly yellow, by transmitted light. Its margin is
APPENDIX
1009
smooth and circular. The lenticular character of the colony allows an inverted image
of window bars or other objects to be seen by looking through it. The colony less than
24 hours old shows no internal markings.
Suspicious colonies, whether derived from cerebrospinal fluid, circulating blood, or
pharyngeal mucous membrane, should be transplanted to trypsin agar without haemoglobin
enrichment. On the next day these cultures are examined by Gram's stain and then sub-
jected to agglutination with specific serum. For this purpose the growth is suspended in
salt solution, thoroughly shaken, and heated in a water bath at 65° C. for 30 minutes to kill
the bacteria and destroy the autolysin. To prepare the suspension of suitable concentra-
tion for the tests, one measures out 0.1 c. c. into a clear test tube 12 mm. in diameter. A
measured amount of salt solution or of clear water is then run in from a burette or graduated
pipette until the diluted suspension is just perceptibly turbid, read by daylight, in compari-
son witli a control tube of the diluent. This end-point concentration is assumed to represent
approximately 100,000,000 cocci per cubic centimeter. One then calculates the approxi-
mate concentration of the original suspension and the volume to which it must be diluted
in order to obtain a suspension of approximately 2,000,000,000 cocci per cubic centimeter.
Salt solution, together with sufficient 5 per cent carbolic acid to furnish 0.5 per cent of this
l)reservative in the final volume, is then added up to this volume and the whole thoroughly
mixed. Such a suspension, heated, diluted, and phenolated, may be kept for several months.
For the agglutination test the specific sera to be employed are prepared in 1 to 100
dilutions and at the same time normal control sera of horse in 1 to 25 and 1 to 50 and of
rabV)it in 1 to 25 dilution. Equal volumes of the bacterial suspension and of the dilute
serum are mixed in eacli instance in a series of tubes so that the final serum dilutions are 1
to 200 for the immune sera and 1 to 50 and 1 to 100 for the control normal horse serum and
1 to 50 for the normal rabbit control. All the tubes are plugged with colon or corks and
immersed in a water bath at 55° C. for 16 hours. Under these conditions a true meningo-
coccus should not be agglutinated in the normal control sera, but should be completely
agglutinated by one of the specific type sera and by the polyvalent immune serum. Micro-
coccus flavus will be agglutinated in the normal control as well as the others. For critical
investigations it is well to employ agglutinating sera of each type in graded dilutions as
well as polyvalent serum, and to control the activity of each diluted serum by running it
against a known standard-type suspension at the same time that the unknown cocci are
being tested. When a large number of cultures have to be tested under field conditions
one will often employ only polyvalent diagnostic serum and the normal serum control.
The supply of meningococcus type sera available in the American Expeditionary
Forces is somewhat uncertain. Three sources of supply are being utilized and the sera
supplied may be from any one of these. They are designated as follows:
I
II
Ill
Rockefeller Institute meningococcus
diagnostic type sera
Pasteur Institute meningococcus di-
agnostic type sera
Gordon meningococcus diagnostic type
sera
Normal meningococcus.
Intcrmcdiato A.
Intermccliiitp B.
Parameningococcus.
Polyvalent.
Type A.
Type B.
Type C.
TypeD.
Normal horse serum control.
Type I.
Type II.
Type III.
Type IV.
Normal rabbit serum control.
The mutual relationships of the recognized types in these different classifications are
still somewhat uncertain.
Serum treatment.— Aseptic technic is essential. The serum should have a temperature
of about 40° C. when injected. At the first spinal puncture, when indicated, polyvalent
antimeningococcus serum should be injected at a rate not to exceed 2 c. c. per minute. The
amount introduced should be about two-thirds of the volume of spinal fluid withdrawn
Following the injection, the patient should lie with his head somewhat below the level of
the buttocks to favor the diffusion of the heavier serum to the head. Immediately after-
ward especiallv in severe cases, 50 to 100 c. c. of the serum should be very slowly introduced
1010
ADMINISTRATION, AMERICAN EXPEDITIONAR V FORCES
intravenously, not faster than 1 c. c. per minute for tlie first 10 minutes, but at a gradually
increasing rate after that if no untoward symtoms appear. <■ „ ,
In severe cases the spinal puncture should be repeated twice at intervals of S to 12
hours giving a further intraspinal injection of serum each time. After that the interval
mav be lengthened to 24 hours. Even in patients who show most marked improvement
after the first injection, a second puncture after 24 hours, with injection of serum, should
always be performed. The character of the spinal fluid withdrawn, in conjunction with
the clinical signs, is a guide for continuing or stopping the intraspinal treatment. Repeti-
tion of intravenous injection is usually necessary also.
Ana7./i?//axi.s-.— Serious intoxication from injection of horse serum is not likely to occur
after intraspinal injection. It mav occur when intravenous injection is done and, for this
. reason, the first part of the serum should always be introduced very slowly and the injection
interrupted at the first sign of distress. Hypersensitiveness to horse serum is often present
in persons who have previously been injected with serum, but it exists also in other persons.
To avoid the dangers of hypersensitiveness, 1 c. c. of the serum may be injected sub-
cutaneously, followed after an hour by the slow intravenous injection of the full dose. Where
time i)ermits, one mav first give a subcutaneous injection of 0.5 c. c. of serum diluted with
0.5 c. c. of salt solution, followed after 5 minutes by a second subcutaneous dose of 1 c. c.
of serum, and 15 minutes later by a third subcutaneous dose of 5 c. c. of serum. One hour
later the intravenous injection of the full dose should be begun. Injections should always
be made slowly, with careful attention to the patient's condition, and the serum should be
warm when injected.
Fear of anaphylaxis should never prevent the use of serum when indicated. Careful
technic and slow administration will go far to avoid serious accidents of this nature.
Contacts. — Military experience has shown that a single case of cerebrospinal fever,
isolated and properly cared for as soon as the disease is recognized, is ordinarily not followed
by subsequent cases in his immediate associates. Those who have been immediately asso-
ciated with the patient, especially at mess and in sleeping quarters, should be segregated
in roomy, light, and clean quarters and eat at a separate mess for a period of two weeks,
at the end of which period they may be returned to their proper organization, in the event
that no other cases have developed. When, however, more than one case has appeared in
a given small group of men, the immediate associates require not only segregation but also
bacteriological examination and treatment.
The amount of time devoted to the examination of contacts will have to depend upon
the circumstances, such as the extent and character of the epidemic, the number of
contacts to be handled, and the amount of trained help available for the purpose. It is
not well to make a pretense of elaborate surveys of contacts when the danger is not considered
sufficient to warrant employing the necessary personnel actually to do the work in an efficient
manner.
According to available facilities, the pharyngeal culture may be taken only once, or
a duplicate set may be made on the following day. In any case the men should be segregated
before the examinations are begun, and when possible those with coughs and colds should
be segregated apart from the others. Separate, clean, airy, and light quarters under strict
quarantine should be provided for them. Their treatment as carriers should begin directly
after the desired number of specimens has been obtained for bacteriological examination.
In addition to general hygienic measures such as cleanliness, good food, properly regulated
work, play> and rest, the local antiseptic treatment of the upper respiratory passages may
with advantage be tried. Various medicaments may be used. Dichloramine-T in chlorco-
sane, administered by atomizer, is a convenient agent with which to begin. This anti-
septic treatment may prevent to some extent the spread of the infection to previously unin-
fected men who may be in company wnth actual carriers while awaiting the result of the
laboratory examination.
As soon as a negative result has been reached in these first laboratory examinations,
the particular man may be released to his organization. In this way the number of men
held in segregation can be very much reduced within two days. Suspicious or positive labora-
tory results warrant retaining the respective individuals in segregation for further observation.
APPENDIX
1011
After six days the antiseptic treatment of the positive cases should be discontinued for 24
hours before new cultures are taken, after which the treatment may again be continued.
At the end of another week the treatment should be stopped for 24 hours before the third
bacteriological examination. The treatment may then again be continued until the labora-
tory reports have been received. All men found negative at these two examinations should
be returned to their organizations. The remaining men should be transferred to a segrega-
tion barracks or available hospital formation for treatment as chronic carriers.
General hygienic measures. — In any command in which an outbreak of cerebrospinal
fever has developed, general measures should be instituted at once to improve the living
conditions and prevent the spread of respiratory infections among the men. Overcrowding
in billets and barracks should be relieved by placing part of the men in tents. Those with
coughs and colds should be quartered apart from the others. Distance between heads
of adjacent sleepers should be increased by head to foot arrangement of bunks, or the bunks
should be separated by wooden partitions or by shelter halves so hung as to separate the
sleepers.
Sleeping (juarters should be fully ventilated day and night, and Ijlankets, mattresses,
and clothing should be aired and exposed to sunlight daily, weather permitting.
A special place for drying clothing should be provided, and clothing, wet or dry, should
not be allowed at the head of the bunk.
Dust in quarters should be avoided by cleanliness and by dampening dirt floors with
a disinfecting solution.
All personal equipment — mess kits, pipes, clothing, towels, toilet articles — must be
used only by a single individual, and all mess equipment washed and rinsed in boiling water
after use.
The entire command should be examined dailj', preferably in the afternoon, to detect
beginning illness. Lounging in quarters during the day should be avoided, and sick should
be hospitalized at once. Pillows should be prohibited unless they have been properly disin-
fected before being issued to new troops.
Careless coughing and sneezing should be prohibited and promiscuous spitting prom])tIy
and severely penalized. Gauze masks, not less than eight thicknesses, or the combat gas
masks, may be worn during cleaning operations involving exposure to dust. The former
should be immersed in boiling water after use.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 63.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
December 30, 1918.
I. Roentgenograms. — Directions for selection and shipping of Roentgenograms for the
Army Medical Museum, Washington, D. C:
The commanding officer of each base or camp hospital in the American Expeditionary
Forces will have all Roentgenograms on file in his hospital examined by the hospital Roent-
genologist with a view to selecting those suitable for preservation in the Army Medical
Museum. In hospital centers or groups the work should be done under the direction of the
consulting Roentgenologist for the group.
The following directions will be observed:
1. Discard all technically imperfect plates unless of unusual interest.
2. Discard all normal or negative plates.
3. In selecting plates, empliasis should not be placed upon the bizarre or unusual. It
should be kept in mind that this collection of Roentgenograms is to be used especially for
teaching purposes.
4. Gastro-intestinal and genito-urinary plates are not desired unless related to war
trauma.
1012
ADMINISTRATION, AMERICAN EXPEDITIOXAHV FORCES
5. Plates especially desired are those of good technical quality illustrating all war
wounds and diseases of the chest.
6. Each plate or film should be plainly marked with the date, patient'.s name, number,
and organization.
7. Each plate or film will be accompanied by the clinical hi.story; autui)sy records, if
any; personal observations by the Roentgenologist; and all other data throwing light on
the case.
8. Plates should be packed with great care, having in mind the special liability to
breakage in overseas shipment. The plates should be placed face to face in pasteboard
boxes and then in wooden cases well protected with excelsior, paper, or straw. Each box
will be marked in both French and English to denote the fragile nature of its contents.
9. Films should be packed in tin cases and sealed.
10. Each box should be numbered and addressed to the Army Medical Museum,
Washington, D. C, via (port).
11. When shipment is made. Col. Joseph E. Siler, central laboratory, Dijon, will be
notified of the fact giving the number of the French ordre de transport, number of car in
which shipped, and the name of the port to which shipped.
12. The senior consultant in Roentgenology will be notified by letter when shipment
is made, giving the number of plates and films shipped, the ordre de transport number, and
number of the car.
13. Any additional advice needed may be obtained by letter to the senior consultant
in Roentgenology, headquarters medical and surgical consultants, A. P. O. 731.
II. Epidemic disease. — Pursuant to request of the French Service de Sante, the chief
surgeon directs that the surgeons of all organizations and commanding officers of medical
units promptly notify the local French military and civil authorities upon the appearance
in their organization of any epidemic disease.
Attention is called to the general neglect by medical officers, particularly those of hos-
pital formations, base, camp, and field, of the requirement that they shall notify the local
French military and civil authorities (the m«dccin chief de place and the maire or prefet) of
all cases of communicable diseases as soon as diagnosed or admitted to their organization.
The letter from the chief surgeon, line of communications, of January 28, 1918, is quoted,
and compliance will be expected.
It is of considerable importance that every case of any of the diseases specified in Sec-
tion XII, Sick and Wounded Reports, be reported to the French authorities at the same time
that it is reported to the chief surgeon, A. E. F.
III. Vacancies in permanent Medical Corps. — The Surgeon General writes as follows to
the chief surgeon, A. E. F.:
There is, at present, a large number of vacancies in the permanent Medical Corps of
the Army, and it is desired to take advantage of the present conditions to fill them with
desirable men — preferably with those who have had some military service in the present
war.
It is therefore requested that you give careful consideration to the selection of suitable
officers and that you make a special effort to interest medical oflflcers who have demonstrated
their ability and fitness.
The attention of all medical officers who may be considering entry into the regular
corps is called to the fact that rank therein dates from entry, and, if they should decide that
they wish to remain in the Army permanently, each week of delay may mean loss of rank
which would affect them during their entire service.
IV. Commutation value of the ration. — This office has been advised by the chief quarter-
master that the commutation value of the ration has been fixed at $0.58 for the months of
January, February, and March, 1919. Amounts collected by hospitals from local quarter-
masters should therefore be $0.68 or $0.83, according to whether or not commissary priv-
leges are available.
V. Clothing for army nurses.— The chief quartermaster advises that he has now in stock
hats, overcoats, Norfolk suits, gray ward uniforms, raincoats, shoes, rubbers, silk and cotton
waists, and that those articles of clothing are for free issue to all Army nurses whose pay
does not exceed $75 per month. Commanding officers of base hospitals and hospital cen-
APPENDIX
1013
ters will consolidate the requisitions submitted by the various members of their unit, and
submit same direct to the office of the chief quartermaster, care being taken to furnish exact
sizes of shoes and other garments desired.
Requisitions will be restricted to actual requirements only. All requisitions must be
approved bj' chief nurses, who will assure themselves of the actual need of articles requested.
Sales to nurses whose pay exceeds $75 per month will be made at cost prices as follows:
Shoes $6. 31
Silk waists 5. 22
Overcoats 27. 86
Norfolk suits 30. 00
Raincoats $5. 60
Hats 3. 17
Uniforms, gray, ward 3. 00
Waists, cotton . 73
VI. Paragraph 229, Manual for the Medical Department, 1916, is changed, as follows:
229. Upon the discharge from the hospital of patients permanently disabled, they may
retain the appliances then in their use which are necessary for their comfort and safety; and
the accountable officer will drop the same from his next return of medical property*, submit-
ting a certificate explaining the circumstances as a voucher for so doing, to which will be
appended the patient's receipt for the appliance.
VII. General office supplies. — Attention is invited to General Order 50, headquarters.
Services of Supply, transferring the procurement and distribution of standard office supplies,
heretofore issued by the Medical Department, to the chief quartermaster. The following
items are excepted from the provisions of this order, and will be required for as heretofore
by Medical Department units:
Books, prescription, paragrapli 240.
Binders, loose-leaf, for medical history of post.
Files, Shannon, for clinical history.
Labels, for dispensar\' sets.
Labels, for vials.
Labels, poison, assorted.
Pads, prescription.
Requisition for office supplies (stationery, office furniture, etc.) will in the future be
made on the Quartermaster Department by all Medical Department units.
VIII. Baggage of patients. — Commanding officers of all base, camp, and evacuation
hospitals will notify the central baggage office, A. P. O. 713, Gievres, of the respective depar-
ture for the United States of sick and wounded, under their care, and of the location of their
baggage, as well as a list of all patients who have already been evacuated. This information
will greatly assist the baggage service in getting baggage to its owner before the owner departs
for the United States.
IX. Publications.— The War Department desires complete files of all pubHcations
made by different organizations in the American Expeditionary Forces.
Complete files, whenever possible, will be forwarded to J. Terquom, Paris agent for
the Library of Congress, No. 19 Rue Scribe, Paris. This office will be notified whenever
files of a publication are forwarded to Paris.
X. Proper papers to accompany men evacuated from base hospitals. — Reports are being
received that base hospitals are careless in forwarding men to base ports for evacuation to
the United States without proper papers. The greatest care must be exercised by all base
hospitals evacuating patients to base ports to see that all papers are complete, with proper
number of copies of each paper, especially those relating to disability boards and orders
directing travel. These points have been covered many times, and it appears that they are
not being followed in a conscientious and painstaking manner.
XI Broken splints.— Instructions previously issued, directing the shipment to splint
repair shop, Dijon, of broken splints, are hereby revoked. In view of the fact that this
shop has been discontinued, these splints will in the future be turned in to the nearest medical
supply issue depot. , , ^
Walter D. McC.\w,
Colonel, Medical Corps, Chief Surgeon.
1014
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 64:
American Expeditionaky Fokces,
Office of the Chief Surgeon, Services of Supply,
January 7, 1918.
I. Hospital fund. — (1) Organizations returning to the United States: All medical
organizations in the American Expeditionary Forces which are under order to return, or
which in the future receive orders to return, to the United States as a unit shall, as long
before their departure as is practicable, close out their accounts, and send in a complete
report to this office (finance and accounting division) of the condition of the hospital fund,
giving in detail anv accounts which remain unpaid or amounts due to the fund which remain
uncollected, together with the number of enlisted personnel in the unit. Instructions will
be issued by this office as to what portion of the fund may be retained by the organization.
The balance, if any, will be forwarded to this office, to be credited to the United States Army
hospital fund; checks or negotiable papers being made payable to "trustee. United States
Army hospital fund." The final account will be audited by the hospital council, and the
proceedings shown in the face of the statement.
(2) Organizations disbanding: Any organization which disbands or for any other
reason ceases to exist as a unit will submit, after audit by the hospital council, a final state-
ment on Form 49, M. D., showing the proceedings of the council, properly signed on the face
of the statement, and turn in all funds to this office to be credited to the United States Army
hospital fund; checks or negotiable papers being made payable to "trustee, United States
Army hospital fund." Upon receipt and acceptance of the final statement the custodian
will be cleared of all accountability for the funds of his organization.
(3) Transfer of funds: No organization under orders to disband or return to the United
States shall transfer funds to any organization without authority from this office.
(4) Disposal of funds: Custodians of funds will be held responsible for the imj^roper dis-
bursement of the funds for purchases of articles which are not proper expenditures from
the hospital fund.
(5) Transfer of fund: Any officer who is custodian of a fund and who is transferred
from his organization, or for any other reason is to be absent for a period of more than 10
days, will submit a final statement on Form 49, M. D., showing the following properly signed
certificates:
I certify that to the best of my knowledge the following is a complete and accurate
statement of all outstanding debts and obligations payable from this fund, and to have
transferred to my successor ^ the sum of
being the balance on hand this date of the hospital fund of '__[
I certify to have received the sum of , from
being the balance on hand this date of hospital fund of
Until the final statement bearing the above properly signed certificates is received,
the present custodian will be held responsible for the funds of his organization.
II. Purchase of medical supplies. — All purchases of medical supplies in Paris will be
made through the office of the medical purchases, room 507, Elysee Palace Hotel, in that
city, when same are properly authorized.
The practice of obtaining medical supplies from the French Government through
local Service de Sante formations, and having same vouchered to the Medical Supply De-
partment, United States Army, payment to be made on consolidated bill bv a medical
disbursing officer, will be discontinued at once.
Authority for purchases must be obtained before purchase is made from the chief
surgeon, A. E. F., except on purchases covered by Circular 15, paragraph 4, office of the
chief surgeon, dated December 15, 1917, which applies to detached base hospitals, and
Circular 43, paragraph 9, dated August 1, 1918.
Hereafter a copy of the authority for purchase will accompanv the voucher; this in
addition to the usual notation of authority on the face of the voucher. Copy of Form
No. 12 accompanying the voucher will have entered thereon the property voucher number
of the accountable officer.
III. History and clinical records.— Reports have been received in this office that
proper histories and clinical records, including laboratory and X-ray blanks, are not being
APPENDIX
1015
forwarded with patients evacuated to the United States. Such history and clinical record
as may be necessary for the proper care and understanding of the case must accompany
each patient upon his evacuation.
IV. Operations.— It has been evident for some time that a large number of operations
are being performed that are not absolutely necessary. In this connection attention is
called to Circular 37, office of chief surgeon, June 22, 1918, with special reference to para-
graph 4 thereof.
V. Leather jerkins available for issue to Army nurses. — Leather jerkins are now avail-
able for issue to Army nurses. Requisition therefor should be made upon the local quarter-
master, approved l)y the chief nurse of the unit, stating that the nature of the nurse's duty
re(iuires the jerkin.
VI. Returning class A patients to dutij.~ln returning class A patients to duty with
organizations, men must be equipped with the following: 2 blankets, 1 overcoat, 1 blouse,
1 pair breeches, 1 suit of underwear, 2 pairs socks, 1 pair shoes, 1 overseas cap, 1 mess kit,
toilet articles. Requisitions will be made immediately on the Quartermaster Department
and Ordnance Department to carry these instructions into effect.
Before returning men direct to organizations, the organization commander will be
telegraphed as to ability to receive them.
VII. Y. M. C. A. patients in military hospitals. — Y. M. C. A. secretaries and workers
who are patients in military hospitals for wounds or any other cause will, when able to travel,
be sent to the Paris headquarters of the Y. M. C. A., where adequate arrangements are made
for their future care and transportation.
VIII. Vaccination against typhoid and paratyphoid fevers. — Typhoid fever has been
recognized in several different organizations in the American Expeditionary Forces, especially
those recently engaged in active military operations. Medical officers should be on the
alert to detect this disease early in its course. Typhoid and paratyphoid fever should be
considered in the differential diagnosis of all obscure pyrexias. Early blood culture is
advised.
Triple typhoid lipo-vaccine is available for immunization of the men of those organi-
zations in which outbreaks of these fevers have appeared. Whenever as many as two cases
occur in the same company, within a period of one month, the vaccination of the entire
company is advised. If scattered cases amounting to one-half of 1 per cent of the strength
of the organization occur in a battalion or a regiment, within a period of one month, im-
mediate inoculation of the entire organization with lipo-vaccine should be undertaken.
Only one dose of this vaccine is required. It must be injected into the subcutaneous areolar
tissue. The precautions and contraindications are the same as for the saline vaccine
previously employed. In this connection your attention is invited to Circular 59, this office.
IX. Lice. — Reports still continue that patients are evacuated from base hospitals
who are lousy. This reflects not only upon the cleanliness of the hospital but the care and
administration as well. Commanding officers will take proper steps to see that every patient
is carefully examined and when found infested with lice will have effective treatment for
their eradication.
X. Convalescent home for rLurses al Antibes, near Cannes. — -The American Red Cross has
opened another convalescent home for nurses at Antibes, near Cannes. Eighty nurses can
be cared for after January 6 and a maximum of 200 about January- 15. All convalescent
nurses should go to Antibes, and arrangements should be made before they leave their stations
to secure reservations at Paris. Many convalescent nurses are reported to have arrived
at Cannes physically exhausted on account of difficulty in securing accommodations on
board the train.
Commanding officers of Medical Department formations will in the future forward
to this office a carbon copy of their daily reports on Forms Nos. 647 and 648, A. G. O.
XI. Neuropsychiatrists. — The senior consultant in neuropsychiatry recommends, and
this office approves, the retention of neuropsychiatrists in tactical divisions. In at least
one case, the division neuropsychiatrist has been relieved from duty with the division because
no allowance was made for his assiginnent to the division by tables of organization. This
difficulty could easilj' be obviated by assigning him to the Sanitary Train.
1016
ADMINISTRATION, AMERICAN EXPEDITIONA H V 1<X)RCES
XII. Quartermaster personnel. — Upon the abandonment of liospitalization from various
places, commanding officers concerned are instructed that all Quartermaster Corps per-
sonnel, not pertaining to statutory units, as they become surplus will be sent to the Quarter-
master casual depot. Camp Clayton, Chateau-du Loir (Sarthe), and the chief quartermaster
notified of action taken.
Walteh D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 65.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
January 15, 1919.
I. Monthly reports, sick and wounded. — The following circular letter. Surgeon General's
office, November 14, 1918, is quoted for the information of all:
1. All resjjonsible medical officers are urgently requested to prepare and forward as
soon as practicable after the close of the calendar year all the monthly reports of sick and
wounded for the year.
2. It is recognized that in large hospitals, and particularly during extensive epidemics,
that it is impossible to prepare and forward the report within five days as required by the
N. M. D. Certainly, however, it should be possible to prepare and forward the reports
some time during the succeeding months. In many instances reports are several months
deUnquent. Requests for information are l^eing constantly received from other Government
agencies for information which it is difficult or impossible to furnish for this reason. It
was impossible to begin the final tabulation of the statistics for the year 1917 until the 1st
of May of the year 1918 because so many reports were dehnquent. Even after the 1st of
May, 1918, a good many reports for the year 1917 were received.
3. Reports for the vear 1918 must be forwarded to this office not later than January
:31, 1919.
II. Salvage of supplies belonging to the British and French medical services. — (1) All
supplies received in salvage belonging to the British medical supply service should be shipped
to ordnance officer, Graville, Le Havre.
(2) All medical supplies received in salvage belonging to the Service de Sante medical
service should be disposed of as follows: A list covering the property in question in each
■"region" should be sent to the "directeur du Service de Sante" of the region concerned,
who will issue instructions covering its disposition.
III. Registrars. — ^The attention of all registrars is called to typographical error in
Manual of Sick and Wounded Reports for the American Expeditionary Forces. In Section
XI, paragraph l,line 6, the parentheses should read "(See Sec. VI, par. 7, and Sec. VIII)."
In the monthly sick and wounded report the cases transferred to the United States
differ in no way from cases completed in other manner except that the field medical envelopes
and contents accompany the patient instead of being forwarded as a part of the report.
IV. Gas for anaesthesia. — Hereafter nitrous oxide gas and oxygen will be furnished by
medical supply depots only. Empty nitrous oxide tanks will be shipped to American Red
Cross nitrous oxide plant, Montereau (Seine-et-Marne), and empty oxygen tanks to the
nearest medical supply depot.
V. Nurses.~{l) Incidents have occurred where Army nurses travehng under orders
changing station, and nurses suffering from physical disabihty travehng between hospitals
or to base ports for return to the United States, have encountered great difficulties and
discomforts at railroad stations, in boarding trains, in securing seats, in changing cars, and
at places of arrival, and have occasionally had to spend the night in raih-oad stations.
(2) Hereafter it will be the duty of commanding officers of hospitals or other units
forwarding nurses to see that seats are obtained and that nurses and their baggage are put
aboard trains, and, after a study of the time-tables and changes, to telegraph the command-
ing officer of any hospital at places where changes of trains are made, or at places of destina-
tion, or to surgeons of base sections in the case of nurses arriving at base ports, giving the
number of nurses, the time of arrival, and destination. '
APPENDIX
1017
(3) It will be the duty of any medical officer receiving this message to have some one
meet the train, arrange for transportation, assistance with baggage, place to remain at
hospitals or other suitable quarters overnight when necessary, to notify the medical officer
at the next place where assistance is desired, and to give any help that may be required.
VI. General Order No. 1, c. s., headquarters. Services of Supply.— The attention of all
commanding officers of Medical Department units is invited to General Order No. 1, c. s.,
headquarters. Services of Supply.
VII. Special articles of clothing not issued generalbj. —The commanding general, Services
of Supply, directs that commanding officers of all hospitals handle special articles of cloth-
ing not issued generally to all enlisted men in such a manner that they will be returned to
their original owners in a serviceable condition upon their discharge from the hospital.
VIII. Neuropsychiatric patients.— In the future no neuropsvchiatric patients will be
transferred to Base Hospital No. 117, La Fauche (Haute Marne). This hospital is in the
process of being closed and abandoned.
IX. Improper classification of patients in hospital. — Many reports, general and specific
are being received regarding improper classification of patients in hospital. Men have
been returned to duty as class A before their wounds were properly healed and when dressings
have been necessary. It is imperative that greater care and attention be given to the proper
classification of patients in hospital. Commanding officers will, either personally or by
delegation of a thoroughly reliable medical officer, supervise this work. The reports received
reflect seriously upon the care and attention given by classification boards to the patients in
hospital.
X. Baggage department. — Regarding the establishment of a baggage department and the
handling of baggage of patients in hospital, attention of commanding officers of all hospitals
is invited to Bulletin 48, headquarters, Services of Supply, Decem))er 3, 1918, and General
Orders, No. 62, December 5, 1918, headquarters. Services of Supply.
XI. Typhoid fever and paratyphoid fever. — All medical officers, and especially those
in charge of hospitals, and particularly those on duty in medical wards of hospitals, are
advised to note carefully and follow precisely the precautions with regard to the handling,
diagnosis, and release after convalescence of cases of suspected or diagnosed typhoid and
paratyphoid fevers, as given in sections 184 and 185, of Article III, of the Manual of the
Medical Department:
184. Early detection of all cases of typhoid fever is necessary, especiallv those of mild
or ambulant type, and of all typhoid carriers or excretors. Undetermined fevers should be
regarded with suspicion and handled like typhoid until that disease is excluded. Specimens
of blood from suspected cases should be sent promptly to the nearest laboratory for diagnosis.
185. No patient convalescent from typhoid should be released from "isolation until
three successive examinations of his stools and urine, collected at six-day intervals, have
shown him to be free from typhoid bacilli.
XII. Commanding officers of hospitals to notify commanding officers of organizations. — In
view of the present prevalence of typhoid fever in the American Expeditionary Forces,
it is directed that commanding officers of hospitals notify by telegraph the commanding
officers of organizations from which the patient has been admitted, as soon as a case of typhoid
or paratj'phoid fever has been suspected or diagnosed. This report will be sent at the same
time as, and in addition to, the telegraphic report sent to the office of the chief surgeon,
in compliance with Section XII of the Sick and Wounded Reports.
XIII. Professional reports. — The office of the director in charge of professional services
lias been closed in our reports. All professional reports required by consultants should be
forwarded direct to the office of the chief surgeon.
XIV. Class A men. — Surgeons of the base ports who are charged with the evacuation
of patients report that there are an increasing number of class A men, or men to become
class A shortly after their arrival in port hospitals, being evacuated to base ports with
the idea of their being sent to the United States. This is contrary to all instructions. Com-
manding officers and evacuating officers will give special attention to this and see that
none of this type of patients are sent to the ports.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
1018
ADMIXISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 66:
American- Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
February 4, 1919.
I. Cafeteria system of messing patients. — (1) During the crisis when personnel and
equipment were being worked to the utmost limit, the line, or cafeteria, system of feeding
patients was in many cases the only practicable one.
(2) Now that the number of patients is reduced to the normal capacity of the units
it is desired that the table service be substituted for patients as rapidly as possible.
(3) Inspectors have reported on the presence of patients in pajamas and gowns standing
in line in inclement weather. This should under no circumstances be allowed to occur,
and the substitution of table service for line will prevent this most undesirable condition.
(4) It is not e.xpected that the table service can be used in all cases for large personnel
and casuals on duty status, as in these cases the line system is perhaps the only feasible
one. It is, however, desired that patients will not be messed in the line system.
II. Sales of excess medical property. — Sales to private individuals or associations can
only be made through the French Government and should be taken up with the "bureau
liquidation .stocks de guerre, " giving a list of medical supplies wanted with sufficient descrip-
tion to enable the supply department to identify items requested with regular stock. Sales
may be made direct to all Governments of the Allied forces, Red Cross, Y. M. C. A., and
Knights of Columbus. Requests from all these latter sources should be forwarded to the
office of the chief surgeon, A. E. F., with a list of items attached. The final decision covering
all sales is made by the general sales board under instructions of the War Department.
III. Accountability for medical supplies. — Section 3, Circular 3, office of the chief surgeon,
line of communications, is hereby rescinded. All property received from whatever source,
such as Red Cross, donation or purchase, will be taken up and accounted for in the same
manner as regular supplies. All initial equipment of hospitals from the United States
whose initial equipment camp from the Red Cross sources should be taken up on property
return.
Property belonging to the French Government, Service de Sante, to hotels under lease,
etc., that has not been purchased by the United States Government will not be taken up
on propert}- return.
IV. Hospital funds — collection of amounts due from officer patients. — Referring to col-
lection of amounts due to fund from officer patients as provided for in Bulletin No. 40,
headquarters, Services of Supply, 1918, every effort will be made, by correspondence or other
suitable method, to secure payment of amounts due from officers indebted for subsistence
received while undergoing treatment, in order that the number of names placed upon the
Quartermaster Corps stoppage circular may be reduced to a minimum. Attention is invited
to the fact that Bulletin No. 40, headquarters. Services of Supply, 1918, affords a method
of collection only after every other means of collection by direct correspondence has been
exhausted without success, and that it was not the intention to relieve commanding officers,
custodians of funds, or mess officers from responsibiUty in regard to such collections. In
future, requests to place delinquent accounts upon stoppage circular must be accompanied
by statement covering details of efforts previously made to collect such accounts.
V. Narcotics.~ln view of that fact that soldiers of the Medical Department have been
recently arrested for selling morphine and cocaine stolen from the Medical Department, the
attention of officers is invited to the importance of carefully carrying out the regulations as
prescribed in paragraphs 240 and 241, Manual of the Medical Department, for the care of
narcotics. They should be kept at all times under lock and key, and the expenditures checked
up to the end of each month against the prescriptions. Care should be taken not to carry
on hand too large a stock of these drugs, and quantities in excess should be turned into a
medical supply depot. Care should be taken not to dispense narcotic drugs by salvage, as
it is difficult to keep track of them in this way. They should in all cases where practical
be turned into medical supply depots direct.
VI. Hospital fund.— The second certificate mentioned in section 1, paragraph 5, Circular
No. 64, dated January 7, 1919, is hereby amended to read as follows:
I certify to have received the sum of , from
being the balance on hand this date of hospital fund of '
APPENDIX
1019
VII. Daily reports of changes.— Commanding officers of Medical Department formations
will forward to this office carbon copies of their daily reports of changes on Form 647 and
648, S. D., A. G. O.
VIII. Daihj reports of casualties and changes.— In the future dailv reports of casulaties
and changes, on Forms 647 and 648, will be rendered separately for the permanent Medical
Department personnel of the hospitals and for casual detachments of patients and convales-
cents. Consolidation of these reports on one sheet leads to confusion in the central records
office.
IX. Orders for return of Medical Department organizations to the United States.— The
provisions of paragraph 2, section 5, Embarkation Orders, No. 13, will be complied with
only after receipt of formal orders for the return of the Medical Department organizations
to the United States. A great deal of confusion is resulting at present through commanding
officers of base hospitals and other Medical Department units reporting to G-1, these head-
quarters, after receipt of notice from this office that they w^ere to prepare for return to the
United States. This notification is not final notice, w^hich is only given by G-4, these
lieadquarters.
X. Class B and C ?nen.— Many men evacuated from hospitals as of class B and C are
still being received at the American embarkation center, Le Mans, presumably intended for
return to the United States. The second depot division was discontinued at this place in
accordance with telegram No. 446, G-1, Services of Supply, on December 7.
The above practice will be discontinued, and the men forwarded in accordance with
General Orders, No. 5, general headquarters, January 5, 1919.
XI. Colored soldiers. — Complaint has been made that colored soldiers have been erro-
neously evacuated from hospitals to organizations consisting only of white men. This
causes considerable difficulty in quartering and messing the colored men pending their depart-
ure for their proper organizations. The only colored divisions which have formed a part of
the American Expeditionary Forces have been the 92d and 93d. Care will be exercised in
evacuating this class of patients to prevent cause for complaint.
XII. Lost baggage of patients. — Paragraph 2, Circular Letter No. 24-A, in which it is
directed that communications regarding lost baggage of patients should be addressed to lost
baggage bureau, Tours, France, is changed to read "central baggage office, Gievres, A. P. O.
713," in accordance with General Orders 62, Services of Supply 1918.
XIII. Members of the Army Nurse Corps. — ^Since the appearance of members of the
Army Nurse Corps, either singly or in groups, when they are traveling or after they reach
the United States will be the only indication to the casual observer of the discipline, morale,
and the standards of those in responsibility for them and the standards which they have
made for themselves, it is most important that instead of relaxing their efforts now that the
time of demobilization draws near, chief nurses should contiiuieto make ever\- effort to enforce
the regulations in regard to the wearing of uniform.
XIV. Priority lists in selecting cases for evacuation. — Complaints have been made that
hospitals have not made use of priority lists in selecting cases for evacuation. It is appre-
ciated that many features enter into the selection of a group of men for transfer to the United
States. It is desirable, however, that, w'hen compatible with e.xisting instructions, tho.se
who have been awaiting evacuation longest should be given preference to avoid discontent
on the part of patients and an}' semblance of injustice.
XV. Recruiting of military police. — Authority has been given to the provost marshal
general to established recruiting parties in all Services of Supply hospitals for the purpose
of recruiting military police from class A men. Commanding officers of hospital centers and
base hospitals will give all assistance possible to these parties.
XVI. Ordnance property. — The chief ordnance officer has directed that the following
disposition be made of ordnance jjroperty upon abandonment of hospitals: Unserviceable
web leather and miscellaneous equipment to intermediate salvage depot No. 8, St. Pierre
(ie Corps; rifles, revolvers, and pistols to ordnance repair shop, Mehun; serviceable mess
and personal equipment to intermediate ordnance depot No. 2, Gievres.
Walter D. McC.\w,
Colonel, Medical Corps, Chief Surgeon.
1020
ADMIXISTKATIOX, AMERICAN EXPEDITIONARY FORCES
Circular No. 67.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
February 8, 1919.
I. Typhoid and paratyphoid /erer.— Date of onset of typhoid and paratyphoid fever:
All commanding officers of hospitals in the American Expeditionary Forces, when reporting
suspected cases of typhoid or paratyphoid fever, or a case in which the diagnosis is based on
clinical grounds, or a case proved by laboratory methods to be typhoid or paratyphoid, in
compliance with Section XII, Sick and Wounded Reports, will add to the data now required
by telegram the word "onset" and the date of the appearance of the initial symptoms of the
disease; i. e., the date when the patient first felt really ill. This date is to be obtained by
careful inquiry into the history of each case; the day when the patient first reports sick or
when he is admitted to hospital or when he first goes to bed is not necessarily the date of
onset of the disease and is not uncommonly a week or more after the true date of the onset
of the disease as diagnosed by careful clinical history.
In order to accomplish effective control of typhoid and paratyphoid fever the personal
attention of the commanding officer of every hospital formation in the American Expedition-
ary Forces must be given to this detailed report. The office of the chief surgeon can then
give immediate and accurate information to surgeons of organizations which will permit of
their discovery of cases and the tracing of the source of infection among the troops.
Typhoid and paratyphoid fever to be reported on clinical diagnosis : In order to comply
with Section XII, Sick and Wounded Reports, the following will be observed:
(a) All suspected cases of typhoid and paratyphoid fever must be reported as such by
telegram without waiting for clinical or laboratory confirmation.
(6) All cases which present a clinical picture of these diseases must be reported as
clinical typhoid or paratyphoid as soon as the diagnosis of typhoid or paratyphoid is made.
(c) All cases in which the diagnosis of typhoid or paratyphoid is confirmed by bacteri-
ological methods or by autopsy must be reported as proved cases of these diseases.
{d) Cases originally reported as suspected or clinical cases of typhoid or paratyphoid, if
subsequently proved by laboratory methods or by autopsy to be cases of these diseases, must
be again reported indicating that they are now proved cases.
(e) If cases originally reported as suspected or clinical typhoid or paratyphoid are
found subsequently not to have either of these diseases, correction of report must be made,
by telegram, giving change of diagnosis.
(/) Individuals who are found to be excreting typhoid or paratyphoid bacilli in stools
or urine, but who have not been sick recently with a disease resembling typhoid or paratyphoid,
must be reported as carriers. These individuals may be temporary or permanent carriers.
(gr) Individuals who are found to be excreting typhoid or paratyphoid bacilli in stools
or urine and who have recently had a febrile disease known to be typhoid or paratyphoid,
or a disease which in the absence of proof to the contrary and in the face of known facts
might have been typhoid or paratyphoid, must be reported as convalescent carriers.
In all instances reports to the chief surgeon will be by telegram.
II. Evacuation of typhoid carriers. — Whenever it becomes necessary or desirable to evacu-
ate a carrier of typhoid or paratyphoid fever to the United States, the carrier shall be evacu-
ated as a patient on sick report. The office of the chief surgeon shall be notified of the name,
rank, organization, and home address of the patient as well as of the fact and date of such
evacuation. A special communication calling attention to the fact that the man is a carrier
and that special precautions must be taken to avoid spread of infection shall be sent with
the transfer slip or field medical card which accompanies the patient.
III. Reports. — The attention of aU medical officers is invited to the fact that personal
reports of change of status should be rendered to this office as promptly as possible and that
monthly personal reports should invariably be mailed on the last day of the month. These
reports have been neglected to a great extent through the active operations of the past year,
and it has been very difficult to keep track of locations and status of officers.
IV. Daily reports of changes of hospital personnel and patients. — The attention of all
commanding officers of Medical Department units is invited to Section IV, General Order
No. 16, c. s., general headquarters, A. E. F.
APPENDIX
1021
V. Psychiatric department, hospital center, Allerey. — Attention of all concerned is directed
to the fact that the psychiatric department for the reception, observation, early treatment,
and evacuation of mental cases is no longer in operation at the hospital center, Allerey!
Paragraph 2 of Circular Letter No. 35-A should be corrected accordingly.
VI. Base hospitals abandoned and being abandoned: (1) The following listed base hos-
pitals have closed their records and ceased to function on the dates shown in each case:
Base Hospital No. 20, Chatel Guyon (Puy de Dome), January 20, 1919.
Base Hospital No. 30, Royat (Puy de Dome), January 20, 1919.
Base Hospital No. 66, Neuf chateau (Vosges), December 31, 1918.
Base Hospital No. 117, La Fauche (Hte. Marne), January 12, 1919.
(2) The following base hospitals are being abandoned:
Base Hospital No. 83, Revigny (Meuse).
Base Hospital No. 71, Vauclaire (Dordogne).
Base Hospital No. 202, Orleans (Loiret) .
Base Hospital No. 236, Quiberon (Morbihan).
Base Hospital No. 218, Poitiers (Vienne).
(3) Hospitalization at the following places has been abandoned:
Pau (Basses Pyrenees).
Lourdes (Haute Pyrenees).
Caen (Calvados).
Autun (Saone et Loire).
VII. Circulars Nos. 73 and 75, War Department. — Circular No. 73, War Department,
November 18, 1918, and Circular No. 75, War Department, November 20, 1918, relating
to the discharge of officers and soldiers, mentioned in Circular No. 61, dated December
18, 1918, this office, have been republished in General Order No. 230, general headquarters
A. E. F., December 16, 1918.
VIII. Hospitals to be furnished with dubbin, or shoe polish. — (1) By direction of the
commander in chief, A. E. F., all hospitals will keep on hand, for use of hospital detachnients
and patients, a supply of dubbin, or shoe polish, to be used on the shoes. Commanding
officers of hospitals will insist on shoes being treated with this material.
(2) Should a supply of dubbin, or shoe polish, not be on hand, requisition will immedi-
ately be made for this material.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 68.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
February 8, 1919.
I. Accountability for medical property. — Disbursing officers, property officers at medical
supply depots, including base storage depots, also at base hospitals and at schools, will
continue to account for medical property, as required by existing orders.
Formal accountability for medical property is not required from any other officers.
Invoicing and receipting for supplies transferred by disbursing officers, property officers
at medical supply depots, base hospitals, and schools will be done in the manner prescribed
by Army Regulations and Manual for the Medical Department, but the receipts given
by all other officers than those above mentioned will be for the sole purpose of clearing the
accountability of the issuing officer.
Officers who are relieved from formal accoinitability for medical property which is
in their care or under their control must remember that their duty to protect the interest
of the Government is in no way diminished thereby. Attention is called to Section II of
General Orders, No. 74, as to their duty in this connection and as to the means which will
be taken to enforce proper care and use of Government property.
II. The attention of all officers coming to Tours is invited to the fact that the address
of the finance and accounting division is No. 4, Rue de Clocheville, and that the sick and
wounded division is at No. 17, Place Forre-le-Roi.
1022
ADMINISTRATION, AMERICAN EXPEDITIONARY FOHCES
III. All medical officers are directed to remove the following drugs from salvage befon
turning same in to salvage depots: Morpliine, cocaine, heroin, codeine, chloral, and (jpiuii.
preparations.
These drugs will be sent to the nearest medical supply depot by courier, with list covering
shipment; depot officer concerned receipting thereon.
* ' Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 69. ^ ^
American Expeditionary Iorces,
Chief Surgeon's Office, Services of Supply,
February 17, 1919.
Typhoid-Paratyphoid Fevers
I. introduction
In view of the appearance and continued incidence of fevers of the typhoid-paratyphoid
group in many units of the American Expeditionary Forces during the past five months,
it is deemed essential to review this subject at the present time, particularly from the view-
point of early diagnosis, prevention, and control.
The occurrence and distribution of typhoid-paratyphoid in our troops has constantly
and continuously been brought to the attention of all medical officers serving with the A. E. F.
through the medium of the Weekly Bulletin of Diseases. It would appear, however, that
many officers have utterly failed to grasp the significance of these reports and warnings,
a fact which may be due to a false sense of security under the popular belief that vaccination
against typhoid and paratyphoid gives a complete immunity even in the midst of gross
unsanitary conditions.
Notwithstanding the fact that typhoid and paratyphoid fevers are endemic in the
United States, and in spite of our extensive experience with these diseases during the Spanish-
American War and, later, during the period of mobilization on the Mexican border, it is
evident that many medical officers have gained but little knowledge of the fundamental
principles underlying prevention and control. It is also quite evident that some medical
officers are grossly careless and neglectful of their duties and responsibilities as medical
officers and sanitarians.
This office realizes fully that the United States has raised, within a short period of
time, an army of several millions of men who have been poorh^ instructed in personal hygiene
and sanitation; it realizes that 2,000,000 of these men have been brought to France where
they have encountered environmental conditions differing entirely from those existing in
the United States; it is fully recognized that military necessity has at time rendered sanitary
control extremely difficult, especially during the stress of active combat.
To our regret, be it said, the high standards of sanitation and personal hygiene set
by the Medical Department during the past 10 to 15 years have not been lived up to
during the past l}/2 years. This has been due to a combination of factors, the more
important of which have been the lack of facilities and materials, transportation difficulties,
and insufficient training and personnel. However, many medical officers serving with
combatant and Services of Supply units have been able to overcome all handicaps and
have by wise counsel and by eternal vigilance succeeded in keeping their units in excellent
fighting trim.
The actual physical fighting is now at an end, and the time-worn excuse that "there
is a war on" will no longer be tolerated. But the fight against disease still continues.
The greater part of the American Expeditionary Forces is now relatively stationary
in training areas or with the armies of occupation, where definite sanitary measures can be
instituted and enforced, where instruction of the line troops can be carried out, and where
opportunity is presented to initiate rules of personal hygiene. Medical officers will there-
fore be held responsible for the proper supervision of the health of troops.
Carbon copies of all general recommendations of medical officers covering sanitation
and personal hygiene, promulgated officially as orders and memoranda by superior authority,
will be mailed to this office.
APPENDIX
1023
II. SUMMARY OF TYPHOID PARATYPHOID INCIDENCE IN THE AMERICAN EXPEDITIONARY' FORCES
In order that all medical officers in the American Expeditionary Forces may have
a somewhat comprehensive view of the occurrence of these fevers in the American Expedition-
ary Forces, the following brief review is presented.
(a) From June 1, 1917, to June 1, 1918, but few cases occurred. The rate was well
within the limits to be expected in view of the sanitary conditions under which the troops
were of necessitj- living. The cases were sporadic and only occasionally did secondary
cases develop.
(6) In July, 1918, a replacement unit consisting of 248 men, from Camp Cody, N.
Mex., reached England with typhoid prevailing extensively; 98 men, or 39.5 per cent, had
typhoid, and the case death rate was 8.42 per cent.
It was evident from the investigation that the men were exposed to infection through
contaminated drinking water while en route to the port of embarkation in the United States.
The unit had been vaccinated a few months prior to the occurrence of the epidemic. Most
of the patients presented the typical clinical features of typhoid. The percentage of posi-
tive bacteriological findings from the blood, feces, and urine was low, as no laboratory work
could be done until late in the course of the disease.
(c) In August, 1916, a small but severe epidemic occurred in a detachment of engineer
troops stationed at Bazoilles. In this unit 15 cases of typhoid occurred, with a death rate
approximating 10 per cent. Typhoid was endemic in the civil population, and the epi-
demic was very definitely traced to a cook in the mess of this engineer detachment who
remained on duty as a cook for five days after the onset of the symptoms. The epidemic
was recognized in its early stages, and in all patients the disease was confirmed bacterio-
logically by positive cultures from the blood and feces.
(d) During the Chateau Thierry offensive diarrhoeal diseases were very prevalent in
the troops engaged (approximately 75 per cent). It was demonstrated bacteriologically,
in this area, that the prevailing intestinal diseases were simple diarrhoea, bacillary dysentery,
typhoid, paratyphoid A and B. The sick and wounded from this sector were evacuated
to base hospitals in various parts of France. Very soon therafter this office began to receive
reports of cases of typhoid, paratyphoid, and bacillary dysentery from base hospitals. In
practically all instances the patients had beem evacuated from the Chateau Thierry sector.
The high incidence of intestinal diseases in this sector was due to the entire disregard of the
rules of sanitation. "MiUtary necessity" and the impossibility of supplying auxiliary labor
troops, at that time, prevented immediate police of the battle fields. In some of the cases
involved in this series the diagnosis of dysentery or typhoid was made by the pathologist
at autopsy. The percentage of positive bacteriological findings was low, as the correct
diagnosis, if made, was not usually arrived at until late in the course of the disease.
(e) Both dysentery and typhoid-paratyphoid fevers were demonstrated to have pre-
vailed to some extent in our troops after the St. Mihiel offensive, but the epidemics of influ-
enza and pneumonia prevailing at that time overshadowed all other medical admissions.
(/) Following the offensive in the Argonne sector, typhoid and paratyphoid began
to be reported from practically all divisions engaged in that offensive. It is quite evident
that the initial cases were due, in large part, to drinking infected water. The initial cases,
however, in large part were not, in most instances, promptly diagnosed, and secondary
cases from contact began to occur. In some divisions either the initial exposure was not
great, the organizations were under good discipline, or the medical officers had a proper
conception of their duties and responsibilities and but few cases occurred. In other in-
stances the contrarv was was true, and many cases have occurred. As examples of the two
extremes mav be cited the Division, in which 5 cases occurred between October 1, 1918,
and February 1, 1919, and the Division, in which 115 cases occurred in the same
l)eriod.
More than 300 cases of tvphoid-paratyphoid may be attributed to the Argonne offen-
sive. Eight hundred and seventy-four typhoids and paratyphoids have been reported in
13901—27 65
1024
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the American Expeditionary Forces since October 1, 1918. Tiie percentage of confirmatory
laboratory diagnoses has been low on account of the fact that the clinicians frequently
failed to suspect the disease in its early stages.
(g) A small but severe epidemic occurred in the Joinville concentration area in Decem-
ber and January. In a group of Medical Department units (evacuation and mobile
hospitals and sanitary trains) concentrated there 75 cases occurred, with a case death rate
of approximately 20 per cent. The cases were suspected in the early stages of the disease,
and the percentage of positive findings by culture of urine or feces has been greater than
75 per cent. The cause of this epidemic has not been completely analyzed as yet, but
there is but little question that it was due to the use of infected drinking water.
III. REPORTS OF CASES
If epidemics are to be recognized in their incipiency and measures initiated to control
and prevent further extension, it is manifestly of the utmost importance that reports of
suspects and proven cases be transmitted to the medical officers of organizations directly
concerned at the very earliest possible moment. The large number of troops involved,
methods of evacuation, delays in transmission of reports, necessary censorship regulations,
frequency of troop movements, laxity in making reports, unwarranted delay in making
diagnoses, and other factors have tendered to hamper this most important instrument for
the control of transmissible diseases. The medical officers charged with the supervision of the
health of all organizations must know at the earliest possible moment of the diagnosis or
provisional diagnosis of typhoid or paratyphoid in a member of his organization, and for this
diagnosis he must depend on the ward surgeon in the camp, evacuation, mobile, base, or
other hospital unit of which the patient has been evacuated. Ward surgeons and chiefs of
medical service in hospitals charged with the care of these i)atients do not appear to com-
prehend their responsibility in this matter. As a matter of fact, they are jointly responsible
with the medical officers of the organization for any epidemics occurring in a command if
they delay, in the least, in making diagnoses or in reporting suspects or positive cases. The
records of this office show that patients with typhoid have passed successively through camp,
field, evacuation, and base hospitals without any documentary evidence that typhoid or
paratyphoid were even suspected. There are records of a stay of two weeks or more in a
single base hospital without diagnosis, and not a few records are on file showing that it re-
mained for the pathologist to make the diagnosis at the autopsy table. If a tentative or
positive diagnosis of typhoid or paratyphoid does not reach the medical officer of an organi-
zation until two or three weeks after the evacuation of the individual from the command,
the damage already is done, additional individuals already are infected, and the problem of
control becomes all the more difficult. If, on the contrary, ward surgeons in hospitals are
keenly alive to their duties and responsibilities, will suspect typhoid and paratyphoid in all
fevers of undetermined origin, will endeavor to confirm their suspicions by early blood cul-
ture, will promptly report all clinical cases as such and positive cases as such, the necessary
information can be transmitted immediately to the medical officer of the organization con-
cerned, who can in turn institute measures for the prevention of secondary cases.
In order that reports of cases of typhoid and paratyphoid may be transmitted more
promptly to the medical officer attached to organizations, the following procedure will be
adopted :
(a) Commanding officers of Medical Department units caring for the sick will be held
responsible for reporting promptly by telegraph, as already provided for in Section XII,
Sick and Wounded Reports; all suspected, clinical and proved cases of typhoid and para-
typhoid. The commanding officers of such hospitals will hold the chiefs of their medical
services directly responsible for the prompt submission of diagnoses in these cases. Any
laxity or incompetency in this respect will be immediately reported to this office for necessary
action.
(6) When reporting these cases, in addition to the data now required by telegraph, the
word "onset" followed by the date of appearance of the initial symptoms of the disease will
be included in each case. In securing these data it must be understood that the date of
"onset" is not necessarily the day on which the patient first reported sick or the date on
APPENDIX
1025
which he was admitted to the hospital, but rather should be regarded as the dav when the
patient first had any symptoms indicative of the disease.
(c) In reporting cases of typhoid or paratyphoid, in compHance with paragraph (a)
above, the following classification will be observed:
1. All suspected cases of typhoid and paratyphoid will be reported as "typhoid or
paratyphoid suspects."
2. All cases which present a clinical picture of these diseases will be reported as "clinical
typhoid or paratyphoid," using the term "clinical typhoid or paratyphoid."
3. All cases in which the diagnosis of typhoid or paratyphoid has been confirmed bv
bacteriological methods or autopsy will be reported as "proved tj^phoid or paratyphoid."
4. Individuals who are found to be excreting typhoid or paratyphoid bacilli in their
stools or urine and who have recently had a febrile disease presenting the clinical symptoms
of typhoid or paratyphoid, will be reported as " convalescent typhoid or paratyphoid carriers. "
5. Individuals who are found to be excreting typhoid or paratyphoid bacilli in their
stools or urine, but who have not been sick recently with a disease resembling typhoid or
paratyphoid, will be reported as "typhoid or paratyphoid carriers."
6. Cases originally reported as suspects or clinical cases of typhoid or paratyphoid and
which have subsequently been proved, by laboratory methods or autopsy, to be one of these
diseases will be again reported, stating that they are now proved cases. The telegram
reporting such proved cases will indicate clearly that they have formerly been reported as
suspects or clinical cases.
7. If cases originally reported as suspects or clinical typhoid or paratyphoid are subse-
quently found not to have been one of these diseases, these cases will be reported by telegraph
showing change of diagnosis. In all telegrams reporting such change of diagnosis, definite
information will be submitted indicating that they have been reported previously as suspects
or clinical cases.
(d) All reports outlined above will be sent by telegraph to the chief surgeon, A. E. F.
If the hospital unit reporting such cases is attached to one of the armies, a duplicate of this
report will be submitted to the chief surgeon of the army concerned, in such manner as he
may indicate. If the hospital unit is under the orders of a section surgeon, surgeon of the
district of Paris, or surgeon of the American embarkation center at Le Mans, a duplicate
of this report will be submitted to the section, district, or embarkation center surgeon, in
such manner as he may indicate.
Chief surgeons of the armies will establish close liaison with base, evacuation, and camp
hospitals in the immediate vicinity of their commands, but not a part of their commands, to
which patients from their commands are to be evacuated. If cases of typhoid or paraty-
phoid from armies are diagnosed in such camp, evacuation, base, or other hospitals, the
commanding ofl?icers of such units will, in addition to the reports called for above, make
immediate report of such cases by telephone, telegraph or courier to the chief surgeon of the
army concerned.
8. The special attention of all medical officers is invited to section 189, Article III,
Manual of the Medical Department, quoted below, which will be strictly complied with.
189. A report will be furnished in every case of typhoid fever or paratyphoid fever
occurring in an officer, enlisted man, or civilian employee who has received the typhoid vac-
cine, describing in detail the method of arriving at diagnosis.
Special blank forms covering the information to be submitted will be obtained on request
to this office.
IV. CLINICAL DIAGNOSIS OF TYPHOID AND PARATYPHOID FEVERS
In view of the fact that the ordinary clinical picture of typhoid-paratyphoid is very
frequently profoundly modified in vaccinated individuals, it is considered essential to enu-
merate briefly the usual clinical manifestations of these fevers, atypical modes of onset,
difi"crential diagnosis, and modifications of the usual clinical manifestations in vaccinated
individuals.
1. Clinical manifestations of typhoid and paratyphoid. — Typhoid fever in the unvac-
cinated is commonly characterized clinically by symptoms due to the gradual development
1026
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
of a general bodily infection. The onset is insidious, with lassitude, malaise, gradual step-
like rise in temperature with slight morning remissions, until at the end of the first week a
continuous fever of from 103° to 105° F. has been obtained. The beginning of the attack is
usually associated with anorexia, headache, and frequently with diarrha^a, abdominal dis-
tress, and epistaxis. The pulse is not increased in proportion to the temperature, is of low
tension and dicrotic. The tongue is coated and white and the abdomen distended and
tender. From the seventh to the tenth day the rash appears in the form of slighly raised
flattened papules of from 2 to 4 mm. in diameter, which can be distinctly felt, are of a rose
red color, and fade on pressure. These rose spots, characteristic of typhoid and paratyphoid,
appear singly or in crops, usually first on the skin of the abdomen and lower thoracic region,
but may occur only on the back or extremities. The individual rose spot persists for from
two to three days, after which it fades, leaving a brownish stain which persists for some
time. Toward the end of the first week the spleen enlarges, and its edge can be distinctly
felt below the costal margin.
At the end of 10 days the symptom complex clinically characteristic of typhoid — con-
tinous fever, rose spots, and enlarged spleen — is usually established. To this should have
been added laboratory findings of absence of leucocytosis and in the majority of instances a
positive blood culture, which occurs most frequently during the early stage of the disease.
One negative blood culture will not suffice, but repeated examinations at 48-hour intervals
will be made in suspicious cases.
During the second week there is continued high fever, with slight morning remissions.
The pulse becomes rapid and loses its dicrotic character, the patient becomes dull and stupid,
the lips are dry, the tongue is dry and covered with a dirty brownish coat and tremulous.
Abdominal symptoms when present, tj^mpanites and diarrhoea, are more pronounced, and
the clinical picture becomes one of intense toxemia. In the third week, in favorable cases,
the morning remissions in temperature become more marked, the fever becomes distinctly
remittent in type, and toward the end of this period a gradual fall in temperature by lysis
is noted. Rose spots cease to appear. In severe cases the pulse is weak, ranging from 110
to 130, and pulmonary complications, especially pneumonia and hypostatic congestion, may
occur. The patient is dull and apathetic, and low muttering delirium and subsultus tendi-
num are common. During the fourth week convalescence begins, the temperature gradually
reaches normal, the abdominal symptoms subside, the tongue becomes clear, and the desire
for food returns. In severe cases convalescence may be delayed until the fifth or even the
sixth week, in which case the fever continues high during the fourth week, and it is only
toward the end of this period that marked daily remissions make their appearance.
In individuals previously vaccinated against typhoid, but who have completely lost
their immunity, infection similar to that found in the unvaccinated occurs, giving rise to
the symptom complex described above as characteristic of typhoid fever.
Infections occurring in the vaccinated individual who still possesses a certain degree
of resistance to infection result in the appearance of atypical clinical pictures, such as abor-
tive types of typhoid and paratyphoid in which the constitutional symptoms are mild but
with slight febrile reaction of atypical type and few if any rose spots. The onset may be
either insidious, with headache, loss of appetite and fatigue, or acute and associated with
chills, vomiting, intestinal cramps, and diarrhoea. Fever may be wholly absent or evanes-
cent in character and determined only if observations are made within the first 48 to 72
hours. A low type of temperature, with daily fluctuations of from 98.6° to 100.4°, sug-
gestive of the presence of tuberculous disease, may persist for a week or 10 days. It is in
this class of cases that blood cultures taken early in the course of the disease, and repeated
if negative, frequently give definite information concerning the nature of the infection.
Ambulatory types of typhoid are not uncommon, and the first indication of the existence
of the disease may be furnished by the occurrence of intestinal haemorrhage or perforation.
The vaccinated individual protected against general systemic infection may still act
as a carrier of typhoid infection, and frequently shows clinical manifestations of local disease
of some portion of the gastro-intestinal tract, while the characteristic symptom complex of
typhoid fever due to general infection, namely, continued fever, rose spots, and enlarged
spleen, may be wholly absent.
APPENDIX
1027
2. Distinctive complications. — Intestinal haemorrhage occurs usually during the third
and fourth weeks. The onset is marked hy a sudden and frequently pronounced fall in
temperature associated with increased gravity of the general condition and a rise in pulse
rate.
Intestinal perforation occurs usually during the third or fourth week. Patients
whose sensorium is not too clouded complain of sudden paroxysmal abdominal pain, usually
referred to the right hypogastric region. Signs of peritoneal irritation rapidly become
manifest. Vomiting is common. Hiccough and irritability of the bladder, with frequent
micturition, may be noted. Physical examination of the abdomen reveals tenderness and
muscle rigidity most marked in the right hypogastric or iliac region. Obliteration of liver
dullness is frequently present and constitutes an important sign. Acute abdominal symptoms
associated with a suddenly appearing leukocytosis are indicative of perforation. The
occurrence of intestinal hemorrhage or signs of intestinal perforation in an individual giving
a history of previous ill health should always lead to the suspicion of the existence of typhoid.
3. Atypical modes of onset. — (a) Acute onset, with symptoms simulating meningitis.
Lumbar puncture differentiates.
{b) Acute onset with intense, usually generalized bronchitis or symptoms suggestive
of lobar or broncho-pneumonia.
(f) With chills, fever, vomiting, cramplike pain in abdomen, sometimes localized in
right iliac fossa and suggesting appendicitis.
(d) With symptoms of acute nephritis. Attack begins suddenly, with nausea, vomiting,
pain in lumbar region, diminution in secretion of urine, which is highh^ colored and contains
albumin and casts.
(e) Special mention should be made of the ambulatory type of typhoid in which the
.symptoms are slight, consisting simply of headache and lassitude associated with mild
gastro-intestinal disturbances. The patient is at no time confined to his bed, and intestinal
hemorrhage or perforation may furnish the first clue with regard to the existence of typhoid.
(/) In the above atypical modes of onset early blood cultures are of importance in
differentiation.
4. Paratyphoid fevers. — The paratyphoid fevers, due to infection with A or B organisms,
are evidenced clinically by the same general symptomatology as that of typhoid. They,
however, as a rule, run a much milder course and the intense toxemia of typhoid, evidenced
by marked apathy, muttering delirium, and subsultus tendinum is seldom present. The
onset of paratyphoid is frequently more abrupt, with acute gastro-intestinal symptoms
resembling food poisoning. The intestinal symptoms are as a rule more marked in cases
of infection with paratyphoid B than in cases in which paratyphoid A is the causative
factor. The fever in paratyphoid is not of as long duration nor is it as continuous as in
typhoid, but is more distinctly remittent in type. Enlargement of the spleen, rose spots,
and absence of leukocytosis are, as a rule, present in all three infections. Attempts have
been made by some authorities to distinguish between the eruptions of paratyphoid A,
paratyphoid B, and typhoid. Thus the spots in paratyphoid A are said to be larger,
more macular in type, of a darktr reddish hue, and to correspond more closely to the erup-
tion of measles. However, histologically the rash is the same in all three instances, and it
is doubtful if a clinical distinction in type of eruption can be maintained. Rose spots may
tjc wholly lacking or may be profuse and widely distributed over the body surface. The
occurrence of relapses is more frequent in paratyphoid than in typhoid proper, and partic-
ularly is that true in connection with type A infections. In contradistinction to the relapse
of typhoid, that of paratyphoid is frequently more severe than the original attack. The
distinction between mild typhoid, paratyphoid A, and paratyphoid B can be made definitely
only by the isolation of the infecting organism from cultures of the blood, urine, or stools.
5. Differential diagnosis — Influenza. — Many cases originally diagnosed as influenza in the
American Expeditionary Forces have subsequently proven to be typhoid. The symptoms
which the two diseases have in common are: Continuous fever without localizing symptoms
and slow pulse associated with absence of leukocytosis. The more abrupt onset, the intensity
of the headache, the severe pain in the back and eyeballs, and the early prostration
occurring in influenza are distinctive. Supposed influenza in which the fever persists for more
1028
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
than four days and which is not associated with signs of respiratory involvement, such as bron-
chitis, usually most extensive in the lower lobes, a broncho or lobar pneumonia should be
viewed with suspicion. It should be remembered that a general bronchitis is not uncommon
in typhoid. The appearance of rose spots should determine typhoid. Intestinal types
of supposed influenza should always be considered as possible typhoid until proven otherwise.
Acute miliary tuberculosis. — A family history of association with tuberculous individuals,
a personal history of previous attack of pleurisy or pulmonary hemorrhages, physical signs
of old tuberculous pulmonary lesions, cyanosis appearing early in the disease associated with
increased rate of respiration, a greater irregularity of temperature curve, and a more rapid
pulse with absence of dicrotism suggest acute miliary tuberculosis. Roentgenograms of
the chest and blood cultures frequently give valuable differentiation.
Septicemia. — In cases of late typhoid admitted to the hospitals during or after three
weeks of profound toxemia, together with the, by this time, distinctly remittent temperature,
may suggest septicemia. The slight daily fluctuation in the general condition of the patient
together with the absence of chill and leukocytosis, suggest typhoid. Blood cultures will
always be made in such cases and, if negative, cultures of the stools will be made for the
presence of typhoidlike organisms.
6. Local and unexplained gastro-intestinal derangements, gastritis, acute or chronic,
diarrhea, dysenterj', gastro-enteritis, enter-colitis, colitis, appendicitis, cholecystitis, and
acute catarrhal jaundice, all occuring with or without fever, should be regarded with suspicion
when admitted from commands in which cases of typhoid or paratyphoid have occurred,
and examination of the stools for the presence of typhoidlike organisms should be made.
Medical officers will see that all cases of gastro-intestinal derangement enumerated
above, as well as all fevers of undetermined origin, are subjected to careful clinical and labora-
tory supervision. They will under no conditions be left in quarters, but will be sent at once
to camp, evacuation, mobile, or base hospitals where accurate observation of temperature
at four-hour intervals will be recorded for a period of at least four days. Blood cultures
will be taken in every case of fever of undetermined origin in which the temperature has
persisted for a period of 48 hours and, if negative, will be repeated provided unexplained fever
persists from the second to the fourth day.
Daily physical examinations of such cases will be made, special attention being paid
to phj^sical examination of the abdomen for enlarged spleen, distention, and tenderness,
either general or localized. A careful survey of the entire surface of the body will be made
for the possible appearance of rose spots.
The precautions appropriate for a case of t\^pical proved tjphoid or paratyphoid fever
must be observed in all instances where atypical or undetermined fevers are held under
observation, awaiting clinical or bacteriological diagnosis of specific enteric infections.
The frequencj' with which atypical, mild, unrecognized cases of typhoid and paratyphoid
fever have, occurred in the American Expeditionary Forces among vaccinated men makes it
absolutely essential to surround all such cases of undetermined fever with the same precau-
tions which it is found necessary to apply to establish typhoid or paratyphoid patients, to
avoid contact infections in the wards among other patients and hospital personnel.
7. Temperature records, clinical notes, and the original reports of laboratory findings in
all cases of typhoid, paratyphoid, fevers of undetermined origin, and the above-mentioned
list of gastrointestinal disorders will accompany the patient if transferred to another medical
unit, and wall be preserved and forwarded to the office of the chief surgeon as per instructions
contained in section VI, paragraphs 6-7, Sick and Wounded Reports for American Expedi-
tionary Forces, September 15, 1918. In no instance will the clinical notes, temperature, and
laboratory records of these cases be destroyed upon the completion of the case.
v. LABORATORY DIAGNOSIS OF TYPHOID AND PARATYPHOID FEVERS
Bacteriological procedures are of great value (1) for the certain and early diagnosis of
suspected cases, (2) to determine carrier state in convalescent positive cases, (3) to detect
carriers in otherwise normal individuals.
Blood cultures offer the most certain method for early diagnosis of undetermined fevers,
and it should be kept in mind that the earlier in the disease the blood culture is taken the more
APPENDIX
1029
likely is the result to be positive; thus, in positive typhoid fever the chance of successful
blood culture declines from 90 per cent during the first week to 40 per cent during the third
week. In paratyphoid A fever, because of the frequently short and mild febrile period, the
prompt and early blood culture is all the more necessary. Relapses are more common in
paratyphoid than in typhoid, and taken at such a time blood culture yields positive results in
every case.
The following method of blood culture is recommended as being suitable in all cases of
fever of undetermined etiolog}\
(a) When laboratory facilities are at hand, take 10 c. c. of blood from a vein at the
elbow. Place 3 c. c. in each of two flasks containing 100 c. c. of plain broth. Place 1 c. c.
in tube of agar (melted and cooled to 45° C), immediately mix and pour plate. Place remain-
der of blood in dry sterile test tube to separate serum for such serological tests as may be
suggested.
The two flasks and plate are incubated and examined the following day. Transplants
are made to plain agar slants, or, better, Russell's double sugar agar. In case of development
of Gram-negative njotile bacilli or agar slants, emulsions should be made and agglutination
tests done with immune sera for final identification.
Frequency of nonagglutinability of recently isolated typhoid cultures should be kept in
mind.^ Negative blood culture in suspected typhoid fever means little. Repeat if clinical
conditions indicate.
(6) If the blood culture specimen can not be taken directly to the laboratory, filtered
sterile ox bile is most useful, 5 c. c. in a tube. To such sterile ox bile 5 c. c. of blood is added,
the tube closed with a sterile parafl^in cork, carefully packed, and sent for examination to the
nearest laboratory. Bile medium is furnished in chest No. 1, transportable laboratory. United
States Army, expeditionary force model. Additional supply of this medium may be obtained
as needed from central medical department laboratory, A. P. O. 721.
Bacteriological examination of feces is second only to blood culture as an important
means of positive diagnosis. It is especially important in paratyphoid B fever.
Typhoid or -paratyphoid carriers. — Typhoid and paratyphoid patients excrete the bacilli,
frequently with their urine and practically always in their feces. This is most likely to occur
during the third and fourth weeks of the disease; the condition may persist throughout
convalescence and not infrequently longer. It is therefore important not to release the con-
valescent typhoid or paratyphoid fever patient until he ceases to excrete these bacilli.
Three negative cultures of the urine and feces at six-day intervals should be required
before release of patient, the first not earlier than one week after temperature curve has
become normal.
Some persons who have never had a clinical history of the disease may excrete typhoid
or paratyphoid bacilli. It is important to detect such carriers in any occupation, but espe-
cially among cooks and handlers of foodstuffs. In such a carrier survey, two examinations
should be done on each individual.
For release of patients, therefore, and detection of carriers, the examination of feces is of
especial importance. It is a procedure that properh- requires the most careful attention of
the bacteriologist. A bit of fresh feces the size of a pea (or, better when feasible, 1 c. c. of
liquid stool, obtained, if diarrhoea is not already present, by administration of a saline cathar-
tic) is mixed with 10 c. c. of plain broth or sterile salt solution, then allowed to stand and
sediment for 15 minutes. One or more loopfuls are taken from the top and placed on the
surface of one plate of hardened Endo medium. This droplet is carefully carried over the
surface by means of a glass elbow rod or similar spreader, and without further inoculation the
same rod is used to seed a second Endo plate. In this way a satisfactory separation of
the colonies maj' be secured. .After incubation overnight, suspicious colonies are fished to
plain agar slants or, better, Russell's double sugar and the identification completed by
agglutination tests.
Evacuation of typhoid carriers. — Whenever it becomes necessary or desirable to evacuate
a carrier of typhoid or paratyphoid fever to the United States, the carrier shall be evacuated as
a patient on sick report.
f All strains of organisms of the typhoid paratyphoid group are of special interest and should be sent to the Central
Medical Department Laboratory, A. P. O. 721.
1030
ADMINISTRATION, A^IERICAN EXPEDITIONARY FORCES
The Widal test, in view of previous vaccination w ith T. A. B. vaccine, has been generally
held of little or no value; however, it should be stated that the determination of agglutinin
titer of patient's serum at intervals of one week and tlie demonstration of progressive and
marked increase of agglutinin content of the blood offers, expecially in the absence of positive
blood culture, excellent evidence as to the etiology of the diseases. Thus in typhoid fever
an agglutinin titer (Widal test) of 1 to 40 during the first week of the disease may advance to 1
to 1,280 during convalescence. In paratyphoid B fever the titer frequently advances to 1 to
2,560; however, in paratyphoid A fever it may not reach 1 to 640. Formalinized and stand-
ardized bacterial suspensions of B. typhosus, B. paratyphosus A, and B. paralyphosus B may be
obtained on request from the central Medical Department laboratory, A. P. O. 721.
Post-mortem bacteriology. — At autopsy, on suspected cases, cultures should be made from
the mesenteric lymph glands and from the spleen.
VI. PATHOLOGY
1. The significant gross pathology of typhoid fever can be briefly summarized as an
acute process found in the lymphoid elements of the intestine (chiefly the ileum) and in
the enlargement and softening of the lymph nodes in the mesentery and mesocolon. These
nodes in the immediate neighborhood of the lower end of the ileum, the appendix, and caecum
usually show the most marked change. The opened intestinal tract reveals hyperplasia
of all the lymphoid elements, such as Peyer's patches and the solitary follicles. There may
be in most unusual cases only hyperplasia of these elements, but as a rule they show injec-
tion, exudation, and rather extensive ulceration, particularly in the lower end of the ileum.
The lower third of the ileum is frequently the location of an ulcerated Peyer's patch or
solitary follicle that may have perforated or may have become the source of considerable
hemorrhage. The mucosa of the appendix and the caecum are, in about one-third of the
cases, also the seat of typhoid ulcers.
The spleen is usually enlarged and the pulp is semidiffluent. The parenchymatous
organs are somewhat enlarged and have a cooked appearance, suggesting cloudy swelling
of a moderate or extreme degree. Broncho-pneumonia is frequently present as a terminal
lesion. This represents the usual list of anatomical findings disclosed to gross examination;
therefore, on opening the abdomen, the first important gross features that attract attention
are the size of the lymph nodes in the mesentery and the upper part of the mesocolon and
the size and consistence of the spleen.
In children these structures may be misleading and in adults aflSicted with tubercu-
losis a confusing gross picture can be offered, but in the Army of the American Expeditionary
Forces, composed of young adults, any such picture found at autopsy should be thoroughly
investigated. Such investigation calls for the removal of the intestine and an examination
of the intestinal mucosa for lesions related to the lymphoid elements. Any change noted
should be followed with supporting evidence gained by bacteriological examination.
It should be kept in mind that the American Army has been vaccinated against typhoid,
and as a result the gross pathological picture may not be as clear as in unprotected indi-
viduals. Indeed, several protocols received indicate that there are fewer gross lesions in
the intestine and that they are prone to appear in the ileum at points very near the ileo-
cecal valve and even in the appendix and caecum. Other records indicate that death probably
occurred during a relapse since there was evidence of a few almost healed ulcers near the
location of one or more acute ulcers, one of which had been perforated.
Cases of typhoid may escape attention at autopsy if early and complete regional exam-
inations are not conducted and recorded in a methodical manner, and it is imperative that
the pathologist support any suspicion of tyhoid fever gained on gross examination by a.
well conducted post-mortem bacteriological examination. Cultures taken from the gall
bladder and from the lumen of the bowel may offer the only positive findings of a "carrier"
of the disease. Cultures offering the pathologist the best support may be taken from the
spleen and lymph nodes in the drainage path of actual intestinal lesions.
Cases possessing the pathology and bacteriology of typhoid should be entered under
the cause of death at the close of protocol as typhoid fever, and then, if desired, followed in
parenthetical manner with any important sequel present, such as "perforation." Several
APPENDIX
1031
protocols have been received in which the complete pathological and bacteriological pictures
of typhoid fever were recorded, but the cause of death was entered as "peritonitis," "per-
foration of the intestine," "broncho-pneumonia," "acute enterocolitis."
Attention is directed to Section XVII of the pamphlet Sick and Wounded Reports
(effective September 15, 1918). All diagnoses should conform to these instructions if a
j)roper record of disease is to be made.
VII. PREVENTION AND CONTROL OF TYPHOID AND PARATYPHOID FEVERS
Typhoid fever is increasing in the American Expeditionary Forces; so are the para-
typhoid fevers.
Vaccination is a partial protection only and must be reenforced by sanitary measures.
Faulty conditions of sanitation that may not be dangerous now will become serious
menaces when the warm weather sets in. There is still time to correct many of these con-
ditions. If this is not done, many soldiers will not get back to the United States after com-
pletion of their arduous service, and it will be in part your fault and our responsibility.
The means of conveyance are water and food. Water may be contaminated by drain-
age from latrines and indiscriminately deposited defecations. Food may be contaminated
by hands of carriers, by flies that come to it from latrines and uncovered feces; therefore:
Remember that all water in France is regarded as contaminated unless it is under
constant supervision of water supply personnel. See that General Order 131, general head-
quarters, 1918, is carried out. Do not give orders only; personally assure yourself that
chlorinatioii is properly carried out. The responsibility ultimately falls upon those charged
with sanitary control and not upon the enlisted man who mixes the hypochlorites of lime
with the water. Study the means of prevention of drinking at unauthorized sources. The
best way to do this is to see that an adequate supply of supervised water is conveniently
available wherever men work or live. Other means are the marking of water points; the
removal of faucets; the placing of guards, and last, but most important, the education of
the men.
Remember that the most dangerous carriers are the ones that work in the kitchens.
Enforce the washing of hands by kitchen personnel before the preparation and serving of
food. Do not leave this to orders alone. Have a reliable officer or noncommissioned officer
supervise this and see that the means of washing are on hand. Also remember that many
cooks who have been found to be carriers have often given histories of recent intestinal
disturbance; therefore, inspect your kitchen personnel at least twice a week and remove
all those who are suffering or have recently suffered from diarrheas. Repeated attacks of
diarrhea are particularly suspicious.
Remember that flies breed in manure, feces, and offal of many kinds. PoUcing of
camp and the proper disposal of all such filth will keep down the number of flies. A cam-
paign of such policing, if now undertaken, should go far to yield results by spring. Flies
alone can not spread these diseases if latrines are covered and access to feces are prevented.
Look at the lids of your latrines. Correct the conditions which lead to uncovered feces in
camps. Keep the food covered so that any flies that get through this cordon can not get
at it.
Remember that an outbreak of diarrhoea may mean typhoid fever. At any rate the
occurrence of epidemic diarrhoea shows that there is a hole in your sanitary plan.
Remember that, even though your camp is a model one, the neighboring civilian popu-
lation may be a source of danger. Try to keep informed of typhoidlike disease in the civilian
population where you are stationed.
Remember that from the sanitary point of view the first case is the most important one.
If you evacuate a suspicious case and don't hear what it has turned out to be, make inquiry
through the available channels.
1032
ADIMINISTRATION, AMEBIC AX EXPEDITIONARY FORCES
CONTROL
1. Upon the occurrence of a single case of typhoid or paratyphoid fever in a command,
reinvestigate all the above conditions and correct any deficiencies discovered in the barrier
or protection above described.
Examine all vaccination records and administer a single dose of triple lipo-vaccine to
all in whom there is the slightest doubt concerning completion of required vaccination.
Request bacteriological carrier examination of your kitchen personnel from the nearest
available laboratory. This had best be done through the responsible sanitary authorities.
Before this has been done reinspect your kitchen personnel and remove all who give
a history of recent diarrhoeas or other intestinal disturbance.
Prohibit the use of all uncooked vegetables and unboiled milk.
Investigate the conditions of the neighboring civilian population as to prevalence of
typhoid or typhoidlike fevers.
2. When two or more cases occur in the same command within the same two weeks,
revaccinate the entire command, in addition to the above precautions." If the outbreak
takes an epidemic proportion, add to these precautions the hand washing of all men after
defecation.
Further measures of control must be determined after epidemiologic study of the
individual situation.
Whenever typhoid or paratyphoid fever occurs in any command, the medical officer
will address the officers and the men, at either roll call or retreat, instructing them in the
mode of spread of intestinal diseases, in the seriousness of the situation, and in the simple
methods of personal hygiene, the importance of cleanliness, and the purpose of the sanitarj^
regulations instituted for control of these diseases.
3. The special attention of aU officers of the Medical Department is invited to sections
184 and 185, Article III, Manual of the Medical Department. Compliance is enjoined.
4. All previous instructions from this office in conflict with regulations prescribed
herein are rescinded.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
Circular No. 70.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
February 20, 1919.
I. Hospital centers and base hospitals no longer operating. — (1) Supplementing Section
VI, Circular 67, the following is a complete list of hospital centers and base hospitals that
have ceased operating;
hospital centers
Angers (activities taken over by Base Hospital No. 85).
Clerment-Ferrand.
Commercy (activities taken over by Base Hospital No. 91).
Langres (activities taken over by Base Hospital No. 53).
Pau.
Vittel-Centrexeville.
» Directions for vaccination with triple T. A. B. lipo-vaccine are being issued with the vaccine.
APPENDIX
1033
BASE HOSPITALS
No. Location
1. Vichy (Allier).
2. Etretat (Seine Inferieure), with British
Expeditionary Force.
3. Vauclaire (Dordogne).
4. Rouen (Seine Inferieure), with British
Expeditionary Force.
5. Boulogne (Pas de Calais) , with British
Expeditionary Force.
6. Bordeaux (Gironde).
7. Tours (Indre et Loire).
8. Savenay (Loire Inferieure).
9. Chateauroux (Indre).
11. Nantes (Loire Inferieure).
12. Camiers (Pas de Calais), with British
Expeditionary Force.
13. Limoges (Haute Vienne).
14. Mars (Nievre).
15. Chaumont (Haute Marne).
17. Dijon (Cote d'Or).
18. Bazoilles (Vosges).
19. Vichy (Allier).
20. Chatel Guyon (Puy de Dome).
21. Rouen (Pas de Calais), with British
Expeditionary Force.
22. Beau Desert (Gironde).
23. Vittcl (Vosges).
24. Limoges (Haute Vienne).
25. AUerey (Saone et Loire) .
26. Allerey (Saone et Loire).
27. Angers (Maine et Loire).
28. Limoges (Haute Vienne).
29. Tottenham, England.
30. Royat (Puy de Dome).
31. Contrexeville (Vosges).
32. Contrexeville (Vosges).
33. Portsmouth, England.
34.
No. Location
35. Mars (Nievre).
36. Vittel (Vosges).
37. Dartford, England.
38. Nantes (Loire Inferieure).
39. (Mobile Hospital No. 39).
41. St. Denis (Seine).
42. Bazoilles (Vosges).
43. Blois (Loire et Cher).
44. Mesves (Nievre).
45. Toul (Meurthe et Moselle).
46. Bazoilles (Vosges).
47. Beaune (Cote d'Or).
48. Mars (Nievre).
49. Allerey (Saone et Loire).
50. Mesves (Nievre).
52. Rimaucourt (Haute Marne).
58. Allerey (Saone et Loire).
61. Beaune (Cote d'Or).
62. Mars (Nievre).
66. Neuf chateau (Vosges).
67. Mesves (Nievre).
68. Mars (Nievre).
70. Allerey (Saone et Loire) .
72. Mesves (Nievre).
76. Vichy (Allier).
83. Reviguy (Meuse).
84. Perigueux (Dordogne).
94. Pruniers (Loire et Cher) .
112. Brest (Finistere).
115. Vichy (Allier).
116. Bazoilles (Vosges).
117. La Fauche (Haute Marne).
204. Hursley Park, England.
206. Remorantin (Loire et Cher).
236. Quiberon (Morbihan).
238. Rimaucourt (Haute Marne).
Nantes (Loire Inferieure).
(2) The following hospital centers are shortly to be abandoned :
Allerey, to be abandoned when patients are evacuated.
Beaune, to be abandoned and buildings turned over to general headquarters for use
as a school. Base Hospital No. 77 to remain at this location to care for sick of
the school.
Limoges, to be abandoned when patients are evacuated.
Vichy, to be abandoned when patients are evacuated.
(3) Additional lists will be published in succeeding circulars as base hospitals and
hospital centers cease to operate. . -4. i
II Resharpening blade,.— Machine horse clipper blades in use by vetermary hospital
units should be sent to Medical Department repair shop No. 1, Pans, for resharpening.
These blades upon being resharpencd will be returned to the unit in question.
1034
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
III. Final report on Form No. 30. — When a base hospital, camp hospital, or medical
detachment is disbanded, a final report on Form No. 30, A. G. O., will be rendered— the
original forwarded to The Adjutant General of the Army, Washington, D. C, and two copies
direct to the adjutant general, general headquarters, A. E. F. These returns will be made
out in accordance with the printed instructions on Form No. 30, A. G. O. The records of
events will show the authority for the discontinuance or breaking up of the hospital or detach-
ment and the date and the disposition of the personnel.
IV. The following instructions will govern with reference to requisitions for engineer stores. —
Requisitions for engineer stores originating with the Services of Supply must be submitted
to and acted upon by the local engineer section officer of the C. of C. and F., who, after
taking the necessary action, forwards the requisition to the nearest, or the specially desig-
nated, engineer depot where it is to be filled. Requests emanating from the following sections
will be forwarded to the engineer section officer at the addresses given below:
Base section No. 7, A. P. O. 735.
Intermediate section (west), A. P. O. 713.
Intermediate section (east), A. P. O. 708.
Advance section, A. P. O. 731.
Base section No. 1, A. P. O. 701.
Base section No. 2, A. P. O. 705.
Base section No. 4, A. P. O. 760.
Base section No. 5, A. P. O. 716.
Base section No. 6, A. P. O. 752.
V. Records of returning organizations. — Organizations returning to the United States
are required by embarkation instructions No. 13 to take with them all records pertaining
to the organization as an organization. This has not been done in a number of cases. Steps
will be taken to insure compliance with these instructions.
VI. Correct Mail Address. — The postmaster at A. P. O. 717 — requests that members
of the medical Corps, Sanitary Corps, Veterinary Corps, Army Nurse Corps, and enlisted
men of the Medical Department send their correct mail address to the medical section, A. P. 0.
717, upon each change of station or change to another organization. It is desired that the
commanding oflScers of hospitals and medical detachments have this information placed
on bulletin boards.
VII. Nurses. — In addition to the instructions regarding nurses traveling given in
Circular No. 65, January 19, 1919, the following is to be noted. When it is necessary for
nurses to change trains at Tours or to remain at that station between trains, commanding
officers of hospitals are instructed to telegraph to the headquarters commandant. Services
of Supply, stating the probable hour of arrival of the nurses and the number, in order that
arrangements for their accommodation may be made. The Red Cross officials at Tours
are doing all in their power to assist nurses going through that city, but to prevent embar-
rassment it is absolutely necessary that the probable numbers expected and the time of
their arrival be received beforehand.
VIII. Disposition of surplus subsistence on disbanding of hospitals. — (1) The following
decision of the Quartermaster Department is published for compliance of all hospitals:
(2) In view of the facts set forth in letter of the chief surgeon, A. E. F., to the judge
advocate, A. E. F., of the 28th of January, 1919, indicating deficits on operations hospital
funds, the Quartermaster Corps is wiUing to purchase back from hospital funds all surplus
subsistence on hand which is a good condition, and which was purchased from the Quarter-
master Corps, that may be in the possession of Medical Department units at the time of
their disbanding or when evacuating to the United States.
IX. Rates of commutation for patients. — Attention of all commanding officers of hospitals
is called to General Order No. 19, general headquarters A. E. F., dated January 29, 1919,
which changes the rates of commutation for patients in hospital.
X. Clearance certificates.— -Attention of all commanding oflScers of hlspitals is invited
to BuUetin No. 40, headquarters. Services of Supply dated October 22, 1918. In connection
with the issuance of clearance certificates, it is essential that this office (finance and account-
ing division), be notified immediately of indebtness of a deceased officer or of an officer
departing for the United States, and that this oflfice also be notified immediately upon
expiration of the two months period in the case of officers outlined in paragraph 3 of Bulletin
No. 40.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
APPENDIX
1035
Circular No. 71 :
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
March 8, 1919.
I. Hospital centers and base hospitals no longer operating. — (1) In addition to list given
in Section I— Circular 70, the following hospital centers and base hospitals have ceased
operating:
HOSPITAL CENTERS
Beaune (Base Hospital No. 77 to be returned to United States as skeletonized organi-
zation, and personnel retained to operate Camp Hospital No. 107. Buildings have been
turned over to general headquarters for use of American Expeditionary Forces University).
AUerey (Base Hospital No. 99 to be returned to United States as skeletonized organi-
zation, and personnel retained to operate Camp Hospital No. 108. Buildings being turned
over to general headquarters for use of American Expeditionary Forces University).
BASE HOSPITALS
No
10.
Location
Le Treport (Seine Inf.), with British
Expeditionary Forces (All American
Expeditionary Forces base Hospitals
with British Exj^editionary Force
have ceased operating.)
40. Sarisbury Court, England. (All Amer-
ican Force base hospitals in England
have ceased operating.)
77 Beaune (Cote d'Or).
No. Location
92. Kerhuon (Finistere).''
96. Beaune (Cote d'Or).
97. AUerey (Saone et Loire).
105. Kerhuon (Finistere.)
112. Kerhuon (Finistere).''
202. Orleans (Loiret).
218. Poitiers (Vienne). Reverts to former
status as Camp Hospital No. 61.
(2) The following base hospitals are shorth- to be abandoned: Base Hospitals Nos.
63, Chateauroux (Indre) ; 71, Vauclaire (Dordogne), and 109, Vichy (AlUer).
II. Communications. — The attention of commanding officers and of chief Nurses is
called to the fact that official communications from nurses or women civilian employees
addressed to the chief nurse or the director of nursing service, A. E. F., must be forwarded
promptly, whether approved or disapproved and with reasons for the approval or disapproval
expressed.
III. Mail addressed to patients in hospitals which are to be discontinued. — (1) All hospitals
discontinued will forward a roster of patients evacuated at the time the hospital was discon-
tinued, together with their correct forwarding address, to the central post office, Bourges.
(2) In case a hospital is relieved by another unit, the commanding officer of the hospital
relieved will furnish the mail orderly of the hospital relieving his organization the mail orderly
record on hand of all past and present personnel and patients, including all evacuated patients,
with their correct forwarding address.
IV. Death of prisoners of war. — On the death of a prisoner of war in any hospital,
notification will be immediately made to the commanding officer, central prisoner of war
inclosure No. 1, A. F."0 717, giving place, time, name, number, and description of prisoner.
V. Wound stripes. — At a recent inspection by the commander in chief it was noted
that there was a shortage of wound stripes at certain hospitals. He directs that an adequate
supply of these articles be kept in all hospitals. Requisitions will accordingly be made for
wound stripes in order that they may be on hand at all times.
VI. Evacuation of prisoners of war from hospitals. — When members of prisoner of
war labor companies become sick and are sent to hospitals they are considered as still mem-
bers of their companies. Upon evacuation from hospitals on a duty status they will be
returned to their original organization or to the central prisoner of war inclosure, whichever
is more convenient, and not to a labor company to which they have never belonged.
VII. Pneumococcus vaccine. — The following additional instructions relative to records
to be kept when pneumococcus lipo-vaccine is given will supplement those laid down in
paragraph 5, section 1, Circular No. 59, office chief surgeon, A. E. F., series 1918.
* Never operated as independent unit.
1036 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
• When large numbers of individuals from the same unit are given iirophylactic inocu-
lations of pneumococcus vaccine, the records maj' be consolidated on nominal check list
showing the character of vaccine used, batch number, serial number of individual, name,
age, organization, date of administration.
The consolidated lists should be forwarded to the office of the chief surgeon, A. E. F.
The fact that lipo-vaccine has been given and the date of the administration should be
entered on the individual record and pay book as well as on the service record of each soldier.
VIII. Disposition of ordnance property —Section XVI, Circular 66, is amended to read
as follows:
The chief ordnance officer has directed that the following disposition be made of ord-
nance property upon the abandonment of hospitals: Unserviceable web, leather, and mis-
cellaneous equipment to intermediate salvage depot No. 8, St. Pierre-de-Corps; rifles,
revolvers, and pistols to ordnance repair shops, Mehun.
Serviceable mess and personal equipment will be disposed of as follows: Hospitals
and medical units stationed east of a line drawn north and south through Gievres, to Gievres.
Hospitals and medical units in base section No. 1 to base ordnance depot No. 1, Montoir;
base section No. 2 to base ordnance depot No. 4, St. Sulpice; base section No. 4 to base
ordnance depot No. 1, Montoir; base section No. 5 to base ordnance depot No. 1, Montoir;
base section No. 7 to base ordnance depot No. 4, St. Sulpice; intermediate section, west
of Gievres to Montoir, base ordnance depot No. 1; advance section to intermediate ordnance
depot No. 2, Gievres.
IX. Medical organizations under orders for return. — In order that section 1, general
staff, these headquarters, may be informed concerning the whereabouts and movements
of medical organizations under orders for return to the United States, the commanding
officer of any separate Medical Department unit will report by wire to G-1, headquarters,
Services of Supply, all movements subsequent to receipt of orders to prepare for embarkation.
X. Salvage of quartermaster department material. — The Quartermaster Department
requests that in the future the commanding officers of all hospital centers and base hospitals
operating independently will not ship or endeavor to save any articles of clothing, shoes,
or other quartermaster's material which can not be placed in a serviceable condition by
repairs, or which have no sales value amounting to considerably more than the cost of
handling and transportation.
XI. Patient's laundry. — Circular Letter No. 71, office of the Surgeon General, February,
1919, is quoted, as follows :
1. Amendments of paragraphs 222 and 267, Manual for the Medical Department,
have been approved as follows, and will be promulgated by formal change in due course:
Par. 222, strike out the words "before it is put away" in the first sentence, so that
that sentence shall read: "The soiled clothing of patients will be washed as a part of the
hospital laundry (par. 267)."
Par. 267, change second clause so as to read: "Second, the washable clothing of patients
under treatment in hospital (par. 222)."
2. Commanding officers of hospitals will govern their action accordingly.
XII. Records of inventions and licenses. — Circular Letter No. 59, office of the Surgeon
General, dated January 29, 1919, is quoted for the information of all concerned:
1. This office has received a request from the patent section, office of the director of
purchase, storage, and traffic, for information in regard to records of inventions and licenses.
In order to enable this office to furnish the information desired, you are requested to invite
the attention of all medical, dental, veterinary officers, enUsted men, Medical Department,
and civihan employees serving under your direction, to paragraph 4, General Orders No
93, War Department 1918, and direct such officers and enlisted men, and civihan emplo>^es
as may come within the piirview of that order to furnish the following informatioHo this
office, attention executive officer:
S^x^ ^^-H ^i*^^^ inventions relating to militarv affairs made by them
nnt if i I description of each invention, together ^vith a statement as to whether or
not It has been submitted to the War Department to be patented, and whether formal
tender or licenses to the United States to use the same has been made ^"^^i^er tormai
2. It is requested that this matter be expedited.
Walter D. McCaw,
Colonel, Medical Corps, Chief Surgeon.
APPENDIX
1037
Circular No. 72.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
March 15, 1919.
I. The following general instructions will govern when units are abandoned and equip-
ment ordered turned into medical supply depots:
Upon receipt of instructions from the chief surgeon designating depot or other station
where supplies and equipment will be turned in, the following instructions will be carried out:
(a) The medical supply officer will in each case be advised in advance, by wire, as to
the approximate number of cars to be turned into his depot, also date cars go forward, and
statement in general of contents of each car. The supply officer should also be advised of
the car number and O. D. T. number. In every case, copy of loading list should be inclosed
in an envelope and tacked on the ceiling or some other convenient place in each car, showing
contents of that particular car.
(6) Owing to the scarcity of lumber for packing material, sandbags have been obtained
from the Engineer Department for the purpose of packing linen. These sandbags will be
available for issue at intermediate medical supply depot No. 2, Gievres; advance medical
supply depot No. 1, Is-sur-Tille; and medical supply depot, Montierchaume. Upon receipt
of orders to abandon hospital and turn in equipment, necessary requisition will be submitted
for the necessary number of these sacks. Tests have been made as to the capacity of sand-
bags to be used, and the following results obtained:
One sack will hold 30 sheets, 30 pajaraa suits, 20 mattress covers, 48 bath towels, 120 hand
towels, 120 pillowcases.
(c) Bundling of linens or other preparation of such articles for shipment: All used
bed linen and hospital clothing will be freshly laundered and blankets, when necessary,
will be washed and in every case the latter will be sterilized before being turned into the
depot.
Blankets will be sorted as to color and quality and then bundled as follows: Each
blanket is folded once from side to side and then twice from end to end, making a surface
21 by 34 inches. They are then securely tied in bundles of 25, with folded sides all in one
direction.
Sheets will be folded as commercially received, which is as follows: Each sheet is folded
from side to side twice; then endways three times and then sideways once, making a fold
about 8 by 12 inches. They are then tied up in bundles of 10, or a multiple thereof, with
the folded sides all in one direction.
Pillowcases will be folded as follows: Each pillowcase is folded to one-third its width
on each side and this again folded once end to end, making a surface about 7 by 18 inches.
They are then put up in bundles of 12, with folded ends in one direction, and tied. Four of
these smaller bundles are again tied up in one bundle, making a total of 48 pillowcases
in the larger bundles.
Towels, hand, will be folded and tied in bundles in exactly the same manner as the pillow-
cases, with this exception — two towels will be folded together and but six of the doubled
towels will be placed in the smaller bundles. Size of towels when folded will be about 6 by
18 inches. Total of 48 towels in large bundles.
Towels, bath, will be put up in the same manner as the small bundles of hand towels.
Size when so folded is 8 by 24 inches. Total of 12 towels in a bundle.
Pajamas should be folded as follows: The coat, buttoned, is placed bosom downward.
The pants, with the legs folded together, are placed lengthways on top of coat, projecting
legs of trousers being folded over so as to bring such fold even with tail of coat. The sides
are then folded over to one-third the width of coat and sleeves brought down lengthways
of garment. It is then folded once to bosom size and then once again to half bosom size,
making a package about 8 by 12 inches. The suits are then tied in bundles of 5 or in multiples
of 5, all folds in one direction.
Pillows should be sorted as to class — as hair, feather, cotton, and French or American.
Each class is then tied up in bundles of 10.
Care should be taken to see that all bundles are neatly packed and securely tied with
material of sufficient strength to obviate breaking.
1038
ADMINISTRATION, A:MERICAN EXPEDITIONARY FORCES
When shipped or stored, mattresses will be sorted and classed as to kind — such as hair,
felt or cotton, or excelsior, and as to make as American or French or the quartermaster type.
II. Loss of sick and wounded reports. — Owing to the increasing number of monthly
sick and wounded reports that are being lost by the transportation department, it is requested
that all monthly sick and wounded reports that are too bulky to be sent by mail will hereafter
be sent by messenger instead of by freight or express service.
III. Short course in reconstructive facial surgery. — A short course in reconstructive
surgery of the face, facial cavities, and eyelids will be offered at Paris by Drs. Pierre Sebelean,
Victor Morax, and Fernand Le Maitre. This instruction will bear special reference to war
casualties. Instruction will be didactic, demonstrative, clinical, and operative on the
cadaver. Classes will be limited to 12, and the courses will continue three weeks. A fee of
about 50 francs will be charged to cover expenses due to the use of cadavers.
Any eye, ear, nose, or throat surgeons desiring this course and who can be spared without
replacement should forward application to this office, stating the date on which it is desired
to start. The courses will begin March 24 and every three weeks thereafter.
IV. Disposition of chronic carriers of typhoid and paratyphoid. — All chronic carriers
of typhoid or paratyphoid A or B bacilli will be evacuated to the United States as patients,
accompanied by a statement of the specific diagnosis and records of the laboratory proof
of the carrier state.
V. Antirabies treatment at Base Hospital 57, Paris. — Any member of the American
Expeditionary Forces who has been bitten by an animal infected or proved to be rabid
should be sent at once, with a complete history, to Base Hospital 57, in Paris, where anti-
rabies treatment will be carried out. For full details as to precautions to be observed
in establishing diagnosis of rabies in the attacking animal and for advised emergency treat-
ment of the wound of the patient, see page 31, Bulletin on Transmissible Diseases and Use
of Therapeutic Sera in American Expeditionary Forces, May, 1918, to be obtained from
chief surgeon's office. Note that American Red Cross Military Hospital No. 2, where
treatments have been carried out heretofore, has been closed and that Base Hospital 57
will be used instead.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
Circular No. 73.
American Expeditionary Forces,
Office of the Chief Surgeon, Services of Supply,
France, March 23, 1919.
I. Physical examination of permissionaires.~{l) The surgeons of all organizations
are directed to make a complete physical examination of all men going on leave the day
preceding or the day on which the men depart for leave areas.
II. Sick and ivounded reports.— {I) The attention of all medical officers is again invited
to paragraph 2, section 11, Manual Sick and Wounded Report of the American Expeditionary
Forces, which directs that all monthly sick and wounded reports be forwarded direct to the
chief surgeon, A. E. F., Services of Supply. Strict compliance with these instructions is
enjoined upon all.
(2) No copy of the weekly medical report of sick and wounded patients is required
by the chief surgeon, A. E. F., Services of Supply. These reports should be forwarded to
the central records office at Bourges. (See General ' Order 100, general headquarters,
A. E. F., June, 1918.)
(3) Commanding officers of hospitals and surgeons of infirmaries functioning as hospi-
tals who are required to render monthly sick and wounded reports will, in the future advise
this office by letter, or on Form 51-A, if no cases were completed during the month In
other words a nil report will be required from all organizations hospitalizing patients for more
than three days.
n "^-/ff^'-^P^^'^ ''P^'i records office on death of officer or enlisted man.-{\)
On tlie death of an officer or enlisted man, immediate telegraphic report will be made by
APPENDIX
1039
commanding officer of hospital in wliich death occurs to the central records office, Bourges.
This report will give name, rank, service, organization, serial number of enlisted man;
time, place, and cause of death; whether in line of duty or not; whether result of his own
misconduct or not. Confirmation copy of this telegram will be forwarded by courier service.
IV. Service records of evacuated patients. — -(1) Attention is again called to provisions
of General Order, No. 23, general headquarters, 1919, regarding the procurement of service
records of patients to be evacuated, and the method of transmitting the record to the station
or hospital to which the patient is sent. These requirements are not being carefully fol-
lowed. Immediate steps will be taken to insure their strict obedience.
V. Material for the prospective medical history of the war. — (1) Information has reached
this office that in some instances medical officers, upon leaving the service, are taking with
them official charts, photographs, models, and pathological specimens, etc., which were
prepared in connection with their official duties while on duty in various hospitals or camps.
(2) It is desired that responsible medical officers inform all subordinate medical officers
that all medical records, charts, drawings, models, and pathological specimens, etc., as
well as all writings relating to cases in hospitals, are the property of the Medical Depart-
ment of the United States Army, and must not be removed from camps or hospitals by
any officer without the authority of the Surgeon General of the Army in each specific case.
(3) It is desired that every effort be made to collect and forward to the Surgeon Gen-
eral's office all photographs, drawings, sketches, models, and pathological specimens, etc.,
in hospitals or camps which may be of use or value in the prospective medical history
of the war. All pictures should be forwarded to Col. Louis C. Duncan, M. C, Army Medi-
cal Museum, Washington, D. C. Models and pathological specimens should be forwarded
to Col. Charles F. Craig, M. C, curator, Army Medical Museum, Washington, D. C.
VI. The following memorandum is quoted for the information of all concerned:
•Subject: Personnel ordered to the first replacement depot and base ports.
1. In view of the fact that the majority of casual officers being released for return to
the United States will be needed for duty with casual companies and casual organizations
returning to the United States, instruct all officers whom you may release and order to the
first replacement depot at St. Aignan-Noyers (Loie-et-Cher) or to the ports of embarkation
that they may expect to be held at those places for assignment to such duty. This is to
be done so that the officers may not expect to be forwarded at once from the first replace-
ment depot to ports of embarkation or to sail on the first transport after the arrival at
a port of embarkation.
2. All soldiers becoming surplus as a result of the abandonment of depots, stations,
camps, etc., who are sent to the first replacement depot at St. Aignan-Noyers (Loir-et-Cherj
are subject to reassignment. Many such men now arrive at the depot with the impression
that they are immediatelv to be returned to the United States. In order, therefore, to pre-
vent soldiers getting such impression, instruct all class A soldiers that you may release and
all organizations and detachments that are sent to the first replacement depot, because their
services are no longer required on their present duty, that they are available for reassignment,
that they have no priorrtv for going home, and the fact of their being sent to the first replace-
ment depot does not mean that thev are to be immediately embarked for the United States.
3 Soldiers released for return to the United States under the provisions of Section III,
General Orders No. 8, headquarters services of supply, 1919, do not fall under the above classes
as such soldiers are released for immediate return to the United States and are given nnmediate
prioritv for return to the United States.
By order of tlie commanding general: „
E. E. Booth,
Assistant Chief of Staff, G-1.
VII. Medical department entertainment.— {!) It is contemplated that the Medical Depart-
ment at these headquarters will shortly produce an entertainment, and information is desired
of any members of the Medical Department who may have talents along these lines. In
submitting these names the qualifications should be given in detail so as to enable this office
to pick out the best in the Medical Department in France.
VIII. Report of officers admitted, evacuated, discharged, or died.—{l) In order to enable
the statistical division, adjutant general's office, to answer promptly the many inquiries now
being made all base and camp hospitals will forwaid direct to the statistical division, adjutant
general's office, general headquarters, by courier mail, a daily list of all officers admitted,
13901—27 66
1040
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
evacuated, discharged, or who have died. The list will give tlu> name, rank, service, and
organization, and place to which sent, if evacuated or discharged. This information may be
sent on any form. Copies of the reports that are at present being made, which show the
same data, will be acceptable.
IX. Association of nurses and enlisted we/i.— The attention of tlie Medical Department
personnel is called to the fact that there is no authority in regulations for any such distinc-
tion between officers and enlisted men as is implied by a ruling that makes it an offense for a
nurse to associate with the enlisted man and not with the officer. The association of nurses
with men is to be governed by the needs of the service, by the rules and customs of polite
society, and by constant consideration for the good name of the Nurse Corps of the Medical
Department of the Army and of American representation in France and not by social dis-
tinctions founded on military rank. Any instructions to the contrary are revoked.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
Circular No. 74.
American Expeditionary Forces,
Chief Surgeon's Office,
March 28, 1919.
I. Economy in use of blank forms. — ^(1) All officers of the Medical Department are
directed to see that the utmost economy is exercised in regard to blank forms. Requisitions
received in this office for blank forms indicate that more are requested than are needed, or
that a large wastage occurs. In either case remedial measures should be applied promptly
so that the present large expenditure for printing may be curtailed as much as possible.
II. Shoe-shining and tailoring establishments to be instituted in all hospitals possible. — (1)
The commander in chief has noticed that there is an absence of smartness in the appearance
of personnel and especially of convalescent patients. This criticism reflects greatly on the
care and attention given to proper military duties by the medical officers of hospitals. The
commanding officers of all hospitals will take proper steps to correct this deficiency.
(2.) With this in view, places will be established in each hospital where men will be able
to shine their shoes, and wherever possible tailor shops where they will be able to have their
uniform repaired and pressed, will be instituted.
III. Physical classification of officers. — (1) Reports reaching this office indicate that
some medical officers, members of classification boards, are both lax in their classification of
officers examined and ignorant of existing instructions. The ease with which officers can
apparently be classified and sent home for conditions which would not have seriously inter-
fered with the performance of their duties prior to the cessation of hostilities is causing unde-
sirable adverse comment and is materially interfering with the integrity of the special services
and staff departments of the American Expeditionary Forces.
IV. The following circular has been received from the Surgeon General and is published
for the information of medical officers. Communications on this subject will not be sent
through this office.
Criticisms and suggestions in re medical service of the Army. — (1) A board of medical
officers, consisting of Brig. Gen. Francis A. Winter, Brig. Gen. Jolm M. T. Finney, and Col.
L. A. Conner, has been appointed to consider criticisms and suggestions concerning the medical
service of the Army.
(2) With a view to correcting defects in and increasing the efficiencv of the department,
officers of the Medical Department, including those of the Medical, Dental, Veterinary, and
Sanitary Corps, are invited to submit to the board any criticisms they may have to make of
the present system and methods, together with suggestions for improvements therein.
(3) Communications on this subject should be sent to Brig. Gen. Francis A Winter
Army Medical School, 462 Louisana Avenue NW., Washington, D. C.
(4) Camp surgeons, surgeons of ports of embarkation, department surgeons commanding
officers of hospitals, and other medical officers are requested to call the attention of officers
to the provisions of this letter.
By the direction of the Surgeon General:
C. R. Darnall,
Colonel, M. C, United States Army'.
APPENDIX
1041
V. Abandonment of hospitals.— When a base, camp, evacuation, or mobile hospital is
abandoned, the commanding officer of the hospital will wire the chief surgeon's office the
date upon which the hospital records are closed and the hospital ceases to function. Atten-
tion of all commanding officers concerned is invited to General Orders, No. 15, headquarters
services of supply, A. E. F., dated March 8, 1919, reference to the disposition of records.
VI. Manual of the Medical Department to govern preparation of sick and wounded reports
after embarkation for the United States.— (1) The attention of commanding officers of medical
units and surgeons of organizations is invited to the fact that the Manual of the Medical
Department will govern in the preparation of all sick and wounded reports after embarkation
for the United States. The system used in the American Expeditionary Forces will no
longer apply.
VII. Carriers of meningococcus and diphtheria bacilli. — (1) Chronic carriers of men-
ingococcus and of proved virulent diphtheria bacilli now under observation or treatment
in hospitals in the American Expeditionary Forces will be evacuated to the United States
as patients, promptly. No diphtheria bacilli carrier will be evacuated unless the virulent
character of the bacilli has been proved by appropriate tests upon the guinea pig.
VIII. Autopsy protocols. — (1) It is important, in view of the continued spread and high
incidence of typhoid and paratyphoid fevers, that protocols of all autopsies be forwarded to
the director of laboratories, A. P. O. 721, within 24 hours of completion of the autopsy.
(2) Failure of the pathologist at the hospital to appreciate the full significance of
lesions of the enteric group of diseases in men dying with other more striking lesions, or with
a clinical picture not recognized as that of typhoid fever, can be corrected by review in the
office of the director of laboratories.
(3) In this way, several incipient epidemics of typhoid have been disclosed; and because
of failure to send in autopsy reports promptly, at least one of the existing local outbreaks was
unrecognized for two weeks.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
Circular No. 75.
American Expeditionary Forces,
Chief Surgeon's Office,
April 10, 1919.
I. Preparation of records for final separation of officers and enlisted men from the service
of the United States Army. — (1) Medical officers preparing records of physical examination
of officers and enlisted men on final separation from the service in the United States Army
are especially cautioned to observe the provisions of General Orders, No. 230, general head-
quarters, 1918, and General Orders, No. 20, general headquarters, 1919.
(2) Attention is directed to paragraphs 1 and 2 (War Department Circular 93, Novem-
ber 27, 1918) quoted in General Orders, No. 20, general headquarters, 1919.
(3) When disabilities are found which, in the opinion of medical examiners, were exist-
ant prior to induction into the service, even though the men examined were evidently placed
in class A when inducted, a notation will be made setting forth reasons upon which their
findings are based, in order that the examination at induction and that at discharge may be
reconciled.
(4) In view of the fact that men under treatment for physical training will not be
discharged until the board of review certifies that the maximum of improvement has been
obtained, or that the physical disabilities have not been exaggerated or accentuated, when men
are discharged with disabilities a statement will be made to the effect that further treatment
will off"er no prospect for improvement in physical condition.
II. Men evacuated without service records. — (1) Many complaints are arriving in this
office from different organizations that men are being and have been evacuated without the
service records being requested (see General Orders, Nos. 5 and 23, general headquarters),
and without the organization being notified that the men are not to return to their organiza-
tion. Regarding the cases in the past, organizations will be immediately notified as to the
1042
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
name of men who have been evacuated from their organizations without service records, and
in the future no man will be evacuated without the organization being notified and the service
record being requested.
III. Prophrjlaxis and prophylactic stations. — (1) The following telegram from the com-
mander in chief has been received by this office and is published for the information and
guidance of all concerned:
Headquarters, A. E. F., April S, 1919.
Chief Surgeon, A. E. F., Tours:
During my inspections, following points have been brought to my attention and should
t)e remedied with all possible speed and vigor. All the following criticisms and directions
apply with emphasis to leave areas everywhere.
" A. (1) Prophylactic stations are otten not well organized, equipped, or administered,
and this fact alone ^vould bring discredit upon the treatment rather than confidence in its
use. The equipment should be on a par w'ith that supplied for other functions of the Medical
Department. Medicines should be prei)ared by the pharmacist and renewed at least every
second day. Warm water for washing should always be on hand to prevent delay in the
administration of the treatment.
(2) Treatment should be under direction and supervision of thoroughly trained attend-
ants and given absolutely according to directions posted in the treatment rooms. Attend-
ants must be carefully selected from the most intelligent and reliable men of detachments
and especially trained in administration of these treatments. Their appearance, deportment,
and speech should always be such as to place prophylaxis treatment on a par with other medical
surgical procedures and their number should be sufficient to allow necessary reliefs.
B. (1) Separate rooms or small buildings should be provided where treatments can be
administered in private, with separate accommodations for officers where possible.
(2) The number and distribution of stations should be such as to make prompt and
convenient treatments always possible. The number at most points is entirely insufficient.
C. (1) Individual packets should be supplied to soldiers in convoy or other duties which
may carry them out of touch w-ith prophylaxis stations. This is not at present generally done.
(2) The physical inspections are not being systeruatically and efficiently carried' out in
cases of undiagnosed and untreated venereal disease among the troops arriving at certain
stations.
(3) The education of commands through lectures by medical officers on personal hygiene
is neglected at many posts. Lectures illustrated by diagrams and drawings are one of the
most effective means of urging continence.
(4) Little or no attempt is made by surgeons to locate sources of infections. Every
effort should be made in every case to trace and eliminate the source bv cooperation with
military police and civil authorities, and this is the surgeon's duty.
(5) Little attention is being paid at rest points for leave and troop trains and houses of
prostitution are in many cases not put out of bounds and no prophylaxis facilities are provided.
(6) Medical officers fully provided with facilities for administering prophvlaxis should
accompany all troops and leave trains.
Pershing
Medical officers will be held responsible for any lack of supplies.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
DIRECTIONS FOR GIVING PROPHYLAXIS
(To be posted in all prophylactic stations)
1. Patient will urinate and proceed as follows:
2. Wash hands.
3. Roll up shirt and drop trousers and drawers to knees.
4. Pull back foreskin and wash head of penis very thoroughlv with warm running water
and liquid soap, great care being taken to cleanse undersurface around " G string" and back of
head. After this, wash shaft of penis and adjacent part of body. If there is no running water,
clean basin with clean water and liquid soap will be used. The basin, after use, will be washed
with water and then partially filled with bichloride solution (1 to 1,000) and allowed to stand
for at least 1*5 minutes before being used again.
5. While foreskin is drawn back, wash penis, particularly the head, with warm bichloride
solution (1 to 1,000). This is best done by allowing the solution to flow over it.
APPENDIX
1043
0. The attendant, without touching genitals, will inject slowly one teaspoonful of a 2 per
cent solution of protargol or a 10 per cent solution of argyrol into the penis and, as the syringe
is withdrawn, he will direct patient to close the opening of the penis with the thumb and fore-
finger and retain solution for five minutes.
7. Pull back the foreskin; rub one teaspoonful of calomel ointment all over the head of
the penis and the inner surface of the retracted foreskin, being careful to rub it in on the under-
surface, around the "G string" and in the furrow behind the head. The rubbing of this
ointment should continue for three minutes. After this the surplus ointment will be well
rubbed over the shaft of the penis.
8. The penis is then wrapped in a toilet paper and the patient directed not to urinate for
at least four hours.
9. If more than three hours have elapsed since exposure, the patient, after having taken
the regular prophylaxis, will be directed to report twice a day for two days for an injection of
1 per cent of solution of protargol. This will be held in 10 minutes.
Circular No. 76.
American Expeditionary Forces,
Chief Surgeon's Office,
April 21, 1919.
I. Identification disks of prisoners of war patients. — (1) Identification disks of pi isoners
of war patients undergoing treatment will not be removed from the patient excejjt in case
of death.
(2) In event of the latter, one portion of the disk will be buried with the body or
attached to the grave marker; the other will be transmitted to the central records office,
prisoners of war information bureau.
(3) The information bureau reports that many hospitals have been forwarding them
in all cases. Such practice will be discontinued, as it causes considerable confusion.
II. Disposition of unserviceable medical property. — (1) Commanding officers of hos-
pitals and other medical units, upon receipt of orders to abandon and turn in equipment,
will forward without delay to this office a list of all unserviceable property on hand. Upon
receipt of this information, instructions will be given from this office as to disposition of
same.
III. The following telegram from general headquarters, is quoted for your guidance:
Sd four nine eight five period Vocational strength return has been discontinued period
Orders will be issued shortly period Please notify all concerned period Ulio.
IV. Discontinuance of use of lipo-vaccines. — (1) The following circular from the office
of the Surgeon General, United States Army, is published for the information and guidance
of all concerned:
Circular Letter 134.
War Department,
Office of the Surgeon General,
Washington, March 12, 1919.
Subject: Return to saline vaccines.
1 Beginning with date of receipt of this letter, saline triple typhoid vaccine and saline
pneumococcus vaccine, types I, II, and III, will be used in place of the corresponding lipo-
vaccine used to date. . <• . u • i • i
2 Lipo-vaccines were adopted as a war measure on account of their obvious advan-
tages and have served their purpose. The technique of manufacture, however, needs further
improvement, and the duration of their protective power as compared with that of saline
vaccines needs further investigation. Saline vaccines will, therefore, be used as a routine
and lipo-vaccines will be reserved for emergencies at ^- i a u i . • +
3 All surplus lipo-vaccines will be returned to the Army Medical School, W ashington,
D C.' and to s'ich place as may be directed in the American Expeditionary Forces.
4. Saline vaccines can be obtained by direct request to the commandant. Army Medical
School^ Washington, D. C, as heretofore.
Bv direction of the Surgeon General. r,
IX. uarnall,
Colonel, Medical Corps, United States Army,
Executive Officer.
1044
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
2. In compliance with the above instructions all lijio-vaccine (triple typlioid and
pneumococcus) manufactured in the United States will be reserved for emergency use.
Saline vaccine will be used as a routine.
3. One carton from each batch number will be mailed to the commanding officer, _
central Medical Department laboratory, A. P. O. 721, for further study of its biological
and immunological properties.
4. Adequate supplies of triple typhoid saline vaccines are expected in France at any
moment and will be distributed immediately after arrival.
5. In connection with saline vaccines, the particular attention of all medical officers
administering them is directed to the fact that it will be necessary to revert to the system
of administering three doses at intervals of seven days, in accordance with instructions
contained in Circular 16, Surgeon General's Office, 1916. Copy of instructions for adminis-
tration will be found in each carton of the vaccines.
6. Because of the unanticipated delay in the arrival of vaccine from the United States,
and the numerous changes in the location and strength of the various organizations of the
American Expeditionary Forces, all pending requisitions for typhoid lipo-vaccine hereto-
fore submitted under the provisions of Section II, General Order 31, general headquarters,
A. E. F., 1919, are hereby canceled. The surgeon (senior medical officer) of each district,
camp, post, or other independent command will make requisition for the necessary saline
vaccine, syringes, and needles, requisitioning for an adequate number of syringes and needles
for the men to be revaccinated. If adequate supplies of syringes and needles already are
on hand, that fact will be noted on requisitions and these items will be omitted.
a. The senior medical officer on duty at the first replacement depot, St. Aignan
Noyers, will be held responsible for the vaccination of all casuals passing through that depot
and will make requisitions for adequate amounts of vaccine for distribution throughout
the area.
b. The division surgeon of each division of combatant troops will make a consolidated
requisition for all troops constituting his division and arrange for its distribution through
the divisional medical supply officer. If the division is attached to an armj^ the consoli-
dated requisition will be forwarded to the chief surgeon of the army. If under the orders
of the Services of Supply, the consolidated requisition will be forwarded as indicated below.
c. Requisitions for all units, including divisions, in the American embarkation center
will be forwarded to the chief surgeon of that center, who will authorize the issue of the
necessary vaccine.
d. Except as indicated above, all requisitions will be sent to the director of the division
of laboratories and infectious diseases, A. P. O. 721, Dijon, for visa, and forwarded by him
to the appropriate distributing center for issue. In making requisitions, each unit com-
prising a command will be enumerated, giving exact designation and location of unit, actual
number in that unit to be vaccinated, and American post office number.
e. Because of the scarcity of syringes and needles, the difficulty in getting a suffi-
ciently large amount of the vaccine, and the necessity for preventing the requisitioning of
vaccine for the same individuals or units by different medical officers, extreme caution is
enjoined in making and forwarding these requisitions. A requisition will be forwarded until
assured by direct inquiry of the next higher or subordinate medical officer that requisition
for vaccine for the command has not been made.
(7) Special attention is invited to the absolute necessity for entering the exact status
of the vaccination of each individual in the soldier's individual pay record book, and in the
case of officers making a similar entry in the officer's record book of captains and lieutenants
or furnishing them with a certificate. These entries must be made at the time the vaccine
is administered. This information must include the date of vaccination and kind of vaccine
used. If saline vaccine is administered, the date and whether first, second, or third dose.
(8) Strict compliance with instructions outlined above is enjoined. The foregoing
instructions are not to be construed as requiring further revaccination with safine triple
vaccine of any member of the American Expeditionary Forces who has been revaccinated
with triple typhoid lipo-vaccine in France.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
APPENDIX
10i5
Circular No. 77:
American Expeditionary Forces,
Chief Surgeon's Office, Services of Supply,
April 22, 1919.
Cases of typhus fever have recently been reported in France, and it is being reported
constantly from central Europe.
Liberated people from Alsace-Lorraine and the Rhine Valley, and especially those who
liave been in Ukraine, Poland, and Russia, are the principal carriers of the disease. Allied
prisoners returned from Germany are also special source of danger.
It is therefore necessary that medical officers in the American Expeditionary Forces be
on the alert for the appearance of the disease among United States troops.
Typhus fever may show all gradations in severity, from mild cases to those of mahgnant
type. The following is a brief summary of clinical evidence in a case of moderately severe
typhus fever:
Prodromes are usually so light as not to attract attention or cause complaint. The
individual may have a Httle "indigestion," headache, or weakness. He may look tired,
feel a little dizzy and "achj-.''
The onset is abrupt. Severe chills and violent headache and pains in the back and
limbs are the rule, while often profuse nosebleed and vomiting occur. The temperature
rises rapidly to 102° or 103° F. The patient's face is flushed and his conjunctiva; injected.
He feels very sick.
The eruption appears on the fourth or fifth day. It is rarely altogether lacking. It is
often abundant and widespread. It appears first on the trunk — the armpits and shoulders —
then on the abdomen and limbs.
The eruption is of two types, (1) a deep subcuticular mottling or marbling and (2)
rose-colored spots about the size of a pinhead or somewhat larger. These spots at first
disappear on pressure. In a few days many of them appear somewhat petechial and do
not disappear under pressure. More rarely the ecchymotic character progresses to a dis-
tinctly purpuric appearance. The spots persist for 5 to 10 days.
The fever is sudden in onset, as has been stated, and continues high, with slight remis-
sions, to terminate at the end of the second week by a defervescence during two or three
days, sometimes by crisis.
Nervous and mental symptoms are prominent and may be present from the beginning,
a mild or more active delirium, later coma-vigil, subsultus tendinum, prostration, and stupor
are noted. The stuporous state of typhus is particularly characteristic.
The pulse rate follows the temperature. The beat is full and rapid at first; later it is
small and feeble.
Respiratory tract: Bronchial catarrh is common. A dry cough at first is the rule.
Later the expectoration is increased and may become profuse and even purulent.
Differential diagnosis, in the present situation, involves a consideration of typhoid fever,
influenza, and measles.
(a) Typhoid fever shows a much more gradual onset. Injection of conjunctivae is
absent. The rash comes later, is less abundant, and the rose spots are rarely hemorrhagic;
i. e., they disappear on pressure. The "typhoid state" comes later, and is more mild than
in typhus. Prompt laboratory examinations will estabhsh a positive diagnosis.
(6) Influenza includes so many clinical pictures that it must be considered here. It
may be confused with typhus during the first three or four days. But the decline of the
temperature in influenza after the third or fourth day and the absence of the rash will deter-
mine the diagnosis.
(c) Measles presents a rash that may be confused with that of typhus. But the pro-
dromal coryza and the defervescence following the eruption distinguish it from typhus.
The eruption is prominent on the face in measles; facial eruption is rare in typhus.
Laboratory diagnosis of typhus fever. — The Felix- Weil reaction is of value. This is an
agglutination of B. proteus X-19 by the serum of a patient sick with typhus fever. B. proteus
X-19 is not the cause of typhus fever. The reaction is therefore, not specific. But it has
considerable diagnostic value.
1046
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Technique. — The bacterial emulsion should be prepared from a young agar culture
(16 to 18 hours old). The emulsion should be freshly prepared; old emulsions do not
agglutinate well.
The macroscopic method is used.
Serum dilutions from 1 to 100 to 1 to several thousands are used. (Typhoid patient's
serum will agglutinate B. proteus X-19 at 1 to 25 or 1 to 50 in 10 per cent of cases.)
Time and temperature of the reaction. — Thirty-seven degrees centigrade for one hour,
or room temperature 10° to 15° C. for two hours is used.
A rapid agglutination of B. proteus X-19 in a serum dilution of 1 to 100 or 1 to 200 in
30 minutes is of great value.
The agglutinins appear in the blood in typhus fever between the fourth and eighth
days, reach their maximum titer (1 to 500 to 1 to 10,000) about the eleventh day, and decrease
rapidly after the twentieth day. Agglutinins may be demonstrable in the blood of typhus
convalescents as late as two months after recovery.
Cultures of B. proteus X-19 will be furnished on api)lication to central Medical
Department laboratory, A. P. O. 721.
Prophylaxis and sanitary control of typhus fever is based on the following facts:
(1) It is transmitted by the body louse {Pediculus vestimenti) and perhaps also by the
head louse.
(2) The louse having bitten a typhus patient, does not become capable of transmitting
the disease until nine daj-s have elapsed.
(3) The incubation period of the disease — that is, the lapse of time between the infectious
bite and the appearance of symptoms — is 6 to 10 days.
From these facts it follows that the most effective protection consists in careful delousing
of all members of the American Expeditionary Forces.
The early diagnosis and discovery of all cases of the disease is an essential element
in prophylaxis.
Mild or abortive cases, because they are likely to be overlooked, are a special source
of danger. The possibility of the disease should be constantly borne in mind.
In the event of the occurrence of a case, the organization and quarters will be subjected
to strict quarantine.
Men and their equipment will be deloused every third day.
Careful examinations of the individual men will be made daily.
Quarantine will not be lifted until 21 days after the discovery of the last case. A delous-
ing of the men and their equipment and a disinfection of their quarters will be made on
the last day of the quarantine.
The same measures will be applied to hospitals. A rigid quarantine of all personnel
coming in contact with the case will be enforced.
Walter D. McCaw,
Brigadier General, Medical Corps,
Chief Surgeon.
Circular No. 78. '
American Expeditionary Forces,
Chief Surgeons' Office
April 25, 1.919.
1. The following regulations will govern the investigation of cases of venereal disease
and the control of venereal prophylaxis.
2. All cases of venereal diseases following failure to take prophylaxis will be investigated
and the reason for the failure ascertained and recorded.
3. All cases of venereal disease which develop after having taken prophylaxis will be
investigated and the cause of the failure of the treatment ascertained and recorded.
4. Medical officers, so far as possible, will collect all men at present in their charge
who have had syphilis, and explain to them the course to pursue after demobilization in
order to insure a complete cure.
5. All men who have had chancroids since enlistment will have Wassermann tests done
before returning to the United States. If the blood is found positive, they will be retained
APPENDIX
1047
for one course of specific treatment. If the responsibility for this treatment being giveji
on ship or in the United States will be assumed by the medical officer, the patient may be
allowed to proceed with his resignation.
PROPHYLAXIS ST.\TIONS
Attendants. — The attendants will be selected from among the best men in the organiza-
tion. A noncommissioned officer will be in charge of each station. The men will be
instructed on the following things:
(a) The meaning and method of obtaining surgical cleanliness.
(6) Simple facts about pathogenic micro-organisms, with special reference to those
causing venereal disease. This instruction will include laboratory demonstrations of
cocci, bacilli, and spirochetal.
(c) Simi)le descriptions of the anatomy and physiology of the male and female organs.
(d) Descriptions of the ordinary symptoms and course of the three venereal diseases,
(fi) In the making of solutions of protargol and bichloride.
(/) Method of prophylaxis and scientific reasons for each step.
(g) Each section surgeon will form a central school at which all men having charge of
the prophylactic stations will be trained.
(h) The importance of the work will be impressed on the attendants, and everything
possible will be done to arouse their interest, pride, and a cooperative spirit in the work.
Technique. — The technique of administration of the prophylaxis will be on a par with
that of a minor surgical procedure. Anything less than this will be faulty.
Stations. — Care will be exercised in the placing of stations; regard for privacy will be
observed. At least one room will be given to the station, which will be painted white and
made as inviting as possible. A waiting room for large stations is desirable. The gen-
eral arrangement and cleanliness of the station will correspond to that of a modern surgical
dispensary.
Running water will be installed wherever practicable. The most economical plan is to
have several faucets arranged over a washing trough made of concrete or zinc; if available,
porcelain sinks (individual) are preferred. When possible, individual booths will be made
l)y the erection of partitions or curtains. Near each faucet will be a bottle of liquid soap
with a split cork. Warm water will be provided if possible. When a water system is not
at hand, running water will be supplied by means of an elevated galvanized-iron can to which
a pipe or hose is connected. In temporary stations where basins will be used, a sufficient
supply will always be on hand to insure the cleanliness of the individual basins.
Washing possesses the following advantages:
(a) It has been shown that soap is germicidal for the spirocheta; pallida.
(h) It removes mucoid substances and allows better penetration of the calomel ointment.
(f) It opens minute wounds or cracks in which micro-organisms may have lodged and
allows the calomel ointment to come in contact with them.
(d) It mechanically removes a large portion of the organisms present.
Bichloride solution. — The washing with bichloride solution is essential and is necessary
in connection with the washing with soap and water to destroy Ducrey's bacilli, since it
has been shown that neither calomel ointment nor protargol solution is germicidal for this
organism. The most satisfactory method for use of the bichloride is to have a large bottle,
demijohn, or earthenware vessel holding not less than a gallon, with a rubber tube attached,
I)laced on a wall bracket just above the trough. The bichloride solution will immediately
follow the soap and water.
The following articles are the minimum requirements of a station:
1. A Primus oil stove for sterilization.
2. A stew pan or fish kettle with cover, for boiling.
3. A sterilizer for the sterilization of sponges. This may be made out of two tin buckets,
one slightly larger than the other so that the larger may be inverted over the smaller. A
rack of some kind is placed on the bottom of the inner bucket so as to hold the sponges or
other articles above the water.
1048
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
4. A long clamp for the removal of the sterile syringes, wooden spatulas, and sponges
from their respective containers, thus avoiding the necessity of the patient putting his hands
in these containers.
5. A sufficient number, never less than 12, of good workable syringes.
6. A closed receptable in which to keep the sterile syringes.
7. A number of wooden spatulas, which will be made by the attendant. These are
for the removal of the ointment from the jar.
8. A closed glass receptable in which to keep the sterile wooden spatulas.
9. A glass jar or some kind of vessel for the sterile gauze sponges.
10. An adequate supply of wash basins, certainly not less than 10, if running water is
not at hand. . , . , . , . , n i
11. Small glasses similar to ordinary medicuie glasses in which protargol will be poured
just prior to its being used.
12. A supply of gauze sponges.
13. One 8-ounce dark-colored bottle for the stock solution of protargol.
14. A supply of 30 per cent calomel ointment.
15. A supply of protargol or argyrol.
16. Some means of weighing or measuring the protargol so that small quantities of tlic
solution may be made up, thus avoiding the necessity of using a whole ounce at one time.
17. A supplj- of bichloride tablets.
18. A small clock placed where the patient may see it.
19. A roll of paper.
20. A place for the patient to wash his hands.
21. A sufficient number of small towels 8 by 10 inches so that each patient may have a
clean one.
Regulations. — 1. The syringes will be sterilized by boiling and will be kept in a sterile
vessel. Bichloride solution will not be used for this purpose.
2. The calomel ointment will be removed from the container by means of sterile spatulas.
3. Solution of protargol will be a uniform strength of 2 per cent, will be made fresh
each week, and will be kept in a dark bottle. The date of making solution will be written
on bottle.
4. Protargol solution will never be left standing in an open glass.
5. Basins will always be sterilized with bichloride solution after use.
6. The bichloride will have a uniform strength of 1 to 1,000.
7. Cake soap will not be used.
8. When prophylaxis is given to any soldier who is not a member of the organization
to which the station belongs, a duplicate prophylactic record will be sent on the following
day to the man's organization.
9. The data on the prophylactic cards will be transferred to a book which will be kept
for permanent record.
Circular 79.
American Expeditionary Forces,
Chief Surgeon's Office,
May 9, 1919.
1. Disposition of medical supplies. — 1. On receipt of an order by a medical unit to cease
to function, such medical unit will pack up and prepare for shipment all of their hospital
property and turn over such to the group or center medical supply officer prior to their
departure. The personnel of a medical unit will not be relieved until this is done in a satis-
factory manner.
2. The following instructions as to preparation of medical property, to be turned in to
group medical supply depots, will be observed:
This property will be classified as follows:
(a) Articles that are new and have have never been used.
(6) Articles that have been used but which are serviceable and fit for reissue,
(c) Articles that are unserviceable but which can be repaired at a cost not to exceed
their value when so repaired.
APPENDIX
1049
{(1) Articles which are not worth repairing but which are of vahie for the raw material
of which they are composed.
After the above classification has been made, all property will be put up in compact
and easily handled packages. One type of article only will be placed in the same package,
and the number of articles in a package will be nearly as possible as commercially received.
Whenever possible, baling, sacking, or crating should replace boxing, and except in case of
large bulky articles contents should be in 5's or 6's, or multiples thereof. Fragile articles
will not be packed loosely or without packing material. All enamel ware should be wrapped
in paper or such material as will prevent chipping.
(a) Medicines will be carefully packed in boxes, with excelsior. Amount in boxes
will be as follows:
1-quart in bottle, 12 bottles to box.
1-pint or pound bottles, 25 bottles to box.
i/^-pint or 3^-pound bottles, 50 bottles to box.
3-ounce or smaller bottles, 100 bottles to box.
Attention is called to the instructions in Circular No. 68, III, that narcotics, mor-
l)hine, cocaine, etc., must not be turned in to salvage depots, but must be sent to the nearest
medical supply depot.
Save in exceptional cases, no more than 100 bottles of medicine will be packed in a
case, and only one kind of medicine or size of bottles will be packed in a box. Mineral
acids or inflammable or corrosive substances will be packed in sand or some noncombustible
material and is preferably packed in small quantities.
(6) Tables, bedside, P'rench, will be tied in bundles of 5.
(c) Tables, bedside, folding, American make, when crated will be in bundles of 10,
and when not crated will be tied in bundles of 5.
(d) Chairs, folding, will be arranged as are folding bedside tables, American make.
(e) Bedsteads will be sorted as to kind and make and may be sent in unpacked.
(/) Mattresses will be sorted as to kind and make and where possible will be burlapped
in bundles of 5. ^
(g) Bedding and linens will be arranged as indicated in Circular 72, chief surgeon s
office, A. E. F., March 15, 1919, and section (b), paragraph 1, of that circular is modified
as follows:
One sack (18 by 36 inches) will hold approximately as follows: 24 sheets, 20 pajama
suits, 36 bath towels.
(h) X-ray apparatus as follows:
(1) All fluroscopic and intensifying screens should be packed in a separate case, care-
fully protected from moisture and abrasion.
(2) All X-ray tubes in good condition for service should be shipped in the same form
of container as received from the depot.
(3) Broken or punctured X-ray tubes should be broken and the metal parts wrapped
up labeled, and forwarded to the depot, wliere they will be taken up in place of the tube.
(4) Plates and films should be shipped in a separate container and properly labeled.
(5) MiUiammeters should be removed from machine, excepting in the case of the
bedside or the United States Army portable, and shipped in a separate box with excelsior
or paper to protect them from injury. , , u
(6) All small parts which might become loosened or lost m shipment should be tied
or wired to the part to which they belong. ^- • • ■+ ^
\11 property will be thoroughly cleaned before being turned m. Attention is invited
to paragraphs 512 and 526, Manual of the Medical Department, 1919, and particularly
to paragraph 524 relative to packing of typewriters.
All unserviceable articles will be turned in as salvage only They will be properly
listed in the order and in the nomenclature of the supply table and must have a certificate,
with supporting affidavits if obtainable, stating whether condition was due to fair wear
and tear in the service. , . , . +1 + « +
No supplies or property of any kind will be turned in to a group depot without first
furnishing the medical supply^ officer with a list of such articles, with the approximate amounts
of same and making with that officer such arrangements as will prevent confusion in their
1050
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
receipt. Duplicate loading lists will be sent with every truck load of supplies sent to local
depot. One of these copies will be returned to consigner, signed by the receiving checker.
3. Group or center commanders will effect such cooperation on the part of the unit
supplv officer and the group or center medical supply officer as will aid and facilitate the
work of the latter and will arrange for the detail of a sufficient force from the nonfunctioning
units of his center as will be necessary for the final disposal of all medical property at such
center.
4. Group or center medical supply officers and supply officers of independent medical
units will be guided by instructions contained in paragraph 2 above, wherein they apply
to the preparation of their own supplies for shipment, whenever orders are issued for dis-
continuance of such organizations and for the final disposal of their complete stocks.
II. Correction. — 1. Attention is invited to Circular 78 (minimum requirements for pro-
phylactic stations), item 21, which is changed to read as follows: "A sufl^cient number of
small towels 8 or 10, so that each patient may have a clean one."
III. Treatment of chancroids before embarkation. — 1. Due to inability to procure dark
field microscopes and to the absence of specially trained medical officers in certain centers,
many of the cases which were diagnosed as chancroid were either chancre or mixed infections.
Recent careful examinations have shown that about 40 per cent of all sores occurring in the
American Expeditionary Forces are syphilitic. In view of this it is requested that the
attention of all organizations under your jurisdiction be directed to collect from all of their
available records the names of all men who have had chancroid. All of these men who
are available will be given an immediate Wassermann, and those found positive will be given
one course of the standard treatment for syphilis. These cases will not be reported, as
new cases, but each will be given a syphilitic register. Those preparing for embarkation
will be given treatment provided there is time before sailing, but they will not be detained
for it.
IV. Nurses' records of assignment and pay. — 1. In reference to paragraph 8, Circular
52, this office, October 22, 1918, the attention of all concerned is invited to the fact that
records of assignment and pay of nurses should accompany them on change of station and
should not be mailed to this office. Strict compliance with these instructions is necessary
in all cases to avoid delay in payment of nurses.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
Circular No. 80.
American Expeditionary Forces,
Chief Surgeon's Office,
May 15, 1919.
I. Discontinuance, central Medical Department laboratory and Army laboratory No.
1. — (1) The central Medical Department laboratory, Dijon (Cote d'Or), and United
States Army laboratory No. 1, Neuf chateau (Vosges), will cease to operate May 15, 1919.
After that date pathological, bacteriological, and serological examinations not possible of
accomplishment with the facilities at hand will be made for such units as remain in the
advance section and intermediate section, by the base laboratory, intermediate section.
Tours. Therapeutic biological products, containers for specimens, and prepared culture
media, formerly furnished by the two laboratories mentioned above, will be obtained, after
May 15, from the nearest base laboratory still operating.
(2) Laboratory animals, agglutinating sera for diagnostic use, and amboceptor and
antigen will be obtained from base laboratory, base section No. 5, Brest, by all Medical
Department units in France, and in the instance of units in occupied territory in Luxem-
bourg and Germany., from the Third Army laboratory, Coblenz, Germany.
(3) Bacteriological cultures for confirmation of diagnosis from Medical Department
units serving in the Services of Supply, A. E. F., will hereafter be sent to base laboratory,
base section No. 5, Brest, those from the Third Army to Coblenz, Germany.
(4) Pathological specimens, photographs, and other museum specimens will hereafter be
carefully packed in compfiance with the instructions in Circular No. 58, chief surgeon's
office, A. E. F., December 2, 1918, and shipped direct to the Armv Medical Museum Seventh
and B Streets SW., Washington, D. C. '
APPENDIX
1051
(5) The office of the director of laboratories, Dijon (Cote d'Or), will be transferred to
the office of the chief surgeon, A. E. F., Tours on June 1, 1919. All correspondence, requisi-
tions, reports, and returns heretofore submitted to the office of the director of laboratories,
Dijon (Cote d'Or), (A. P. O. No. 721) will, after June 1, be directed to the director of labora-
tories, chief surgeon's office, Tours (A. P. O. No. 717).
(6) Such provisions of Memorandum No. 21, office of the chief surgeon, division of
laboratories and infectious diseases, September 18, 1918, as may conflict with the above
l)rovisions, are hereby rescinded.
II. Reports of communicable diseases when closing hospital formations. — 1. In carrying
out the final evacuation of patients, failure to report cases of communicable diseases which
have developed in or have been admitted to the hospital within a few days prior to the evacu-
ation is common. The confusion of the process of closing of a hospital is no excuse for the
neglect of Section XII, Sick and Wounded Reports, which must be complied with promptly
under all circumstances.
III. Sale of unserviceable material and supplies. — 1. The following instructions have
been received from the United States Liquidation Commission, War Department:
Paris, May 8, 1919.
Commanding General, Tours:
Authority has been obtained from F'rench Government for American Expeditionary
Forces to sell in France unserviceable material and unserviceable supplies now on hand
or such as may accumulate at the various stations throughout France.
The unserviceable material and unserviceable supplies are defined as junk, scrap ma-
terial, unserviceable salvage material and supplies, and unserviceable property and material
and supplies not worth transporting to depots.
These sales may be made under direction of the chiefs of the various services with-
out reference to United States Liquidation Commission, War Department, for approval.
Please advise all services interested, but instruct them to make no sales in excess of
authority granted herein.
Suggest necessary publicity be given to sales by advertising in newspapers where
advisable and by handbills, posters, and circular advertisements.
Krauthofp; G. S. A.
A-182.
By authority of United States Liquidation Commission, War Department.
2. Under the above authority, all unserviceable property and supplies, as well as
material and supplies not worth transporting to depots, will be disposed of on the ground,
after survey, under the provisions of paragraph 678, Army Regulations. It is desired that
survey be instituted with a view of directing sale in compliance with the above instructions.
3. The proceeds of sales held under the above authority will be forwarded to the re-
ceiving finance officer, office of the general sales agent, Paris.
IV. Authority to drop property issued from depots from returns. — 1. The following
memorandum is quoted for guidance of all concerned:
American Expeditionary Forces,
Headquarters Services of Supply,
Fourth Section, General Staff,
May 9, 1919.
1. Depot and other accountable officers who have shipped property to regulating
stations for distribution to combat organizations, who have been unable to obtain a receipt
from the regulating officer or the combat organization concerned, are authorized to drop
this propertv from their returns, with a certificate that the property in question was duly
shipped, and that it was impossible, due to the exigencies of the service, to obtain a proper
receipt for the propertv. This certificate should be accompanied, when possible, by the
ordre de transport covering the shipment of the property, or a true copy thereof.
2. Regulating officers have been instructed to return any invoices which they are
unable to accomplish to the proper depot with all information they are able to give on the
shipment in question.
By order of the commanding general: ^ ^ „ , . , , nu - t f 4r r a
J. C. Rhea, Assistant thiej oj otajj, (jt-4.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Sxirgeon
1052 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Circular No. 81.
American Expeditionary Forces,
Chief Surgeon's Office,
June 3, 1919.
I. The optical division, medical repair shop, in Paris, is closed and further prescriptions
will not be filled.
II. Venereal rate. — 1. The venereal rate has been rising for a month past and has now-
reached a point 25 per cent above its general average for several months. The attention
of all medical officers is called to the fact that the Medical Department is held largely re-
sponsible for venereal rates, and that it has taken just pride in its work. There must be
no relax action, and the greatest activity must be carried on to the very end. Every effort
must be made to influence the enlisted men, to obtain the full and hearty cooperation of
commanding and other officers, and of the military police and to maintain prophylactic
stations at the highest point of efficiency. Put a good ending on a good work.
III. Hospital funds. — 1. Hospital funds do not come under the provisions of General
Order 77, general headquarters. May 10, 1919. They should be accounted for to the chief
surgeon in the regular manner.
IV. Promotions in American Expeditionary Forces. — 1. Medical officers are informed
that no more promotions are being made in the American Expeditionary Forces, and it is
therefore useless to continue to send recommendations to the chief surgeon's office. No
action has been taken upon recommendations which reached this office after March 25,
1919.
V. Propertij. — 1. Upon transfer to the French Government of movables pertaining
to the Medical Department in any section of the American Expeditionary Forces under
authority contained in letter from headquarters, Services of Supply, fourth section, general
staff, dated May 27, to section commanders, a report will be made, before transfer is started,
to the chief surgeon's office, attention supplies division, by the section surgeon; giving
location of unit and in general terms, supphes and equipment to be turned over, such as:
"25-bed infirmary, 100-bed camp hospital, etc." It is essential that this information be fur-
nished as early as practicable in order that disposition may be given on any part of equip-
ment which it may not be desired to turn over to the French. A record will be maintained
in this office of all units transferred to the French Government in order to check same against
bills for final payment; also to have data showing outstanding accounts. Section surgeons
are advised that it is the desire of the Medical Department to dispose of as much movable
property in every instance as the French will agree to take over on the ground without ship-
ping same into depots.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
Circular No. 82.
American Expeditionary Forces,
Chief Surgeon's Office,
June 6, 1919.
1. Disposition of records.— 1. Confusion seems to exist in the minds of registrars of
hospitals closing for return to the United States as to the disposition of clinical records of
the Form 55 series and other similar records.
2. These will be carried with the unit to the United States, to be held until disposi-
tion by the Surgeon General's office.
3. The only retained records which will be accepted by the chief surgeon's office are
Form 22, Form 52 (register card), and retained nominal check lists. Every unit closing
its site permanently will, in compliance with Circular No. 61, chief surgeon's office, forward
these records, together with final monthly report of sick and wounded, to the chief surgeon's
office, in charge of the registrar and such personnel as are necessary to insure its prompt
and safe delivery.
II. The following letter is quoted for your information and guidance :
APPENDIX
1053
1. The following telegram from general headquarters, dated May 19, 1919, repeated
for your information and action necessary:
"Qualification cards of officers of staff corps have been delivered to the chiefs of serv-
ices at headquarters Services of Supply, Tours. Cards for officers of divisions and corps,
not a part of the Third Army, have been delivered to the personnel adjutant of their respec-
tive divisions and corps. Cards for officers on duty with base and intermediate sections,
Services of Supph' , not members of the staff corps, have been delivered to the personnel
adjutants of these sections. In the future, requisitions for cards of officers returning to the
United States will be made to the heads of staff corps departments instead of to the officers'
qualification section, general headquarters. Authority for the execution of blank cards will
be obtained from the head of the sections above indicated.
"Davis."
2. Hereafter application for the qualification cards of officers in the various staff corps,
returning to the United States, will be made to the chief of the staff corps to which the officer
belongs.
3. If an officer is transferred from any staff corps his card will be put in a sealed en-
velope and given to him to present to the proper officer at his new station.
By command of Major General Harbord.
L. H. Bash, Adjutant General.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
Circular No. 83:
American Expeditionary Forces,
Chief Surgeon's Office,
June 16, 1919.
I. Circular Letter No. 223, office Surgeon General, is quoted herewith:
Subject: Record card, Form 627, A. G. O., enlisted men of staff corps and departments.
1. Attention is invited to paragraph 41, Manual for the Medical Department, which
directs that:
"When a man is enlisted for, reenlisted in, or transferred to the Medical Department,
the medical officer who first receives him will prepare and forward a record card of the soldier
directly to the Surgeon General, except in the case of a man stationed in the Philippines,
Hawaiian, or Panama Canal Department, when the card will be sent through the department
surgeon." (As amended bv C. M. M. D. No. 3, September 29, 1917.)
2. It is directed that in cases of those who have been enlisted for, reenlisted m, or
transferred to the enlisted forces of the Medical Department since February 28, 1919, a
record card be furnished this office and that in future paragraph 41 of the Manual for the
Medical Department be strictly complied with.
II. Sick and tvounded reports. — 1. Attention of all commanding officers of medical
detachments is again called to the American Expeditionary Forces requirements regarding
sick and wounded reports. Any medical formation habitually hospitalizing for more than
three days is required to render to the chief surgeon, A. E. F., a daily report of casualties
and changes for patients in hospital (Form 22), and to make monthly report on field medical
card and Forms 51 and 52. Infirmaries, small post hospitals, and other similar units will
invariably complv with this when so hospitalizing, and will notify the chief surgeon's office,
immediately by telegraph, that they are beginning to care for patients that, heretofore,
would have been hospitalized in a larger formation.
2. Beginning with the report for July 3, weekly telegraphic report of sick and injured,
Form 86, M. D., A. E. F., will be made direct to the office of the chief surgeon, A. E. F.,
instead of to the surgeons of first replacement depot, embarkation center, Le Mans, and
district of Paris, and sections. Services of Supply. Great care will be exercised to see that
the form checks before the telegram is sent. All units rendering reports mentioned m para-
graph 1 are required to submit this weekly report. The above does not apply to units of the
army of occupation, which will continue to report as heretofore through the surgeon of that
army. . ^ . r o i i
3 At the time of report for June 26, each surgeon of section Services of Supply and
independent center will forward to the chief surgeon, A. E. F., a final list of units sending
this report through his office, giving designation, location, strength, and complete "K' line
for each unit so reporting.
1054
ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
III. Method of closing accountability for medical supplies upon turnover to French authori-
ties.— 1. Upon completion of turnover to the French authorities under the provisions of
letter, headquarters, Services of Supply, fourth section, general staff, dated May 27, 1919,
of property and supplies for which a medical property return is being rendered, an extra
copy of the receipted inventory as furnished by the French and American representatives
will be submitted with final return of medical property and constitute a voucher covering
the entire accountability to be dropped. If it is impracticable to obtain an additional copy
of this inventory signed by both representatives, a certified true copy of same will be fur-
nished in lieu thereof.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
Circular No. 84.
American Expeditionary Forces,
Chief Surgeon's Office,
July 1, 1919.
I. Sale of property. — 1. Sales of unserviceable property as indicated in Section III,
Circular 80, this office. May 15, 1919, is suspended. Due notice will be given when such
sales may be resumed; and when such is done, the following instructions, contained in letter,
commanding general A. E. F., Services of Supply, June 29, 1919, regarding the disposal of
such supplies, will be observed:
In order to put a stop to practices which have obtained heretofore in the disposal of
Government property, the following instructions will be communicated to all concerned and
steps taken to see that the full intent of these instructions is complied with when sales arc
again authorized.
(o.) No material will be sold under the heading of scrap or junk which ought not to be
so classed.
{b) Property such as typewriters, wagons, motor vehicles, and miscellaneous machincrv
and equipment, which is not in immediate working order and can be so placed with little
expense, will not be classed as scrap or junk. Such property and all property which can hv
rendered fit for good second-class sale with some slight repair will be cared for and property
listed for sale.
(c) When sales are resumed, sales of any kind, including sales of junk, will not be made
at stations where there are troops until or unless it is necessarv to make such sales in order
not to delay the departure of troops at that station, and then onlv sales of material which is
really junk and beyond repair.
Walter D. McCaw,
Brigadier General, Medical Department,
Chief Surgeon.
Circular No. 85:
American Expeditionary Forces,
Chief Surgeon's Office,
July 30, 1919.
The following revised instructions as to civilian laborers are published for the informa-
tion and guidance of all concerned:
1. Laborers of the administrative labor companies are in all cases entitled to the same
medical care and infirmary treatment awarded to United States troops. When hospital-
ization IS necessary, agreement has been made with the French Government wherebv French
civilian laborers will be evacuated to French civilian hospitals.
2. In cases of emergency any laborer may be admitted to American Expeditionary
I^orces hospitals, but as soon as practicable these cases should be evacuated.
3. Cases of venereal disease are to be evacuated to the hospital when necessarv in the
same way as other cases, but for this class of cases French hospitals shall be used exclusively.
4. By agreement with the French Government, the American Expeditionary Forces
are not required to pay for care and subsistence for cases of venereal disease while in hospital
5. Transportation of sick and injured laborers to and from hospital is furnished and
provided for by section 1, paragraph 4, General Order 26 Services of Supply as follows-
APPENDIX
1055
, The transportation department will furnish the necessary transportation for all laborers
wlio may be discharged, transferred, or leave by the termination of contract, upon the request
of the commanding officer of the labor company to which the laborer belongs.
6. Subsistence for laborers in American Expeditionary Forces' hospitals is provided
for by section 1, paragraph 8, General Order 26, Services of Supply, c. s., as follows:
When laborers employed under contract through the general purchasing agent are
admitted to a United States military hospital, they will receive the same subsistence furnished
United States troops. The Quartermaster Corps will reimburse the hospital fund at the
rate prescribed in existing orders applicable when soldiers of United States Army are admitted
to hospitals.
7. The surgeon on duty with the labor companies will have general supervision over
the sanitary conditions of these companies, reporting upon same under paragraph 5, Form No.
2, M. D. L. B.
8. The surgeon, medical division, labor bureau, Army Service Corps, A. P. O. 717,
should be notified at once by the surgeon attached to the labor company on Form No. 1,
M. D. L. B., in all cases when laborer is —
(1) Admitted to hospital,
(2) Transferred to French hospital,
(3) Dies, or
(4) Suffers from any condition, though not necessitating admission to hospital, may
have bearing on any future claims against the Government.
The same action will be taken in cases of emergency admissions to American Expedi-
tionary Forces' hospitals or infirmaries by the commanding officers of the latter.
9. Diseases and injuries will be described in all reports in accordance with nomenclature
prescribed in article 17, page 18, Sick and Wounded Reports for American Expeditionary
Forces.
10. It is requested that special care be taken in reporting injuries, namely, giving
definitely the nature of injury, manner incurred, and anatomical parts involved.
11. Form No. 2, M. D. L. B., will be submitted promptly each week, the week ending
midnight Tuesday, and will embody all the data called for upon said report.
12. Whenever laborers are employed or discharged, the surgeon will make a thorough
physical examination embraced under the following headings: "Height," "weight," "gen-
eral examination," "head," "chest," "abdomen," "genital organs and anal region," "extrem-
ities." These reports should be forwarded promptly to chief of medical division, labor bureau.
13. Venereal disease is not necessarily a case for rejection, but all acute cases and every
case that may make the individual a menace to his associates should be considered sufficient
grounds for rejection. The presence of developmental and acquired abnormalities or defects,
that in themselves are not sufficient cause for rejection, should always be noted on the physical
examination report.
14. All reports and correspondence relating to civilian laborers by surgeons attached to
labor companies will be made to the chief of the medical division, through the base surgeon.
By order of the chief surgeon :
L. Mitchell,
Lieutenant Colonel, Medical Corps, United States Army,
Chief, Medical Division, Labor Bureau.
13901—27 67
THE MORE IMPORTANT MEMORANDA PROMULGATED BY THE
DIVISION OF LABORATORIES AND INFECTIOUS DISEASES,
A. E. F.
From: The director of laboratories, A. E. F.
To: The division surgeon, division.
Subject: Divisional laboratory unit.
1. The accompanying letter of information is intended to define the organization,
equipment, and scope of work of the divisional laboratory.
2. The section of infectious diseases of this office has been organized for the instruction of
divisional laboratory personnel and the advisory reinforcement of divisional facilities in the
control and suppression of communicable disease. Paragraph 4 of the accompanying memo-
randa states the mechanism by which this reenforcement can be obtained when desired by
division surgeons.
3. As the divisional laboratory persormel (mobile laboratories), in many instances, is
not coming to France as an integral part of divisions, but arriving as casual vuiits, division
surgeons are experiencing some difficulty in locating this personnel.
In order to overcome this difficulty, the chief surgeon, A. E. F., has been requested to
automatically order all these units to the central Medical Department laboratory for special
instruction, to obtain equipment, and for assignment to divisions.
4. If your divisional laboratory personnel (1 medical officer, 1 Sanitary Corps officer,
and 4 enlisted men) did not arrive as an integral part of your division, the personnel and equip-
ment will be supplied by this office, as soon as available, on written or telegraphic request
from you.
5. If your divisional laboratory personnel arrived with your division and has not received
special instruction and equipment from the central Medical Department laboratory, it is
requested that the names of the commissioned officers, two in number, be submitted to this
office in order that we may request orders for them to proceed to the central Medical Depart-
ment laboratory for temporary duty.
(Office letter 5-a {revised), division of laboratories and infectious diseases, July 7, 1918.)
OUTLINE OF ORGANIZATION AND ADMINISTRATION OF LABORATORY ACTIVITIES IN HOSPITAL
CENTERS
1. In order that building space, equipment, and personnel may be conserved and at the
same time that units comprising hospital centers may be given high-grade laboratory service,
it has become necessary to pool the laboratory facilities of such units and to establish a base
laboratory which shall serve equally all units comprising the center together with small
subsidiary laboratories attached to each unit.
2. The plans of organization contemplate that all highly technical bacteriological,
serological, pathological, and medical chemical work shall be done at the base laboratory of
the center and that the small subsidiary laboratories shall be equipped for clinical pathological
examinations only.
PERSONNEL
3. The allowance of personnel estimated for in the proposed revision of the Tables of
Organization is 6 officers and 18 enlisted men. This is only an estimate, however, and the
personnel may be increased, decreased, or distributed to meet local conditions.
4. Laboratory personnel, as outlined above, should be detailed by the commanding
officer of the hospital center from the personnel of the units comprising that center. French
women should be utilized as laboratory technicians wherever possible, thus releasing enlisted
men for other duties. Requests for the employment of such women will be made to the chief
surgeon, A. E. F., through the commanding officer of the hospital center and paragraph 3,
General' Order 13,' headquarters A. E. F., July 13, 1917, compiled with.
1057
1058
ADMINISTBATION, AMERICAN EXPEDITIONARY FORCES
5. The laboratory officer of a hospital center will be detached from his unit and attached
to the staff of the commanding officer of the hospital center. All other laboratory personnel,
commissioned and enlisted, will be attached to the laboratory service for professional dutie>
only and be carried administratively on their unit returns.
DUTIES OF THE LABORATORY OFFICER, HOSPITAL CENTERS
(a) In charge of base laboratory.
lb) Responsible to the commanding officer of the hospital center in all matters relating
to laboratory activities.
(c) General supervision of the subsidiary laboratories.
(rf) Direct supervision and control of all laboratory personnel under the commanding
officer of the hospital center.
(e) Correlation of the activities of the laboratory service, both central and subsidiary,
with those of the clinical service served.
(/) Advisor to the medical supply officer of the center as to issue, distribution, and
requisitioning of laboratory supplies for his center.
The name of one medical officer, well grounded in general bacteriology, will be submitted
to the director of laboratories and infectious diseases, chief surgeon's office, A. P. O. 721, who
will request orders for his transfer to the central Medical Department laboratory for a two-
weeks' com"se of instruction in wound bacteriology.
SUPPLIES
6. All laboratory equipment now on hand at units comprising hospital centers will be
pooled and turned over to the medical supply officer of the center and will be redistributed
by him on memorandum receipt, after consultation with the laboratory officer, as the latter
indicates. Inventories will be prepared showing all items that are not suited for use in the
center (such as electric equipment not suited to the current available), together with items
that are in excess of the actual needs, and forwarded directly to the office of the director
of the division of laboratories and infectious diseases, office of the chief surgeon, A. P. 0.
721, who will indicate the disposition to be made of such items.
7. All requisitions for supplies for the laboratorj^ service will be prepared and forwarded
by the medical supply officer of the center. Requisitions will be made in quadruplicate,
one copy being retained and three copies forwarded. Requisitions for laboratory supplies
only should be sent to the director of the division of laboratories and infectious diseases,
office of the chief surgeon, A. P. O. 721, and it is desired that as far as possible requisitions
be so timed as to permit shipment thereupon to be included in larger shipments made from
supply depots on ordinary requisitions. These special requisitions should therefore be sent
approximately ten days prior to larger requisitions contemplated and should bear notation
that shipment should be held pending the receipt of requisition for general supplies.
8. Laboratory animals (sheep, rabbits, guinea pigs, and mice) will be purchased locally
if possible, and if not, required for from the nearest army or base laboratory. In view of
the great demand for laboratory animals in France by the Chemical Warfare Service, requisi-
tions for such animals, especially mice, will be reduced to a minimum. Requisitions for
white mice will be honored only in cases of great emergency and in small quantities. The
Avery method or some other suitable technique as a substitute for the mouse method of
pneumococcus type determination should be used.
9. Estimates have been prepared and orders are now being placed for standard items
of laboratory equipment, and it is hoped that the laboratory equipment for hospital
centers may be standardized in the near future. Until then, medical officers should be
guided by the realization that technical apparatus of all sorts is obtained with great difficulty
under present conditions and, that in view of the difficulties of transportation, all ordinary
demands should be anticipated two or three months in advance.
10. An allotment of $100 per month will, on request, be made by the chief surgeon's
office to the medical supply officer of each hospital center to cover purchases of laboratory
animals, milk, eggs, meat, and other ingredients of culture media and such other items as
are necessary for the proper functioning of the base laboratory, and properly chargeable
against Medical Department appropriations.
APPENDIX
1059
TRANSPORTATION
11. Transportation for central laboratories at base hospital centers has not been author-
ized as yet but this office has recommended that these laboratories be allowed one motor
cycle with side car and one bicycle in the proposed revision of the tables of organization.
{Memorandum No. 8, division of laboratories and infectious diseases, July 23, 1918.)
Divisional Laboratory Unit
1 . In the organization of the laboratory service for the American Expeditionary Forces
provision was made for a divisional laboratory unit to serve with each division.
The personnel, equipment, and proposed transportation for each unit is as follows:
Personnel :
1 Captain or First Lieutenant, Medical Corps or Medical Reserve Corps,
Medical Department.
1 Captain or First Lieutenant Sanitary Corps, Medical Department.
4 enlisted men, Medical Department.
Equipment :
Chest 1. Standard equipment for clinical pathology.
Chest 2. Standard equipment for clinical patholog}\
Chest 3. Standard equipment for bacteriological incubator.
Transportation :
1 light truck (3^ -ton Ford or other standard).
1 motor cycle with side car.
2. It is contemplated that these laboratory units shall constitute a part of the sanitary
staff of the division surgeon and that they will be used by the divisional sanitary inspector
in the investigation and control of communicable diseases and in the inspection, supervision,
and control of sterilization of water supplies. While the question of immediate control of these
units is a matter of internal administration, it is deemed advisable to place the medical
officer in charge of the divisional laboratories because of the relative importance of the fields
covered by the members of these units.
Some division surgeons have found it most practicable to attach the laboratory unit
to the divisional sanitary train. When in divisional training or rest areas, it is contemplated
that the laboratory unit will be attached to the camp hospital functioning for the division.
At the front it is attached to an immobilized field hospital, preferably the one through which
infectious diseases and medical cases are evacuated.
3. To properly perform its functions, it is contemplated that the medical officer and
officer of the Sanitary Corps attached to this unit shall, on arrival in France, be sent to the
central Medical Department laboratory for temporary duty for a brief course of instruction
in the epidemiology of communicable diseases and supervision of water supplies respectively
and to obtain their laboratory equipment. Further practical instruction will be given
thes3 officers by specially trained officers of the infectious diseases and water supply sections
of this office, who will visit them from time to time for the purpose of giving aid in the solution
of local problems.
4. When an epidemic disease prevails in a division in such proportions as to make it
seem desirable to temporarily reinforce the divisional personnel and to have special epi-
demiological and laboratory studies made for the control of the disease, the division surgeon
is authorized by Bulletin No. 32, general headquarters, A. E. F., to communicate directly
with the director of laboratories and infectious diseases, who will dispatch special personnel
and mobile equipment to reinforce the divisional authorities in controlling the epidemic.
In the zone of the advance these units are usually located in close proximity to evacuation
and mobile hospitals. These organizations are provided with a complete laboratory equip-
ment, which is available for use by the members of the divisional laboratory units when
liiglily technical laboratory examinations are required.
1060
ADMINISTRATION, AMERICAN EXPEDITIONAKV FORCES
Many of the evacuation and mobile hospital laboratories are prepared to do Wasser-
mann tests, and the officer in charge of the divisional laboratories should consult with the
laboratory staff of the organization to determine whether demands for such examinations
can be met.
5. The equipment to be supplied the divisional laboratory unit has l)een standardized
and arranged in chests in order that it may be packed and moved at a moment's notice.
Chest 1 (weight 230 pounds, dimensions 24 by 24 by 36 inches), chest 2 (weight 140 pounds,
dimensions 21 by 24 by 30 inches), chest 3 (weight 180 pounds, dimensions 39 by 22 by 28
inches) constitute the divisional Laboratory equipment. Chests 1 and 2 contain the equip-
ment and supplies for routine clinical pathology, while chest 3 contains a bacteriological
incubator complete, arranged for heating with coal oil. The coal oil is to be secured from
the divisional supply officer.
6. With the equipment mentioned above, the following classes of work can be done:
Sputum. — Microscopic examinations of smears for the tubercle, pneumococcus, influenza,
and animal parasites.
Urine. — Appearances, color, odor, reaction, specific gravity, and qualitative tests for
albumin, sugar, acetone, and diacetic acid. Microscopic examinations of urinary sediment.s.
In suspected cases of typhoid fever about 10 c. c. of the urine should be sent to the central
Medical Department laboratory or the nearest base or army laboratory in a bottle of bile
medium, for isolation of the suspected microorganism.
Venereal lesions. — Miscroscopical examinations of smears for gonococci and Fontana
stained preparations from venereal sores for spirochetes.
Blood. — Hemoglobin estimations (Tallquist), leucocyte counts, red-cell counts, and
differential leucocyte counts. Microscopical examinations of stained preparations for patho-
logical changes, plasmedia, etc. In every case of undetermined fever of over 48 hours'
duration, 2 to 5 c. c. of blood should be collected in a bottle of bile medium and the culture
sent to the general Medical Department laboratory or the nearest base or army laboratory
for further study. Sera for agglutination tests, the Wassermann test, etc., should be col-
lected in the serum capsules furnished with this equipment and sent to the nearest of the
laboratories mentioned above.
Feces. — Microscopical examinations of fresh specimens for parasites, ova, blood, mucus,
and pus cells.
In suspected cases of typhoid fever, paratyphoid fever, or dysentery, about a gram
of the feces should be sent to the central Medical Department laboratory, or the nearest
base or army laboratory, in a bottle of bile medium, for isolation of the specific microorganism.
Transudates and exudates. — Microscopical examinations of stained specimens for
tubercle bacilli, gonococci, spirochetes, etc., and cytological changes.
Spinal fluid. — Microscopical examinations (cytologic and bacteriologic) .
7. It is not intended that highly technical bacteriological and serological work shall
be done by these units. In epidemics requiring epidemiological study and laboratory control,
it is contemplated, as noted in paragraph 3 above, that special personnel and mobile equip-
ment will be sent to reenforce the local authorities on request from the division surgeon.
8. It is not contemplated that the Sanitary Corps officer attached to this unit for
supervision of water supplies shall do any extensive chemical or bacteriological laboratorv
work. In so far as his water work is concerned, it will usually be confined to sanitary sur-
veys of sources of supply, recommendations concerning quahty of water, and supervision
and instruction of sanitary detachments in the detail of the sterilization of water by chlori-
nation or otherwise. His work will be done under the supervision of the divisional sanitarv
mspector. Where bacteriological or chemical analyses are deemed advisable, the specimens
will be collected by the water supply officer of the laboratory unit and forwarded to the
nearest army or base laboratory or mobile water laboratorv. A chlorine testing outfit for
use in controlling the chlorination of water supplies will be issued to divisional laboratorv
units. Where extensive surveys requiring laboratory control are necessarv, the Medical
Department representative on the staff of the water supply officer for the armv will be called
on for assistance. He has under his control mobile water analysis laboratories designed to
carry out such investigations.
APPENDIX
1061
9. Instructions for Sanitary Corps officer attached to divisional laboratory- and for
other officers concerned in the chlorination of drinking water.
(a) The official method of sterilizing water is by means of calcium hypochlorite. The
l)owder is issued in 1-gram tubes. One tube is usually sufficient to sterilize one Lyster bag
full of water. Break a tube of calcium hypochlorite into a clean ordnance cup, moisten the
powder with a few drops of water, and mix into a smooth paste. Now fill the cup with water
to within 1 inch of the top and mix thoroughly by stirring with clean spoon. Add this solu-
tion to a Lyster bag filled with clear water, stir thoroughly and allow to stand 30 minutes
before using. After 30 minutes, test a cupful by adding 10 drops of a solution containing
10 per cent potassium iodide and 1 per cent soluble starch (suppHed in laboratory equipment).
The appearance of a blue color is indication that sufficient chlorine has been added to the water.
If no color appears, the water is highly polluted and should be reported immediately to the
medical officer having water supplies under his supervision.
(b) In emergency, when a Lyster bag is not available, the hypochlorite method can be
applied to smaller containers of known volume, by calculations based on the knowledge that
a Lyster bag contains about 36 gallons of water. Thus if a 10-gallon container is available
one-quarter of the concentrated solution prepared in the ordnance cup as above can be added,
etc. When smaller containers, such as 2-gallon tins, are used the original concentrated
solution in the ordnance cup can be diluted by one-half, this dilution again diluted by one-
half in another ordnance cup, and one-quarter of this second dilution added to the tin. By
u.sing a little ingenuity, the hypochlorite method can thus be applied to any container of
known capacity.
(c) When tubes of calcium hypochlorite are not available and the powder is available
in bulk, the following procedure should be adopted:
(1) An empty shell used in the Colt's 45 automatic pistol will hold 1-gram of powdered
calcium hypochlorite when filled level with the top. Always use this empty shell as a meas-
ure. Add one shell full of powdered calcium hypochlorite to an ordnance cup and make a
solution as described in paragraph (a), filling the cup with water to 1 inch from the top.
Part of this solution is used in titrating the water to be sterilized, and the remainder is used
for sterilizing the water.
(2) Rinse four ordnance cups with the water to be tested and fill all four cups to 1 inch
from the top (500 c. c.) with the water to be tested. From a medicine dropper (to be obtained
from regimental medical supplies) or pipette, add 4 drops of the calcium hypochlorite solution
to the first cup, 8 drops to the second cup, 12 drops to the third cup, and 16 drops to the
fourth cup. Mix the solutions in each cup thoroughly and allow the cups to stand 30 minutes.
Note. — Twenty drops delivered from a medicine dropper or a glass tube of 2 or 3 mm.
bore is equal to 1 c. c.
(3) After 30 minutes, add 10 drops of potassium iodide-starch solution from a clean
medicine dropper or pipette to each of the four cups and mix thoroughly. Some of the cups
will show no color, some will show a blue color. The cup that contains the smallest amount
of a hypochlorite solution capable of giving a blue color with the potassium iodide-starch
solution contains the proportion of chlorine necessary to sterilize the water being tested.
Thus, suppose the cup of water to which 8 drops (0.4 c. c.) of this hypochlorite solution was
added gives a color with potassium iodide-starch solution, and the sample to which 4 drops
(0.2 c. c.) of the solution was added gives no color. The cup to which 8 drops (0.4 c. c.) of
the hypochlorite solution was added contains the right amount of chlorine to sterihze the
water being tested.
(4) There are 36 gallons, or 288 pints, in the water bag when filled to the white mark
on the inside. Since eight drops (0.4 c. c.) of the hypochlorite solution were sufficient to sterihze
1 pint, 115 c. c. of the same solution will be sufficient to steriUze the 288 pints in the Lyster
bag. In practice, it is believed to be safer to use twice the amount indicated by the titration,
so that in the example quoted 230 c. c. of the hypochlorite solution would actually be added
to the water to be treated, or one-half of the concentrated solution, in the cup to which the 1
gram of calcium hypochlorite has been added, could be added to the water in one bag, and
the solution prepared from the measure of hypochlorite would be sufficient to sterilize two
bags of water.
1062
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(5) The following table shows the amounts of hypochlorite solution to add to a bag of
water corresponding to the number of drops used in the titration:
Number of drops
4
8
12
16
20
24
28
32
Amount of hypochlorite solution (cup measure)
Vi
V2
Vi
1
Wa
m
2
Note.— In the titration, if the first series of drops do not show a blue color the water requires more than one measure
of hypochlorite. The second series of drops will indicate the amount of a second measure of hypochlorite dissolved in a
cup of water to be added to the bag in addition to the first cup.
10. In order that troops may be protected from the possibility of contaminated water,
it has been ruled that all water not specifically designated as safe by the water-supply divi-
sion of the Engineering Department shall be regarded as probably polluted and subjected
to chlorination in Lyster bags. The ideal to be attained is that eventually no soldier with
his unit shall drink untested or unchlorinated water. There are two obstacles not easily
overcome, which render the attainment of this purpose difficult. These are chiefly the
prevention of drinking at unapproved promiscuous sources, and the proper supervision of
chlorination. The former difficulty is a matter of discipline in individual units. The latter
can be accomplished only by the utilization of the proper personnel. In each division it is
the duty of the Sanitary Corps laboratory officer to supervise the proper handling of Lyster
bags and the chlorination of the water. Alone, however, he can not carry out this duty.
No special personnel being available for this work, it is suggested that men be selected from
the regimental sanitary detachments who can assist the sanitary laboratory officer in these
duties. If, in each regimental sanitary detachment, one noncommissioned officer and two
men could be assigned to the water service, these men could be instructed in the dosing and
perhaps the testing of chlorinated water, under the guidance and supervision of the laboratory
officer.
11. Expendable items of the laboratory equipment will be replenished from the central
Medical Department laboratory, and spare parts of the nonexpendable equipment are car-
ried in stock at the central Medical Department laboratory and will be supplied on requisition.
All replenishment items should be requisitioned for by number as well as by name.
12. At the present time no transportation is provided for these units in Tables of
Organization, and request has been made that one motor cycle with side car and one light
truck (M-ton Ford or other standard) be included in the revised tables of organization for
this unit. The request has not as yet been approved.
{Memoranda 5 and 7, division of laboratories and infectious diseases, August 14, 1918.)
TECHNIQUE FOR THE "WASSERMANN TEST"
In order that the results of Wassermann tests made on members of the American Expe-
ditionary Forces may be as nearly comparable as possible when different workers in different
laboratories are performing the tests, and in consideration of the fact that tests on the .serum
of the same individual may not always be made in the same laboratory, it is necessary to
adopt a uniformity of reagents and a standard method. Moreover, there are not many
instances of any two men who use exactly the same methods for performing the test, unless
their training in Wassermann work was obtained in the same laboratory. The principal
differences have to do with the hemolytic system, the "antigen," the preliminarv amboceptor
or complement titration, and the total volume of the test. While everv laboratory worker
naturally feels that his method is either as good or perhaps better than some other, it is
advisable that the various workers adapt themselves to the method herein prescribed. How-
ever, if there be any suggestions for improvement which will materially benefit the purpose,
the director of laboratories will be pleased to receive them in w^ritten form and thev will be
given full consideration.
APPENDIX
1063
REAGENTS
" Antigen"; alcoholic extract of beef heart or calf heart, half saturated with cholestrin.
Hemolytic sj^stem: Anti-sheep (amboceptor, or sensitizer).
Complement, or alexin: Guinea-pig serum
"Antigen" and amboceptor will be prepared and standardized at the central Medical
Department laboratory and furnished to laboratories where Wassermann tests are made.
Monthly supplies will be forwarded without requisition, and additional supplies will be
forwarded on special request by telephone, telegraph, or letter.
Arrangements have been made for each laboratory to be furnished with guinea-pigs
and sheep.
STANDARD METHOD
The total volume of each test is 1.25 c. c, one-fourth that of the original Wassermann.
1. Amboceptor, or sensitizer. — The test is based on the "quarter-unit" amount; i. e.,
the amboceptor unit is that amount giving complete hemolysis of 0.25 c. c. of 5 per cent
sheep cell suspension, in the presence of excess complement, after incubation in water bath
at 37.5° C. for one hour. The amboceptor is furnished in glass ampules containing 0.1 c. c.
inactivated anti-sheep serum. The dilution stated for any particular lot of serum represents
the dilution in the titration containing the amount of serum determined as one unit. For
example: It may be stated that a dilution of 1: 3,000 is one unit, meaning that this dilution
contains the amount of serum which is one unit. Two units are used in the test, so in pre-
paring the reagent a dilution of 1: 1,500 will be made; i. e., 0.1 c. c. of serum diluted with
149.9 c. c. of physiological saUne will give a reagent each 0.25 c. c. of which represents two
units of amboceptor.
2. Complement, or alexin. — Without entering into a controversy about the advisability
of whether a preliminary complement or amboceptor titration be made, we feel that the
variation in amboceptor is less than that of complement and that it is better to adjust the
complement to a given unit of amboceptor.
Two or three guinea pigs should be bled the night before the day the test is done. The
Ijlood should be taken from the heart by means of dry sterile needle with syringe or suction
apparatus and placed in a dry, sterile, conical centrifuge tube. After clotting has taken
place, a stiff sterile wire should be run around the rim of the clot and the tube placed in an
ice box until the following morning. The following morning the tube should be centrifugcd
and the clear serum drawn off. The serum is diluted 1 to 10 with physiological saUne for
use as complement. Each serum should be tested for hemolytic and complementary prop-
erties. For hemolytic properties, 0.5 c. c. of the dilution and 0.25 c. c. of 5 per cent sus-
I^ension of cells should be incubated in the water bath at 37.5° C. for one hour. Providmg
each serum has good complementary properties and no hemolytic property, the sera should
be cooled and diluted. In titrating for complementary properties the followmg protocol
should be followed: , ^.
Protocol for complement titration
Tube
Guinea
pig se-
rum 1-10
Physio-
logical
saline
2 units
ambo-
ceptor
1
C. c.
0. 15
C. c.
0. 60
C. c.
0.25
2 _
.14
.61
.25
3..
.13
.62
.25
4... ._-
.12
.63
.25
5
.11
.64
.25
5 per cent
sheep
cell sus-
pension
a c.
0. 25
.25
.25
.25
.25
Tube
Guinea
pig se-
rum 1-10
Physio-
logical
saline
2 units
ambo-
ceptor
C. c.
C. c.
C. c.
0. 10
0.65
0.25
.09
.66
.25
.25
.75
.00
.00
1.00
.00
.00
.75
.25
5 per cent
sheep
cell sus-
pension
C. c.
0. 25
.25
».25
''.25
25
' Complement control.
■ Amboceptor control.
<> Saline control.
The dose for the test is twice the amount in the tube, showing complete hemolysis
after incubation in the water bath at 37.5° C. for one hour. With a good serum 0.1 c. c.
will usuallv be this amount and 0.2 c. c. will be the dose for the test.
3 "^n^it^en."— "Antigen" is adjusted so that 0.1 c. c. of an emulsion in physiological
saline will be the dose for the test, the proper dilution will be stated with each lot. It is
1064
ADMINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
very important that the "antigen" emulsion be prepared as follows: Place the amount of
alcoholic extract to be emulsified in a flask, add physiological saline drop by drop, shaking
the flask vigorously between drops, until at least 5 c. c. volume is obtained. The balance
of the saline may be added in large amounts, the flask shaken well between each addition.
4. The test. — The amount of patient's serum (inactivated) used in each test is 0.0.')
c. c. In many instances there is sufficient natural and sheep hemolysia in human scrum
to produce hemolysis of one unit of cells with the amount of alexin or complement u.sed
in the test. On account of this, a unit of cell suspension, 0.25 c. c, is added to the test
and allowed to incubate 15 minutes. At the end of this time complete or nearly complete
hemolysis will have taken place in the control tube (back tube ). It will not be necessary
to add amboceptor to these tests. To all other tests, 0.25 c.c, representing two units of
amboceptor are added to each tube.
First incubation period (for complement fi.xation), 1 hour.
Second incubation period (for natural hemolytic activity), 15 minutes.
Third incubation period (for hemolysis), 1 hour.
Too much emphasis can not be laid upon the necessity of controls for every reagent,
and for their behavior with known negative and positive sera, before the actual test is
set up.
The following protocol serves to illustrate the tests:
[Sera for controls: One serum; one serum; one serum; one (— ) serum]
Inacti-
vated
patient 's
serum
A ntigen
emulsion
Comple-
ment
Physio-
logical
saline
5 per
cent
sheep
cell sus-
pension
Ambo-
ceptor,
2 units,
if neces-
sary
Back tube
C. c.
0.05
.05
C. c.
0.0
. 1
C. c.
0.2
.2
C. c.
0.50
.40
C. c.
0.25
.25
C.c.
0.25
.25
Front tube
Antigen controls
Known negative serum
C. c.
"Antigen" emulsion
C.c.
0.3
" Antigen" emulsion
Complement
Complement .
Saline
Saline
Incubate in water bath at 37.5° C. for 1 hour.
5 per cent suspension sheep cells
25
Incubate in water bath at .37.5° C. for 1 hour.
5 per cent suspension sheep cells
.25
Incubate in water bath 15 minutes.
Ambocepter, 2 units if necessary.
Ambocepter, 2 units
Incubate in water bath, etc., for 1 hour.
Incubate in water bath 1 hour.
Protocol for spinal fluid
Tube
Spinal fluid
"Antigen"
Complement
Saline
Incubate in water bath at 37'..5° cVfor 1 hour
Amboceptor, 2 units
5 per cent sheep cells. "
Incubate in water bath at 37.5° C. for 1 hour
1
2
3
4
C. c.
C. c.
C. c.
C. c.
C. c.
1.0
1.0
0.5
0.25
0.12
.0
. 1
. 1
. 1
.1
.2
.2
.2
.2
.2
.0
.0
.0
. 2
.25
.25
.25
.25
.25
.25
. 25
.25
.25
.25
.25
Another important control which should be run in the regular test is one for serum
specimens showing marked hemolysis when received.
Inactivated patient's serum
5 per cent suspension sheep cells _____
Saline-.., •
APPENDIX
1065
The tinge of red imparted to the supernatant fluid will serve as a comparison for reading
the result on that particular serum.
INTERPRETATION OF RESULTS
Four symbols will be used to designate results:
+ + (complete fixation) .
+ (almost complete fixation) .
H (partial fixation) .
— (complete hemolysis) .
Attention is directed to the necessity of having thoroughly clean glassware for sero-
logical work.
Reports should be made on Form 55q M. D.
{Memorandum No. 3 (revised), division of laboratories and infectious diseases, August
15, 1918.)
Directions for Use of Apparatus for Intravenous Infusion of Gum-Salt
Solution
An outfit for the intravenous infusion of standard gum-salt solution now available
for issue and may be obtained for use in all places where gum-salt solution is used. It is
the object in putting these sets out to enable the surgeon to use the solution directly from the
original bottle and thus avoid an unnecessary transfer from one container to another. The
articles composing this outfit are:
1 glass tube with curved end (long).
1 glass tube (short).
2 pieces rubber tubing.
1 rubber stopper (double-hole).
2 needles.
These outfits are furnished to facilitate the use of the gum-salt solution, and are to be
considered as permanent property, which may be replaced only under the same conditions
that other property is so replaced. The same care must be taken of these parts as of those
of the transfusion sets. Great care must be exercised in the care of the needles, as they are
scarce and hard to obtain. The use of the paraffin oil furnished with the transfusion sets is
recommended for their care.
DIRECTIONS for USE
The tubing, stopper, and needle are to be sterilized in the usual manner. If a fine
sediment exists at the bottom of the bottle containing the gum-salt solution, introduce the
long glass tube carefully, so as not to disturb the sediment (assuring yourself that the opening
in the curved end is above any sediment present) . Then allow the solution to run out through
the long tube to the needle by siphonage, or force the solution out by pressure from the bulb
of a blood-pressure apparatus attached to the short tube. In case the solution has no sedi-
ment, the long rubber tubing with the needle attached can be connected with the short glass
tube and the bottle inverted, so that the fluid flows into the vein by gravity.
The same precautions against introduction of air into the vein must be taken as in the
case of blood transfusion.
A supply of these intravenous infusion outfits are available for issue to field, evacua-
tion, mobile, and advanced base hospitals attached to the first Army, at army medical dumps
Nos! 1 and 2. Requisitions from other units should be addressed to the commanding officer,
central Medical Department laboratory, A. P. O. No. 721. The allotment for each hospital
is 6 complete sets and requisitions must be limited to this number.
{Memorandum No. 18, division of laboratories and infectious diseases, September 9, 1918.)
1066 ADMINISTRATION, AMEBIC AN EXPEDITIONARY FORCES
Food and Nutrition Section Inspection Data
1. The following information compiled from Appendix No. 4 of the Quartermaster's
Manual, from the new Quartermaster's Inspection Manual, and from other sources, will be
of value in connection with the examination of food supplies. Officers of the food and nutri-
tion section should familiarize themselves with Appendix No. 4, Quartermaster's Manual, as
well as with the information below. Quotation from new inspection manual:
It should be clearly understood that responsibility of final inspections, upon which
depend acceptance or rejection of shipments, rests as heretofore entirely upon the officer
in charge at the depot or camp where delivery is made.
2. (Sizes of cans now in use in United Stales supplies. —
No. of can
Diam-
eter
Height
Capacity
No. of can
Diam-
eter
Height
Capacity
1
Inches
2H
2H
2H
4
Inches
4
414
4A
4H
Fluid
ounces
11.6
12.3
21.3
31.2
3
Inches
4H
4H
6A
Inches
iVs
5
7
Fluid
ounces
35
35.5
39
107
1 tall
3
2
3
10
3. Inspection of spoiled protein foods. — In recent years there has been an increasing
tendency to discount the idea of ptomaine poisoning from spoiled protein material. It is now
the opinion of sanitary experts that the intestinal disorders that result from eating such
spoiled material are usually due to infection from organisms swallowed with the material
and not from organic poisons of the ptomaine character. As Rosenau puts it:
Meat poisoning is not a poisoning as that term is ordinarily understood, but almost
always an infection; rarely an intoxication * * * many other foods, as milk, custards,
vegetables, and even water may conve}' the responsible bacteria, which in the great majority
of instances belong to the paratyphoid group.
Aside from the paratyphoid group, there is another type of meat poisoning comprised
under the name botuhsm. The bacillus {Bacillus botulinus) generates a toxin as it grows
in the meat or other protein media outside the body. Sausages readily become infected
by this organism and are responsible for its name. When food infected by this organism is
swallowed it is the toxin which produces the evil effects. Fortunetaly this toxin is killed
by heat, if the heat is sufficient and penetrates through the mass.
In view of these facts and in the interest of protection of the health of the troops, the
duty in regard to spoilage may be summarized under the following three heads:
(a) "Swells" among canned goods should be rejected; "springers" are also as a rule
decomposed, but should be carefully inspected before condemnation. Meats that have a
bad odor, after all possible trimming has been done, should be rejected as unfit for human food.
(b) Secure thorough cooking of all protein food to kill the micro-organisms and toxins
of the botuhsm.
(c) Give especial attention to preventing the contamination of food after it is cooked,
by flies, dirty hands, or any other agent which could plant in the material the disease-producing
organisms.
4. Quartermaster specifications which form the basis of food acceptance for the United
States Army.—{1) Canned goods in general— In sampling take at least three samples from
each case. Examine cans for rust; and if found, test spots thoroughly to make sure there
are no perforations. Test bent places in the same way. To detect "springers," "knock"
the can on a hard surface by striking the end forcibly. If the end springs out the can is
improperly processed. This does not necessarily mean spoilage, but in the field such cans
should be rejected as much as "swells, " as there is neither time nor faciUtv there for analysis.
In reporting a faulty brand, give the percentage of spoilage. Also look for nail holes in the
cans, which will cause spoilage without swelling.
(2) Canned tomatoes, corn, and peas.— To be sound and ripe, free from artificial coloring
matter, packed without addition of water, tomato pulp, or juice. Goods guaranteed against
APPENDIX
1067
"spoils" and "swells" until July 1 following date of shipment. "Spoils" and "swells"
to be held subject to seller's orders.
Net weight of No. 3 cans, not less than 2 pounds 1 ounce.
Net weight of No. 10 cans, not less than 6 pounds 7 ounces.
Net weight of No. 2}4, cans, not less than 1 pound 12 ounces.
(3) Canned fruits. — Prime ripe fruit packed in either 20 or 30 per cent sirup. Orchard
run after removal of* culls. May have some blemishes. Canned fruits containing pits
such as cherries, may swell and still be fit for food. Contents however, should be examined.
(4) Canned vegetables. — Field run of good stock. May be shght discoloration or breaking
due to processing. Canned hominy may spoil without swelling the cans; if spoiled, is usually
discolored and has a putrid odor.
(5) Canned salmon. — Pink, red, or medium-red salmon. Smell is the best test of
unsound salmon. Meat should be firm, with no undue proportion of tips and tails. Packed
in 1-pound or 3^-pound cans. Bones cooked soft is indication of correct processing.
(6) Canned sardines. — Fish of uniform size and evenly packed. Not all sardines are
eviscerated. Army now accepts regular Maine pack. Look out for indications of bellies
burst by gas and the presence of red food. Oil must be free of rancid flavor, decay or odor.
Very little or no added oil is a cause for rejection. Lack of or leakage of oil can always
be determined by shaking the can. Contents will shake about in a solid mass. Net weights:
Quarter cans run 3.6 to 3.8 ounces; key cans run 3.5 to 3.7 ounces.
(7) Canned bacon. — Examine condition of the bacon itself for sourness or rancidity.
External examination of the containers is all that is necessary, as bacon is not processed.
Vacuum drawn simply to facilitate packing. If container is defective, examine the bacon.
(8) Canned lard. — Steam rendered lard for issue. Examine labels. Beef or mutton
tallow or vegetable oils, when present, are adulterants. Color should be white, surface
smooth and not grainy. Flavor not scorched or burned.
(9) Lard substitutes. — Two sorts allowed: (1) Entirely of vegetable oils (refined cotton-
seed oil plus 10 to 15 per cent of vegetable stearine or by hydrogenating cottonseed oil);
(2) cottonseed oil plus oleo stearine. Both must be firm, white in color, free from water
and foreign material.
(10) Meats {beef). — At the front or in the field in general the principal meat problem
concerns care of frozen beef. Specifications do not concern us, because all of this beef is
United States inspected before shipping. The minimum weight of the carcass is 450 pounds,
from which should be deducted 3}^ pounds from each hind quarter to compensate for the
shank bone, left on for hanging. The difference in weight between a fore and a hind should
not exceed 25 pounds the carcass. * * * Beef should always be inspected for the follow-
ing qualities: (a) Its soundness; (6) its quality; (c) whether it has been properly trimmed;
{d) whether it satisfies requirements with regard to weight; (e) whether the limitations
as to sex (steers and spayed heifers only allowed) have been satisfied; (/) whether an equal
number of fores and hinds is supplied; (g) whether it has been handled in a cleanly manner.
(11) Hash, corned-beef. — Consist of 50 per cent vegetables (potatoes and onions) and
50 per cent corned beef, seasoned with salt and pepper. If the cans when shaken seem to
contain much liquid they should be considered as of suspicious quality and opened for fur-
ther inspection.
(12) Bacon. — Inspect for soundness (10 per cent inspection considered sufficient). Sur-
faces free of mold, insects, skippers, rancidity, or sourness.
(13) Flour. — Made from sound wheat, free from smut, good color, best quality. When
in doubt on this material send sample to office. Weevily condition can be determined by
examination of the ears and seams of the bags. Worms also can be found on outside of
bag if it is exposed to sunlight for awhile, but generally they are found in the flour; can be
sifted out if not excessive,
(14) Hard bread. — Square crackers, flour and water only, thoroughly baked. Other
forms which are made in France are also now supplied.
(15) Baking powder.— To be a tartrate phosphate, or alum powder from pure and
dry ingredients. Yield not less than 12 per cent CO2 gas.
(16) Beans.— Good beans are plump and firm under pressure. They should not dent
when pressed with the thumb-nail. Should not exceed 20 per cent moisture. Should be
1068
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
clean, of uniform size, and free from disease, especially anthracnose. Beans may be weevily
or worm eaten. In either case they can be separated from sound beans bj' placing in water;
unsound beans float readily and can be thus skimmed off, before cooking.
(17) Rice. — Good, clear, fresh milled, head rice. Should be semitransparent, free
from grit, dust, or hulls, and presence of broken or dead white grains. Uniform-sized grains.
Should also be free from seeds. Rice packed in sacks may get wet, and then cake and mold.
If the sack is allowed to dry undisturbed, the moldy part can then be eut through and easily
removed without contamination of the balance of the rice.
(18) Potatoes. — Texture firm when pressed by the hand, crisp when cut, and the cut
halves when rubbed together briskly and then pressed together firmly should hold together.
U. S. Grade No. 1, sound potatoes, practically free from dirt, foreign matter, frost injury,
sunburn, second growth, cuts, scab, blight, dry rot, and damage caused by disease, insects,
or mechanical means.
(19) Onions. —
Grade
Mini-
mum
diam-
eter
Maxi-
mum
diam-
eter
Tolerance for
defects
Addi-
tional
toler-
ance for
pink-
yellow
onions
Maturity
Brightness
Dirt or for-
eign matter
Shape
Variety
Total
Decay
U. S. No. 1.
U. S. Boiler.
U. S. No. 2.
U. S. No. 3.
Inches
2
1
2
1
Inches
None.
2
None.
None.
Per cent
6
6
10
10
Per cent
1
1
2
5
Per cent
5
5
(-)
(«)
Must be
do
Need not be.
do
Must be
do
Need not be.
do
Free from
do
Need not be
clean.
...do
Well..
...do
Any ..
do..
One.
Do.
Do.
May be
mixed.
<• No limitation.
Onions of all grades, except for tolerance, must be sound, free from "doubles," "splits,"
"bottle necks," and seed stems and practically free from damage caused by moisture, sunburn,
cuts, disease, and mechanical means. Sacks, ventilated barrels or crates called for.
(20) Corn goods {hominy, hominy grits, corn meal). — The lowest grade of corn that can
be used is No. 4. This grade shall be white corn, shall be sweet, shall contain not more than
19.5 per cent moisture, not more than 5 per cent foreign material and cracked corn, and not
more than 8 per cent damaged corn, which may include not more than 0.5 per cent heat-
damaged and mahogany kernels. Yellow No. 4 is same specification. Table hominy
shall be degerminated hulled corn, thoroughly screened and dusted and shall contain not
to exceed 1 per cent fat by ether extraction and not to exceed 14 per cent moisture. Grits
shall be made from hominy screened and dusted clean, not over 14 per cent moisture or 1
per cent fat.
(21) Standard meal, — From entire grain, with 10 per cent food removed and 45 per
cent feed meal extracted. Not over 11 per cent for export.
(22) Dried fruits. — Should be in good condition and free of insects and decay. Prunes,
50 to 60 per cent; peaches unpeeled. Dried fruits are attacked by weevils and molds.
Figs are quite apt to be weevily in the center of the fruit, and while the worm is not often
found the web is easily seen. They also mold, and at times both conditions are found.
Dates will sour along the edges of the box, and unless promptly looked after sourness will
penetrate the entire mass. Apples and peaches may be found moldy or weevily, or both.
Prunes may sour and get wormy or moldy, but the moldlike white, sugarv formation found
on prunes at times is not ground for condemnation and can be readily removed by washing.
(23) Co/ee.— Roasted and ground. Porto Rican, Hawaiian,^ or Central" American
preferred.
(24) Milk. — Unsweetened, evaporated, in 1-pound cans.
(25) Vinegar.— Cider, 4^ to 5 per cent acetic acid, in half barrels.
(26) Pickles.— F\ain, uniform in size, about 40 to the gallon, thoroughly cured free from
nubs and soft stock, in half barrels. All soft pickles, in or out of vinegar, should be rejected
APPENDIX
1069
(27) Oleo. — Must be iincolored, not less than 10 per cent butterfat and 2 to 4 per cent
salt. The coloration must be uniform, not streaked or blotchy. Odor and taste pleasant
and resembling butter. Not rancid or sticky or grainy in the mouth. Oleo showing dis-
coloration or dark patches on the sides or ends of the package should be cut into. Mold w ill
usually penetrate the entire mass.
(28) Sirup. — Sugar cane, sorghum, or sugar sirup or blend, of same.
(29) Flavoring extracts. — Lemon, 5 per cent by volume of oil of lemon. Vanilla, 40 per
cent by volume absolute ethyl alcohol and at least 2.5 percent true vanilla solids.
****** *
5. The proper care of subsistence supplies. — In inspection of storage of supplies attention
is called to a few important facts to have in mind. In this connection, officers of this section
should be familiar with sections 2729 to 2746 of Volume I of the Quartermaster's Manual; also
with 2309 to 2313 of the same manual.
(1) Care of beef. — The care of frozen beef in camps is largely a question of treatment and
ventilation. The following extract from Weekly Bulletin of Disease, No. 16, issued by the
the chief surgeon's office, covers the practical points involved:
Whenever a quarter of beef is suspected of taint, first thoroughly wash the quarter with
brine, examine the exposed surface, and if these are tainted cut off such portions as are affected.
If the covered surfaces seem to be affected, have the butcher remove the covering tissue,
taking care not to cut into the flesh. Do not condemn any part of the beef until these pre-
liminary steps have been taken.
To determine whether decay has started within the beef, introduce a probe at the shoul-
der and hip joints; by the smell at the end of the probe you can determine whether the joints
are affected or not. If they are affected, dissect out the bone and trim away the adjacent
meat until a sovmd layer is reached. In no instance is it desirable or necessary to slash the
quarter, the object being removal of affected parts with as little waste as possible.
To prevent flyblow, make sure that fly eggs are immediately washed off when the beef
arrives. These are usually found on the shank.
The following methods are recommended for the best care of frozen beef:
It is better to hang beef in an airy, well-ventilated place, out of the direct rays of the sun,
rather than to store it in damp, dugout refrigerators. Meat safes, covered with cheesecloth
to exclude flies and with free access of air, will protect the beef for several days if it is wiped
as frequentlv as moisture accumulates on the surface.
If it is necessary to retain cut-up beef for more than 24 hours, it may be placed in a con-
tainer and covered with brine, but in cutting up beef require the butcher to first remove any
tainted outer skin before he cuts into the meat; this avoids the carrying of the decayed portion
into the sound meat.
In some places such safes can be constructed in the sides of the Adrian barracks; in
others they have been erected in sheltered places out of the sun and near the kitchen. The
cheesecloth that comes around the beef can be used to exclude flies. The main object is to
keep the beef surface dry and with a free current of air passing over it.
(2) Bacon. — Excess of supply should not be allowed to accumulate. Note dates on
packs and issue oldest bacon first. Keep dry and well ventilated, also cool. If in crates,
should not as a rule be removed from them until used.
(3) Canned meais.— Should keep, if properly processed and stored, for many months.
Should be kept dry to prevent rusting of containers. While freezing does not injure the
contents, it is apt to spring seams through the swelling of the liquids.
(4) Canned goods in general— AW canned goods should be stored in a cool, dry place.
Cold has no ill effect unless below freezing point, but freezing tends to bring about a separation
of the contents and deterioration of quality. In camps, this sort of goods should be kept as
far as possible from the range. Dampness causes rust, which in turn causes perforation. On
this account see that they are not left in wet or damp boxes. Acid products should not be
kept too long.
(5) Beans, rice, etc.— The greatest danger to these articles are weevils and moisture.
Drv storage and good ventilation are essential, and they should never be placed directly on the
ground. Also see to it that the old stock does not accumulate at the bottom of the bins.
The same recommendations apply to flour, corn meal, hominy, etc.
(6) Vegetables.— Whenever possible these should be in slatted, well-ventilated bins. If
it is necessary to keep in sacks, the materials should be often emptied out and sorted to remove
1070
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
decayed or sprouted material. Potatoes should not be exposed to light any more than is
necessary. They may be well stored in dugouts or pits, but not piled high. Onions should
not be left in sacks or crates, but emptied out and spread as thinly as possible. They should
not be put in pits, as they require air. Carrots and parsnips may be stored in pits and are not
injured by slight freezing. The same is true of turnips.
(7) 'Dried fr uits.— The best temperature is 34° to 36° F. It is important that they be
protected from insect infection; also from moisture and other conditions that will produce
rotting or moldiness.
(8) CoJ'ee.— Requires dry, well-ventilated storage. Should not be kept near pci)per,
tobacco, or other things from which it can absorb odors, and containers should be kept tightly
covered at all times.
(9) Lard and butter. — Keep cool. Melting and rehardening favors rancidity.
(10) Protection from rats. — All goods like flours and meals are often protected from rats
if old newspapers arc placed between the sacks. The rats use these to make nests of and spare
the other materials.
(11) . It seems to be an established fact that practically all bread mold can be traced
to delayed shipment or unsuitable storage. The bread is a culture medium for mold, requring
merely favorable conditions for its development. Any treatment that makes conditions
unfavorable to mold growth represents an optimum treatment for bread. Obviously this
means good ventilation, freedom from moisture, the prevention of accumulation of old
material, daily cleaning of bread boxes, and the like.
(12) . Section 2745, Quartermaster's Manual, gives the insects that are injurious to
subsistence supplies and their habits. The lowest and highest temperatures to which certain
perishable goods may be subject without injury under the conditions stated are given in
the following table:
Perishable goods
Lowest
outside
tempera-
ture,
unpro-
tected
Temper-
ature
above
which
injury
occurs
Perishable goods
Lowest
outside
tempera-
ture,
unpro-
tected .
Temper-
ature
above
which
injury
occurs
o p
25
30
20
18
34
20
o p
75
75
Pickles
o p
22
33
20
26
22
° F.
Cheese -
Potatoes
80
90
Extracts, flavoring
Rice -
Fish, canned -
Tomatoes, canned . . _ -
Vinegar
Onions
6. Members of this section have been familiar for some time with the value of the
garbage pail as a basis for diagnosis of mess troubles. With the garrison ration, a secondary
and almost equally important place for this purpose is the storeroom. Learn to know
the bearing of each article there on the daily menu. If you find excess sugar it means no
desserts are being made. Excess flour, the same thing. Lack of fruits or baking powder
means a definite reduction in menu possibilities, etc. This correlation between storage
and menu possibilities should be a special study of every inspecting officer.
7. A few waste statistics. — (o) Potato peeling: Refuse and waste as ordinarily peeled,
25 per cent; as carefully peeled, 13 per cent; by machine and eyes removed by hand, 12
per cent; peeled by machine, 4.5 per cent; unnecessary waste as ordinarily peeled, 12 per
cent.
Ration (80 per cent of 20 ounces) is 16 ouncesX 1,750,000 men = 1,750,000 pounds; 12
per cent waste = 210,000 pounds of food for that number of men for 1 day.
Potatoes also supply 55 per cent of all the basic ash in the ration; 12 per cent waste
reduces this markedly and increases the acidity of the ration.
(b) Value of beef ration per day for 1,500,000 men is $294,999 in the market at home,
without adding the cost of transportation. In one shipment of 25,000 pounds of beef
nearly 75 per cent was salvaged by trimming at the station, though the whole had been
condemned in the field.
APPENDIX 1071
8. Methods of survey and condemnation. — Paragraph 2311, Quartermaster's Manual:
Before shipping subsistence supplies to other points, quartermasters will carefully
examine the supplies, opening original packages when there is a doubt as to the sound and
serviceable condition of their contents. Damaged or unserviceable articles, or those liable
soon to become so, will not be shipped.
This article supplies sufficient authority to prevent depot quartermasters from sending
out goods which you find defective, and can 1)6 used by you for this purpose.
Paragraph 2787:
If the storefe have not deteriorated so as to render them unfit for human consumption,
and are not required in the military service, they will be sold at auction.
If the stores have deteriorated to the extent of rendering them unfit for human con-
sumption but are of value for other purposes, they will be sold at auction, and prior to the
sale the accountable officer will cause each can, box, bottle, or other container to be stamped
or indelibly marked as follows: "Deteriorated military supplies condemned and sold under
section 1241, Revised Statutes."
If the stores have deteriorated to such an extent that they are without value for any
purpose whatever, they will be destroyed. (Cir. 89, M. D. 1908.) Such stores must be
acted on by an inspector or survey officer before being disposed of.
The last sentence of this article calls attention to the necessity of a board survey. In
practice, the following methods are used: (a) When meats are to be condemned: As
soon as possible after their receipt the commanding officer summons a board of medical
inspectors. They may call on a quartermaster meat inspector to aid them, especially to
save any part of the carcass fit for consumption. Whatever they condemn, in whole or
in part, the quartermaster credits the company for the amount destroyed. In such a case
a field officer with his butcher should first ask for the cooperation of a sanitary inspector and
take action with a view to saving as much as possible.
(6) Subsistence stores: Canned goods or spoiled goods generally are usually returned
to the commissaries by the mess or supply sergeants for exchange or credit. If the quarter-
master refuses to accept these articles, the sergeant should report the matter to the mess
officer and through him to the commanding officer, who may call a medical board to pass
upon the food. It must be remembered (par. 2322) : "After rations leave the quartermaster
they are in the keeping of the troops, and any loss sustained by subsequent deterioration or
avoidable circumstances is theirs. " In other words, the quartermaster is justified in refusing
to receive back goods accepted by the sergeants, unless they are acted upon by a surveying
officer. He may, however, accept prima facie evidence. If he refuses to accept it, the
survey board is the only resource of the company.
There are several articles of the Quartermaster's Manual which should be familiar to
all our officers. See paragraphs 2309-2313, also 2769-2853. The methods of appointing
a surveying officer and his responsibility and method of procedure are covered by paragraphs
710-726 of the Army Regulations, 1913, corrected to April, 1917. Of these articles, 711
covers appointment; 712, his duties; 715, scope of action; 716, his report; and 717 (2), the
character of supplies that may be destroyed and the amounts.
In the American Expeditionary Forces there is usually to be found associated with
large camps some officer of the salvage service with whom you should get in touch. If none
such exists, locate the nearest one and determine what is his relation to your unit. Secure
liis cooperation in the matter of disposal of condemned goods.
Please report to this office the names of manufacturers and brands of goods which are
found to be markedly defective, in order that we may report the same to the chief quarter-
master.
The following circular indicates the attitude of the Quartermaster General in regard to
disposal of canned foods. It will be noted that this is addressed to the depot quartermaster
at New York and applies strictly to conditions in the States. It may be useful, however,
for quotation in troublesome cases.
\cting Quartermaster General, May 24, 1918, to depot quartermaster. New York,
N Y —Disposal of canned foods when containers are of questionable appearance:
1 Some of the containers of canned vegetables, fruits, meat and meat-food products,
and other canned goods, delivered to the Army, do not show proper vacuum. The food in
such containers may or may not be sound.
13901—27 68
1072
ADMINISTEATION, AMERICAN EXPEDITION ABY FORCES
2 The contents of these cans, known as "swells" and "leakers," are unsound because
of fermentation or putrefaction. The contents of other cans, commonly known as springers
and "flippers" (those showing loose tin or insufficient vacuum), and overfilled cans usually
are found to be sound. ^ ,,1^1 * • <• i • 1
3 To distinguish between these two classes of canned foods, the containers of which
have a questionable appearance, requires expert knowledge It is impracticable to provide
special inspectors having expert knowledge of canned foods for the examination of those
products at all camps, especiallv at those where only a few troops are stationed, lor this
reason canned foods should not be issued to troops unless the containers are in jierfect
condition and show a good vacuum. Inexperienced persons should not attempt to «ineren-
tiate between questionable cans, the contents of which may be sound or unsound, but should
reject all those packages which are not in perfect condition . j , ^ ^
4 The term "good vacuum" means the ends of round cans, large sides of flat cans, and
the sides and ends of high four-sided cans should be tightly drawn and should neither show
tin nor distention. uuiuu
5 All canned foods, the containers of which are not in perfect condition, should be held
for reclamation. "Swells," "springers," "flippers," "overdefects, " should all be inchided
in this class. Immediatelv after the discovery of canned foods showing any one of these
conditions, the facts should be reported to the depot or purchasing quartermaster, in order
that arrangements mav be made with the contractor to replace the rejected products. (See
pars. 809 and 2310, Manual for the Quartermaster Corps.)
By authoritv of the Acting Quartermaster General:
J. W. McIntosh,
Lieutenant Colonel, Quartermaster Corps, N. A.,
Subsistence Division.
9. Requests. — We are anxious to secure a series of recipes based on practical handling
of dried vegetables. Please collect such data and mail as fast as accumulated to this office,
that we may publish them for the benefit of all officers.
Also continue to send in recipes which have been found of value and which utilize the
components of the garrison ration.
In case your division has special experiences such as troop movement or combat expe-
rience, send us all the information you can gather as to the efl^iciency of the ration under
these conditions.
{Memorandum No. 22, division of laboratories and infectious diseases, September 10, 1918.)
Prophylactic Serum Treatment Against Gas Gangrene
A test of the prophylactic value of anti-gas-gangrene sera in the human subject is about
to be made.
The first serum to be used will be one which protects in the animal experiment against
the toxins of both the tetanus bacillus and the Bacillus perfringens (B. Welchii). While the
experience of French and British investigators indicates that gas gangrene may be caused by
a variety of anaerobic organisms acting alone or conjointly, the high percentage incidence of
perfringens infections justifies the thorough trial of the univalent anti-gas-gangrene serum
now' available in amounts sufficient to conduct such experiments on a large scale.
Polyvalent sera capable of neutralizing the toxins of other anaerobic bacteria concerned
in the causation of this condition are now in the process of preparation and will be made the
subject of a similar trial where available in adequate amounts. It is proposed to use in
every instance sera which protect against the toxin of the tetanus bacillus as well as the
toxin of one or more anaerobic bacteria to avoid the necessity of giving several injections,
in some instances sera derived from horses inmmunized against the toxins of two or more
pathogenic anaerobes will be employed. In others, the pooled sera derived from several
horses each immunized against the toxins of a single anaerobic bacillus will be used. For
the present it is our intention to confine the trial to antitoxic sera. Bacteriolytic and com-
bined bacteriolytic and antitoxic sera have been prepared by several French authorities and
are now being put to a practical test. The results of these experiments will determine
whether similar tests will be undertaken by the medical staff of the American Expeditionary
Forces.
To secure reliable results the complete cooperation of all medical officers concerned
with the care of the wounded and all laboratory officers taking part in the examination of
APPENDIX
1073
these cases is absolutely essential. The development of gas gangrene in patients who have
received the prophylactic injections of anti-gas-gangrene serum can not be accepted as evidence
against its value unless it is established that the only pathogenic anaerobe present in the
case is the microorganism against which the particular antiserum is supposed to protect. In
view ot the fact, as indicated above, that several anaerobes may be responsible for the con-
dition under consideration, and in view of the further fact that the detection and the recovery
of some of the less common pathogenic anaerobes presents many difficulties, it is only by the
exercise of the greatest care on the part of the examining bacteriologist that false interpreta-
tions can be avoided. Apart from the study of the anaerobes found, special attention should
be paid to the Streptococcus hemolyticus owing to the important part which this organism
appears to play in favoring the development of the gas gangrene.
To avoid errors, it is proposed to adopt the following precautions:
1. Every case in which the records show that anti-gas-gangrene serum has been admin-
istered as a prophylactic measure should be reported to the bacteriologist the moment symp-
toms of gas gangrene develop, and all cases in which from the nature of the injury or the con-
dition of the wounds such an occurrence might be expected should also be reported so that they
may be made the subject of a detailed clinical and bacteriological study even before the symp-
toms of this disease have developed.
2. In all such cases the bacteriologist should make every effort to isolate in pure cultures
all of the anaerobic bacteria present. Such strains should be sent under proper conditions
(preferably by courier) to the central Medical Department laboratory for verification of the
diagnosis.
3. In addition the original cultivations in cases of gas gangrene should be made in du-
plicate. One set should be sealed and sent to the central Medical Department laboratory by
courier after 24 hours incubation, and the name, number, rank, and organization of the patient
and the diagnosis of the case. In view of the good results secured in this laboratory by the
use of liver peptone water medium it is recommended that this medium be employed in place
of the standard veal or beef broth. The liver peptone water is prepared as follows: Peptone,
10 gr.; sodium chloride, 5 gr.; water, 1,000 c. c.
Boil 30 minutes; neutralize to phenolphthalein, then add 20 c. c. of normal sodium
hydrate solution; autoclave for 15 minutes at 115° C; filter; tube (10 c. c. in each tube) and
add approximately 1 gr. of rabbit, beef, or human liver. Autoclave for 15 minutes at 115° C;
incubate for 3 days to insure sterility (it sterile, fluid will remain clear; it may assume a faint
yellow color).
Owing to the importance of determining the exact nature of the infection in cases
receiving prophylactic injections of the anti-gas-gangrene serum these double checks seem
necessary. A report of the findings will be transmitted to the bacteriologist submitting the
specimens to the laboratory.
4. In all cases of death of individuals who have received prophylactic injections of
anti-gas-gangrene serum, excepting when the cause of death is obviously due soley to the injury
and the fatal issue occurs very soon after the injury, a complete autopsy should be performed
and detailed bacteriological examination of the blood and internal organs be undertaken to
exclude the possibility of death from causes other than a gas bacillus infection.
Method of injecting the serum. — Intramuscular injections should be made in every
instance. Concerning the most favorable site for these injections opinions differ. Some
French investigators claim that the injection should be given in the neighborhood of the
wound. Since this method may have some advantages over the injection of the serum in
distant parts, it is recommended that when possible the serum be introduced into the extrem-
ity in cases where the most serious wound involves one of the limbs. These injections should
be administered on the proximal side of the wound. In all other instances, and where the
pressure of work precludes the selection of a particular site, the injection should be given in
the region recommended for the administration of tetanus antitoxin. The injections of
tetanus antitoxins in the cases that are to serve as controls should also be administered intra-
muscularly.
Cases that are to receive prophylactic injections.— The original trials will be confined to
the wounded of a single division. To secure results of value the recipients will be selected
at random. Approximately one-half of the wounded arriving on a given day will receive
1074
ADMINISTEATION, AMERICAN EXPEDITIONARY FORCES
injections of a combined tetanus and anti-gas-gangrene serum, while the remainder will
receive usual injections of tetanus antitoxin and will serve as controls. Both the treated
and the untreated cases should receive the anti-gas-gangrene card referred to below.
It seems necessary to select the controls from the same division and from the same
group of wounded, in view of the fact that the incidence of this complication (gas gangrene)
is determined by a number of factors which may vary from day to day. Weather conditions
the character of the soil over which the fighting occurs, and the character of the missels
employed all may have a determining influence on the incidence of gas gangrene among the
wounded.
Records. — For this experiment special antigas-gangrenc record cards will be provided.
The front face of this card concerns solely the officer administering the anti-gas-gangrene
serum and the officer who has charge of the controls. These officers should fill in all of the
dates called for on the front face of this card. The back of the card concerns only the medical
officers in the evacuation, mobile, and base hospitals. The officers belonging to these
organizations should fill in the data called for on the back of this card. All cases showing
evidence of gas gangrene at the time the operation is performed or in which the nature of
the injury or the condition of the wound suggest the probability of such an occurence should
be reported as already indicated to the laboratory officer, who will begin his bacteriological
investigations immediately, if such are indicated, and also begin the collection of all clinical
data called for on the standard bacteriological report card. Form No. 3, and all other data
which in his opinion may be of interest in the particular case under consideration. When
the patient is to be evacuated immediately and the time for bacteriological investigations
is not available, it is important that the clinical data be gathered and transmitted with the
patient to the hospital organization to which he is sent.
The control cases should also be made the subject of a special study, but only if time
and the persoiniel available permit. Apart from establishing beyond a doubt the occurrence
of a gas-gangrene infection in these cases, the results secured in connection with these con-
trols have no bearing on the interpretation of the results of the present experiment.
The gas-gangrene card and a copy of all other laboratory records should accompany
the patient. This applies to the recipients of the prophylactic injections as well as to the
controls. After death, or as soon as the danger of the development of gas gangrene in con-
valescents has subsided, these cards and all other laboratory records should be sent to the
director of laboratories, American Expeditionary Forces, A. P. O. No. 721.
{Memorandum IVo. 24, division of laboratories and infectious diseases, October 16, 1918.)
Organization of Laboratory Service in Hospital Centers
1. The following outline of the organization of the laboratory service in a hospital
center has been worked out tentatively in the hospital center at Nantes and is submitted
for your information.
2. It is requested that the chief laboratory officer submit to this office a similar statement
concerning the arrangement of the laboratory service in his particular center.
OUTLINE OF LABORATORY ACTIVITIES IN HOSPITAL CENTER, NANTES
Clinical microscopy. — All routine work, as urinary analysis, blood counts, sputum foi
tuberculosis examination of warm stools for amoeba, and blood cultures, is to be carried on
in the subsidiary laboratories.
Wou7id bacteriology.— (a) Aerobes: A portion of the material to be examined is first
smeared on a slide made sterile by heat, a Gram stain made, and the morphologv of the
organism and bacterial count noted on the bacteriologic record card. If streptococcus is
present, inoculate a portion of the material on agar slanr, and agar' plate. In inoculating
plates, a portion of the material is placed in one corner and streaked out on plate with a
platinum spatula. ^
To reduce as far as possible the duplication of work in the subsidiarv and central labora-
tories, tiie isolated colonies on plates are to be picked, using the original Gram stain as a guide
for the different organisms to be sought for, subcultured on plain broth if it is a bacillus, and
sent to the central laboratory with the bacteriologic record card for identification. On the
otner Hand, it a staphylococcus is present, the organism is not isolated and sent to the
central laboratory but held for type determination in the subsidiarv laboratorv, and recorded
on the bacteriologic record card. ' • ' rt-i^orubu
'Blood.
APPEXDIX
1075
Should the isolation be unsuccessful from the first inoculation, and the time is pressing
the original agar slant, and if advisable the original agar plate, are to be sent without delav
to the central laboratory. In each case note carefully the results of all previous work done
(6) Anaerobes: For anaerobic cultures, the officer in charge of the subsidiary laboratory
is to take the material from the wound to be examined with a Pasteur pipette. After
sufficient material is secured, the contents are expelled into a sterile test tube. The pipette
is secured in the test tube with a cotton stopper and sent to the central laboratorv wrapped
in a bactcriologic record card, or Form 55u. '
The subsidiary laboratory is to retain at all times the Form 55u so that preliminary
reports can be recorded. On completion of identification, the bacteriologic record card
will be sent back to the subsidiary laboratory, where two extra copies will be made; one is
to be sent at the end of the month to the central laboratory, the other is to be attached
to the clinical brief, while the original copy is to be filed in the subsidiary laboratorv for
reference.
The same procedure holds true for aerobic identification.
Every effort should be made to secure anaerobic specimens in the forenoon as it will
facilitate the distribution of the day 's work in the central laboratory.
Miscellaneous examinations. — All specimens are to be sent through the subsidiary
laboratories to the central laboratory.
(a) Stool cultures: This work is to be done in the central laboratory. Special specimen
bottles are to be used.
(b) Sputum for pneumococcus typing: Sputum from the deep air passages is collected
in a sterile Petri dish and sent immediately to the central laboratory.
(c) Throats cultured for diphtheria: Where one or more wards are to be cultured
the swabs are taken and sent to the central laboratory for diagnosis. However, if there
are only a few cultures to be made, the diagnosis can be made in the subsidiary laboratory.
(d) Urethral smears: These are to be reported on in the subsidiary laboratories.
(e) Chancre and chancroids: These examinations are to be made in the subsidiary
laboratories.
(/) Water analysis: This is to be carried out in the central laboratory.
(g) Wassermanns: These are to be done in the central laboratory. The blood is to
be sent to the central laboratory before 5 p. m. on Monday and Thursday, with Forms
55u (in duplicate) and 97.
(h) Pleural and spinal fluids: These are to be examined in the subsidiary laboratories.
(i) Carriers for meningococcus: Blood plates are to be inoculated and incubated
overnight in the subsidiary laboratory. The plates are then sent to the central laboratory,
with Form 55u.
ij) Surgical pathology: Pathological tisgue removed at operation is to be wrapped in
gauze moistened with saline and sent immediately to the central laboratory, with complete
clinical data.
(k) Autopsies: The central laboratory is to be notified by the registrar of a death
occurring in a base hospital. The clinical brief is to be brought with the body to the morgue.
The central laboratory will notify the adjutant of the time the autopsy is to be held.
It is desirous that the force in the central laboratory will be at all times as busy with
laboratory activities as those of the sub^diary laboratories. For that reason the above
outline of laboratory activities is to be looked upon as a tentative working arrangement.
If the officer of a subsidiary laboratory is at any time desirous of doing central labora-
tory work in his laboratory, the necessary material will be gladly furnished by the central
laboratory.
^ (Memorandum No. 28, division, of lahoratories and infectious diseases, November 23,
1918.)
Bacteriological Technique for Investigation of Pneumonia
This technique and blank for tabulating findings (Form No. 11) have been formulated
with the idea of obtaining sufficient imiformity in tlie results of different workers for them to
be readily comparable.
It has been attempted to make the methods of examination as simple as possible so
that very little extra work should be added to the usual routine bacteriological examination
of autopsv material.
If it becomes the consensus of opinion that more detailed studies can be undertaken,
the program mav be enlarged accordingly.
There will no doubt be differences of opinion concerning the best culture media, proper
technical methods, etc., to be used, and you are invited to make criticisms and offer any
suggestion you may deem advisable. ., , ^,
In the meantime, however, you are requested to follow as closely as possible the pro-
gram as outlined. Alterations which meet with general approval may be made subsequently
1076
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
It is the intention to send out to each laboratory taking part in the investigation a
monthly compilation of the reports received from all other participants. In this way, all
may keep generally informed as to the progress and development of the undertaking.
A. AT AUTOPSY TABLE
1. Material necessary:
(a) Alcohol or gas lamp.
(6) Potato knife or similar instrument for searing surfaces.
(c) Sterile swabs in individual test tubes.
((/) Test tubes containing about 3 c. c. of nutrient broth.
(e) Sterile pipettes.
if) Sterile slides.
2. Material from the following places will be examined:
(a) Heart (blood).
(b) Large bronchus, right and left lung.
(c) Small bronchi, right and left lung.
(d) Lung tissue, right and left side.
(e) Accessory head sinuses and meninges which may show pathological process.
(J) Pericardial and pleural cavities in case of involvement.
3. The heart's blood will be obtained as soon as the heart is exposed and before it
has been opened. The surface will be seared and a sterile pipette plunged through the
seared area into the heart cavity, at least 1 c. c. of blood withdrawn and transferred to a
test tube.
4. The remainder of the material will be collected by means of tightly rolled cotton
swabs. That from the lung tissues will be taken by first searing the cut lung surface and then
forcing the swab through the seared area. Two smears from each swab will be made separately
upon different slides. The slides will have been previously sterilized in the laboratory. This
may be conveniently accomplished by wrapping them in paper and sterilizing in a hot-air oven.
The swabs will then be put in the tubes containing the nutrient broth and taken to the labora-
tory for culture.
B. IN LABORATORY
1. Microscopical examination of direct smears. — One set of the smears will be stained with
a weak aqueous fuchsin (one-fourth per cent saturated alcoholic solution of fuchsin in distilled
water) and the other by Gram's method.
The weak fuchsin stain is selected because it is particularly satisfactory in demonstrating
influenza bacilli.
The various morphological types of organisms will be noted and the relative proportion
of each estimated.
It is of course obvious that the true nature of the organisms in many instances will be in
doubt until cultural studies are completed, but by a comparison of the microscopic and cul-
tural findings it should be possible to link them together and obtain an accurate idea of not
only the identity of the organisms but also the approximate percentage of each.
The direct smears will be particulary important in determining the percentage and the
cultures in working out the identification.
Cultures. — (a) Heart's blood: One loop full of the heart's blood will be spread on the sur-
face of a blood agar plate and 1 c. c. inoculated into a tube containing at least 10 c. c. of
calcium dextrose broth. (The blood agar will consist of a meat infusion agar having a reaction
of plus 0.5 to phenolphthalein, to which is added 3 per cent of citrated or defibrinated blood.
Human blood will probably be the most convenient to obtain. The broth will be a meat
infusion broth, plus 0.5 to phenolphthalein and containing 1 per cent dextrose and 1 percent
calcium carbonate. It must be frequently agitated while tubing so that an equal distribution
of the calcium carbonate is obtained.)
(6) The swabs will be stirred about in the broth, rolled over the sides of the tube to
squeeze out the excess of fluid, and inoculated over a small area of a blood agar plate. Further
spreading is accomplished by a bent wire or glass rod spreader. The importance of a uniform
and well-distributed seeding over the plate in identifying B. influenza and slow-growing
streptococci can not be overestimated.
APPENDIX
1077
3. Examination of primary cultures. — (a) After incubation at 37° C. for 18 to 24 hours
the plates will be ready for examination.
The different types of colonies on each plate will be studied and their relative numbers
noted.
From all different types smears will be prepared and stained by Gram's method.
Subcultures will then be made as indicated.
(6) If no growth is obtained from the heart's blood inoculated upon the plate, a smear
will be made from the broth culture and a loopful streaked upon a blood agar plate and further
incubated.
4. Methods of study and identification of organisms most likely to be encountered. — (a) B.
influenzae (Pfeiffer's bacillus) appears upon whole blood agar as minute pin-point, dewdrop-like
colonies which are very likely to be overlooked unless searched for with a hand glass. They
are more easily seen in reflected light.
If such colonies prove to be small Gram-negative bacilli, a diagnosis oi B. influenzae is
probably justified, but as further proof transplants may be made to plain and blood agar slants.
Failure to grow on plain agar along with the other characteristics, is a distinguising feature of
the organism. In some instances, especially if there is an overgrowth of other organisms, the
influenza bacillus may fail to develop, in which event opinion as to its presence will have to
be based upon the microscopic examination of the direct smears.
Special media have been devised for its growth, but are not so satisfactory as whole-blood
agar in distinguishing other organisms, and it has seemed advisable to attempt to select a
single primary medium which would be generally adapted to the growth and differentiation of
all organisms likely to be met with.
(6) Streptococcus and pneumococcus group. — At least one colony from all of the different
appearing types of streptococci or pneumococci developing upon the blood agar plate will
be transplanted to calcium dextrose broth (preparation previously described). After 18 to
24 hours' incubation the cultures will be examined microscopically and the following points
noted: Size, shape, regularity, and chain formation. It is advisable to always save the
plate until the following day so that if growth fails to occur in any of the transplants refish-
ings may be made. Bile solubility test will then be performed by transferring with a sterile
pipette 1 c. c. of the culture to an agglutination tube and adding 0.2 c. c. of clear ox bile.
After incubating 20 to 30 minutes in water bath or 30 to 45 in incubator the results are
read.
From those that are not bile soluble a subculture will be made into plain infusion
broth, containing 5 per cent citrated or defibrinated blood, and after 16 to 18 hours' incubation
the hemolytic effect will be noted. It is well to shake the culture after about 4 hours' incu-
bation. It is very important that fresh blood be employed, and in all instances a control
tube which has not been inoculated should be subjected to the same incubation.
Streptococci will be classified as hemolytic, nonhemolytic, streptococcus mucosus,
and streptococcus viridans.
Hemolytic and nonhemolytic streptococci grow on blood agar as small white to grayish
colonies. If hemolytic, the degree of hemolytic activity should be recorded as indicated
on attached form.
Streptococcus mucosus (or pneumococcus) grow as rather large greenish colonies and
may be hemolytic.
Streptococcus viridans appear as small green nonhemolytic colonies.
All bile-soluble cultures will be tested against pneumococcus types sera I, II, and III.
There will usually be sufficiently heavy growth to use the broth culture direct. Utmost
care should be used in withdrawing a portion of the culture to prevent agitation of the cal-
cium carbonate, which will have settled to the bottom of the tube.
Strains of pneumococci which are not agglutinated by Type I, II, or III sera will be
subcultured to calcium dextrose broth to which approximately 5 per cent of defibrinated
blood has been added, and after 10 to 12 hours' incubation will be sealed, properly labeled
with name of case and location from which culture was taken, and mailed to the central
Medical Department laboratory.
Agglutination tubes containing about 2 c. c. of broth and 2 drops of blood will be found
convenient for this purpose. To avoid the loss of strains a subculture of each organism
1078 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
mailed will be retained until the notification of receipt at this laboratory has been received.
Cultures in blood broth should remain viable for several weeks at room temperature after
a short primary incubation.
(c) Staphylococci. — The hemolytic effect of the staphylococci should be noted upon
the plates, and if any doubt exists it should be further tested in blood broth. The presence
or absence of pigment will also be observed and classification made accordingly. It should
be borne in mind that pigment frequently does not develop until 48 hours or more.
(d) Gram-negative cocci. — Transplants from colonies of Gram-negative cocci will be made
upon Loeffler's blood serum medium or blood ether agar. From the transplants emulsions
will be made in salt solution and set up against Rockefeller polyvalent serum 1 to 200 and
normal rabbit or horse serum 1 to 100.
Subcultures upon brain medium of all strains agglutinated by the Rockefeller serum
will be sent to the central Medical Department laboratory for typing.
The brain medium is prepared as follows: Brain (calf) run through meat grinder,
3 pints; distilled water, 1 pint; tube and autoclave (see office letter No. 30).
5. The necessary diagnostic sera will be obtained from the central Medical Department
laboratory.
{Memorandum No. 37, division of laboratories and infectious diseases, February 9, 1919.)
Consolidated report of laboratory work accomplished in the American Expeditionary Forces during
the month of January, 1919
Comprising U base-section laboratories, 16 hospital-center laboratories, 70 base-hospital laboratories, 26 camp-hospital
laboratories, 22 evacuation-hospital laboratories, 2 mobile-hospital laboratories, 19 divisional laboratories, 3 water-
analysis laboratories; total, 169. Number of deaths in hospitals, 948]
EXAMINATIONS MADE
I. Clinical pathology:
Blood—
Erythrocyte counts 1, 347
Leucocyte counts 7, 361
Differential leucocyte counts 4, 933
Hemoglobin estimations. 1, 384
Malaria examinations 492
Positive examinations 34
Urine —
Urinalyses —
Ordinary chemical 29, 976
Ordinary microscopic 20, 354
Feces —
For parasites and ova, examinations 745
Positive examinations 96
For Entamebse examinations 395
Positive examinations 42
Sputum —
For tubercle bacilli, specimens 15^ 165
Positive specimens 750
For other organisms 881
Positive specimens 508
Gastric contents, examinations of 165
Spinal fluid — -
Smears for meningococci g31
Positive , 286
Smears for other organisms 73
CeU counts 290
Globulin tests 228
Colloidal gold reactions 1
APPENDIX
1079
I. Clinical pathology — Continued.
Venereal specimens —
Smears for gonococci g 53^
Positive 2, 548
Examinations for T. pallidum —
Dark field examinations 1 631
Positive 164
Stained specimens 453
Positive 70
Clinico-pathologic examinations not otherwise listed 1, 986
Total 95^ 222
II. Anatomic pathology:
Operation specimens, macroscopic examinations 257
Autopsies performed 846
Histopathologic examinations 552
Museum specimens prepared 50
Photographs of wounds, specimens, etc 506
Drawings of wounds, specimens, etc 77
Anato mo-pathologic examinations not otherwise listed 286
Total 2, 574
III. Bacteriology (specimens examined culturally) :
Blood, specimens of 1, 546
Urine, specimens of 607
Feces, specimens of —
For dysentery 2, 048
Positive 29
For typhoid or paratyphoid 2, 983
Positive 263
Sputum, specimens of —
For pneumococci 1, 383
Positive 653
Typed by Avery's method 702
Typed by mouse method 52
For other organisms 521
Positive 316
Nasopharynx, specimens from, for B. diphtherise 21, 542
Positive examinations 1, 972
For meningococci 5575
Positive examinations 508
Spinal fluid, specimens of 627
Positive examinations 174
Pus, exudates, etc. (exclusive of wounds) —
Aerobic cultivations 816
Complete identifications (number of stains) 456
Anaerobic cultivations 228
Complete identifications (number of stains) 43
Wounds —
Aerobic cultivations 1> 944
Complete identifications (number of stains) 498
Anaerobic cultivations 237
Complete identifications (number of stains) 34
Autopsies, Total original cultures from 983
Milk, total number of specimens of 86
Water, total number of specimens of 3, 595
Bacteriologic examinations not otherwise listed 2, 322
Total
48, 744
1080
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
IV. Serology:
Agglutination tests (with bacteria) 2' ^^^'^
Bloods grouped (for transfusions) '^^'^
Wassermann tests —
Blood 9. 265
Double plus, or plus 834
Spinal fluid - 1^7
Double plus, or plus 25
Serologic examinations not otherwise listed 1, 453
Total 13, 120
V. Chemistry (specimens analyzed) :
Blood. 174
Urine, special examinations 1. 568
Water 1, 280
Milk 3
Drugs, foods, beverages, etc 32
Chemical examinations not otherwise listed 64
Total 3,121
VI. Operative procedures (by laboratory staff) :
Treatments with salvarsan 753
Treatments with therapeutic sera 839
Treatments with bacterial vaccines 1, 172
Schick tests 6, 260
Luetin tests 3
Animal inoculations 172
Operative procedures not otherwise listed 1, 925
Total 11, 124
Total laboratory examinations not included above. 927
Grand total 174, 832
{Memorandum No. 38, division of laboratories and infectious diseases, February, 1919.)
THE MORE IMPORTANT FORMS USED IN THE LABORATORY
SERVICE, A. E. F.
BACTERIOLOCIC RECORD Ward Bed
Undaracor* (•pma which applT
Dole A I
r or Injury
r of nrtmlsil
, Inillal
A.M.- P.M.
.A.H.-P.1I.
BACTERIOLOCIC EXAMINATION
Nome of hospital....
•MfUllM If II
Summarif of ■aetarlologto fladlDas - — -.
BACTERIOLOCIC NOTES
r of
i.lary
Op.
Dole of primary discharge .
FfQD Etic Hotp. No MoblU lloip. No
To tH*e Hotp No Ult •( mwUn *\*t^*
Or. Sviici ON - ~
JLM.-P.U.
■ - Improved • Cu red • Died
— „B«H lloip.Mo —
lairtfM-UfH-IM
Surgical Dlagnotlt
..No. of Wounds...
irY or Tr«atment -
;vrn»r - iU-su«italion Yes - No -
Inltisioii - Ves - No. Chnracler
Tninsfusion • Yes - No. Cliaracter
Scrum Trcalmcnl -Type —
HcMilu — Scnitr
jcal -Oiicrnlive
Debridement - P.Trlinl - Complete
Foreign bo*!)- removed Yes -So-? Number ~
Primnry closure Yes- No - Di-alnage - Vcs- N^
Amputnlioii • Yes - No • t" tt lilirr - It Nttrtl
Delayed primary closure - Yes - No
Secondary closure - Yes - No
Trcalmeiit of wouiul before closi
- Aseptic - Antlscpltc
BtATeniAL ron Eumikatiok.
Eiudate secured • before - during- after
Siclc 0-1-2-1
Debridement
Primary Sutura
Delayed Primary
Secondary Sulura
Character of Exudate _ -
Foreign Bodies - MIsslla. Wood - Cloth - Bone
MlCnOSCOPlC CXAUINATION
CoLTunxL ExAtir
Aerobic - Uedia & McUtoil -
Anaerobic - Media & Method.-
ivs (complete -t- Incomplete —
yllc Yes - No + —
ylic Yes - No -f -
Serum Treatment -
Hlatologle Biamlnatlent -
PniHARI •
Cause of Failure
Delayed rniMAriT ci
Cruise of Failure
^CCONDAnV Clo^lhe
Cause of Failure
hours aflcr Injury •
Failure
Pnrlia) Fallun
Suceess
l-uilure
Partial Failura
CLINICAL DATA
When feasible secure the following additional Information
Local L.«fllon*
Location OP Wd. M"*-
Drschiption op Wd. <t»t- wm^ikW ImImJ-ms*"'""!-**"*""'!
Degree of contusion - 0 - 1 - 2 - 3 mnt t li«nllM 0-1-2-3
MissiLR - Bullet - Shrapnel Boll - Shell fragment - Hand
Grenade - Bayonet - Knife
FonBiGw BODIES In Wd.-Yes-No Retained Yes - No - 7
Local Signs op iNPEcriOK liaH. 0- 1 -2-3-6m •...m«0- 1 -2-3
Associated Lealona
Bone-Fracture of r"""*^
bH (•■■iMttI T« • U
joinT - - penetrated by missile t»*i«
Ckten^tion of fracture into Joint Yes - No -
Vmsf.i.. - Coulusion or Section of •
Degree of Imi^nirmenl •! \m\ Ort»\»u*t 0-1-2-3
Bouv CAVITY penetmted-pcrforated
Viscera Involved — ■—• -
OTIIBn COHPLICATIOWJ! -
C«neP«L-PHVSICALOEVELOPMBKTi-l-»ST*TEOFNDTRITIONl-t-»
l^viDBNCBS OF States Ltmphaticus 0-1-2-3
Gekbral CONDITION OH Admission-good-falr-poor.
DtGi.ER OP SHOc^on admission -0-1-2-3
HiiTonv or HSMonnHAOE -0-1-2-3 Visiblb blebdino 0-'r-2-S
Degreb of Anaemia 0-1-2-3 Cyanosis 0-1-2-3
Degiitk op exposlrf. 0-1-2-3-to wet- to cold.
TKMFKftATUBK on AdmlwIOR After RewscilallOQ
PtLSB OD admission • lUle quality
Respiration on admission - Rale qualily
EviDBMCBS OF Gassikg 0-1-2-3 Type
AntopST. — Amatomical uiaonosis
niCROBIC CURVE CHART
in.tructlon.. - This form is to ^e filled out In duplicate
bv Imcleriolonist. If necessary, fill out one d"P'*<^"'* * . .
Mr ^mind examined but omit repetitions. TTie original to
Je retaS in Inboralorv-the copy'^lo be ke,.t with clinical
reeort The copy is to be sent (o lahoratrfty with speci-
reeor*.. proper entries have been made is fo be
(vord on doy of receipt of same. I he original
Tipleted Is lo be sent to the Director of Ubo-
aiorle% A. E. F- with the monthly statistical report.
Definition of ir?!.^.".!^J^.^'''.:r.d^r^;e^t*S^
and mode of
lids
ptie
aDDll.iilion. Becord under proper dole final operallon. and
'AlVrniedlal. opero.lons undertaken lo remove sequestra
foreign bodles.|^ "1' a7c.?e^"'^ -"ijlJjJ'ua^o^JuJr'enie. fo
be recorded under proper dote. — Idfmtificatioh op SxnAiNt.
_ When feasible chaln.forminj coeel and orgnniims respon-
sible for failures follo^vliia wound elosures slwuld be Ideo-
1 ned or sent lo the Central Medical Dpp.-irlmenl LaborBtory
for iderlincallon. Appro.lmale Idenliflcallon »'<>;»•"'''"'
resnonstble for ans iiongrene should be ntlempted ana sucn
It«in. shoi.1.1 Be «nl to the Ccninil Medical Department
Laboratory for Idantiflcatlon, porliciilarly in cases in whlcb
curative or prophylactic sera proved valueless.
Sigu and Abbmlitloiti
Signs for entering types
of Bacteria In clinrt.
Streptococcus ....
Staphylococcus
Cram -{-bacillus v
Gmm — bacillus CD
Spore bearing bacilli
a -o
For Anaerobic Bae.
3 = marked or good.
Other Abbrevations =
use those employed
(b clinical records.
1081
1082
ADMINISTEATION, AINIERICAN EXPEDITIONARY FORCES
Form No 4,
(rcvl^d)
MONTHLY STATISTICAL REPORT
SECTION OF WOUND BACTERIOLOGY
Name of Hospital (code No.) - R=P<»' coveHuR period From 1!» to K
L- i^sUL'il. It is 10 be filled out
irgani/-ation from which llir
il to the Director of the Surgical Service. A. E. F. respectively beftre
,h<ifeach month. In compiling this report all cases entering the Hospilnl during the preceding month shouUM,. includca lU.nMs of woutid closure*
n before the 10 th of the following month should be included in this report. Other stolistical evidence « III
of practical value is revealed.
This form is designed for the use of a general surgical hospital. For head.-chest and abdominal wound centers spec.al forms w.ll
In triplicate by the Wound Bacteriologist or his Statistical assistant, One copy is to be retained as the permanent record of the hospital
report is i^sued. the other copies are to be sent to the Director of Laboratories, A. E. F
made during month covered by this report and ki
be compiled from individual case reports and submitted to those concerned if infor
!■ Total number of Wounded . . .
<i Single
/.. Multiple
i. Total number of Wounds . ...
3. Average time of arrival aflrr injury
in hours
4. Wounds treated Surgically (MriitoiMl
5. Wounds Sutured
<i. New Wounds
(i. Old Wounds Irom previous months
6. Unsutured Wounds
a New Wounds
h. Old Wounds (r»m previous months
7. Wounds evacuated before suture
was attomplcd
S. Unsutured Wounds disposed of be
caus.- of de;Uh of cases
9. Amputations
a. No. due to severity of injury . - .
/». No. due to simple infection
c. No. due to gas gangrene
10. Primary Sutures
. Suci
b. Partial failures
c. Failures
11 Primary Suture wounds reopened
hecause of bacteriologic findings . . . .
12. Primary Suture wounds reopened
because of Clinical findings (in which
I'acteriologic lindings were superfluous
nr misleading)
13. Delayed Primary Sutures
a. Successes
b. Partial failures
c. Failures
11. Delayei Primary Sutures based on
microscopic bacteriologlc exams. . . .
a. Failures
I'l. Delayed Primary Sutures based on
cultural bnct04iologic exams
./. Failures
10. Delayed Primary Suturesaitt without
prrvious bacteriologic exams
a. Failures. . . .
17. Secondary Sutur<
I'. Partial failu
IS. Secondary sutures based <
19. Secondary sutures based on cultural
bacteriologlc exams
a. Failures
20. -Secondary sutures made without
previous bacteriologic exams
a. Failures
21. Average time elapsing between in-
currence of injury and primarj- suture.
22. Averagetimeelapsing between incur-
rence of injury and pfi«»r; sainrt . ,
a Aseptic treatment
b. Antiseptic treatment
23. Averagetimeelapsing between incur-
rence of injury and secondary suture .
a. Aseptic treatment
b. Antiseptic treatment
24. Total number of Wounds examined
culturally . .
a. Aerobic cultivations
b. Annerobio cultivations
c. Aerobic and anaerobic cuitiuiioBs . .
25. Wounds In which Streptococci were
a. Microscopically. .
b. Culturally
26. Wounds la which haemolytlc Strep-
tococci were found (Percentage based
on number of chainforming tatti it^lti) . .
27. Wounds In which nonhaemolytic
chainforming cocci were found (Per-
centage based on No. of chainforming
cocci tested)
28. Blood cultures; in cases of simple
Infection
29. Number of cases of Streptococaemla.
30. Wounds In which anaerobes were
found
a Microscopically
b. Culturally
31. Wounds contaminated with anae-
robes but pursuing a favorable course
(»l BO tia* ikstiif Mi<»D«s •>( jjs lit. iBfert ) . . .
32. Wounds contaminated with anae-
robes in whicli gas bacillus infection
developed
33. Wounds in which gas bacillus Infec-
tion was evident before bacteriologic
examinations were undertaken. . . , ^
34. Wounds In which the discovery of
anfterobea determined the course of
treatment
>5. Wounds in which anaerobes and
haemolyticstreptococcl were found
, sho
3G. Wounds in which gas gangrene fol-
lowed when both haemolytlc strepto-
cocci and anaerobes were present.
37. Wounds In which anaerobesand hae
molytlc streptococci »*re foaml iu (iienlow-
. Wounds In which gas gangren
ted or lul
0 till
i of gas gangrene
of gas gangrene U
39. Blood cultu
a. Single e;
b. Multiple
40. Cases In which anaerobes were
isolated from blood
a. Ifi first cxaminal
b. After two or moi
41. Number of ca8<
42. Number of case
which B.welchli wasthe only anaerobe
a. Completely identified
b. Partially identified
43. Number of cases of gas gangrene in
which Vlbrlon septique \\as the only
anaerobe found.
, a. Completely identified .
b Partially identified
44. Number of cases of gas gangrene In
which B' cedematiens was the only
anaerobe found
a. Completely identified
b. Partially identified
45. Number of cases of gas goilgrenc In
which B. sporogenes was the only
anaerobe found
a. Completely identified
(). Partially identified
46. Nu"mber of cases of gas gangrene in
vbicb >iD|lc ir»i»orioi«robes«lhcrlbii the ibi'tvtrt (osdI.
47. Number In which ijalxtures of , . .
48. Number In which mixtures of . ■ .
49. Number in which mlxturi
I of . . .
Lus. (Foi
50. Number of cases of teta
each case a special report will u dlN out j
51 . Number of cases of tetanus associated
with gas gangrene
BACTERIA RESPONSIBLE FOR FAILURES FOLLOWING WOUND CLOSURES (Fill in names of orgni
^ held res|Min?ililc for failures)
W. Primary Sutu
53 WOUNDS OF SOFT PARTS
5^. Delayed Primary Sutures
N;>.-| ^ No. 1 X
56. Secondary Sutures
58. Primary Sutures
59. Delayed PrinnLry 9utureB
f'O. Secondary Suturea
No. 1 %
No. 1 A
NO. J.
No. j K
N„. 1 f j-No. 1 X j No. j X
No.|.
No. 1 X
No. 1 X
No. j X
No. j *
No j *
1,1 v^ou.nds of joints
62 Primary Sutures
G3. Delayed Primary Sutures
C4. Secondary Sutures
No.|.
No.|,
No.,,|no.,.
NO.,.
..|.
No. 1 X
No. 1 X
No. 1 X
No.|.
No|,
No.|.
N». j *
No. j X
No j X
APPENDIX
1083
Oj. Reaulta of Wound-CIo
70. Wound* of Solt Paru
a. Suture witliin 6 Itrs. of injury. . .
b. — belwcoii 6-10 lirs. of injur
e. — ■■ 10-1.'.
rf. -
5-34
t. — within 2 dnys of injnrj
/• - - * -
»• - - 7 -
l>- - -U -
I, — later timn 14 <lays of injury
J, Of face and scAlp. -
It. — Trunk.
I. — Eitremillcs eiel. or nands & feet. . . . .
m. — Hands
II. — Feet
71. Wound* of bone without o-naplete Fracture.
(Elcl. of Skull & Spinal Column)
a. Suture within 6 hrs. of injury
». — between 6-10 hrs. of ii\Jurv
e. - - 10-15 -
d. ~- - 15-24 —
«. — within 2 days of injui-j'
f- - - 4 -
A. —
— 14
I. — later than 14 (lays of injury
7i. Woiinda of bone with oomplete Fracture .
(Eicl. of Skull & Spinal Column)
a. Suture within 6 hrs. of injury
h. — between C-10 lirs. of injurv . .
t. — — 10-15 — . . . .
d. — — 15-21 — . . . .
*. — within 2 days of injury ....
/■ -
— 4
— 7
14
/. — later than 14 days of injury.
/. of Femur
m. — Tibin & Fibula .
n. — Tibia
o. — Fibula
p. - Humerus
— Rsdius & flna
r. - Radius . . .
>. — Ulna
/. — Rones of Hand
u. — Bones of F/.OI
y, — other Bones
73. Wounds of joints
a. Suture within G hrs. of injury. . . .
b. — between G-10 hrs. of injury .
c. — — 10-15 —
</. — - 15-24 -
r. — within 2 ilav s of Injury . .
/. - - 4
h. -
- 14 —
Inti r than II davs of injurv.
Jt. of Hip
(. - Knee
ni. - Anklo
n. — Shoulder
o - Elbow
p. - Wrist
74. Wounds of Skull
a. Without injury to dura
^ Willi injury to dura and Brant
75. Wounds of Spinal Col
0. Without injurv to Dura
^, With injurv to Dura and Co:d
16. Wounds ol Pleura (only)
77. Wounds of Pleura Sc Lung
78. Wounds o( Pericardium (only)
70. Wounds of Porlcardlum 4 Heart
80. Wounds of Peritoneum
fl. Wounds ol Peritoneum & Abdom. Viscera .
«2. Wounds of Kidney 4 Ureter
83 Wounds of Bladder
81 Wounds of Urethra
85. Wounds of Gen It jl la ...
86. Totals
A„Bar.v,*T,ONS. - S ^ Successful closure. - P F = Partial failure - Partial reopening of wound
neeessar^■ .0 control Infection. - F = Failure - Complete reopenins of wound necessary 1o combat
infection' - D = Died - St = Streptococcus. - A A = Anaerobic bacteria.
6G. Primary Sutures
67. Delayed Primary Sutures
68. Secondary Sutures
69. Causes of Failure
Tola
No.
S
PF
F
D
T °
No.
S
PF
F
D
T °a
No.
S
PF
d
F
D
St
;>
AA
d
lite
■
""
1
-
-
Cbief Wound Bacterlologlit.
1084
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
o
:ompIel
Q.
O
tji
s.
D-
O
H
o'
O
ould be!
9
z
o
H
B
a.
I
O
5*
m
3-
f»
o
o
D
very
<
AR
o
•o
p
o
r
H
S-
o
a.
5'
a.
>
a.
F.. A.
1 other
n
3
■o
-D
>
P
borat<
■<
5-
3
REMARKS. SPECIAL •CAS-GANCREN r CARD
Combined Tetanus znd Welch Bacillus Antitoxin
OFFICER ADMINISTERING SERUM
fill in following data.
Field HospUalNo.
Dreuing Station No
Name
(Block letters)
Rank No.
Regiment or Staff Corps
Combined tetanus and Welch bacillus antitoxin
administered on 191
at *;JJ}; hours
after injuiy.
U. S. Army.
SUReEON OPERtTlXe, FILL IN FOLLOWINE
DATA, CHECKINe TERMS THAT APPLY
Field
Mobile
Ew.
Walking
I Hosp. No Stretcher J
Resuscitation ,
OATEiUIIIBOIlOrADIlSSlDII
t r
P.H.
DATE Am im or HITIAI OPERATIOJ A "
p.«.
Local Sigru of Infection
Simple. 0-1-2-3
Cas bacillus. 0-1-2-3
Nalun of Initial Operation
Debridement | ^''^pij,^ Primary closure | Jjj"
•Foreign BoJy
Present \ Removed^
(No < No
A . .■ i Yes ( degree o( injury
Amputation J ., for! '. ,
infection SS;-;pIe^„„,
Diagnosis of Operating Surgeon.
Date of Evacuation following initial
operation
LABORATORT OFFICER
FILL IN FOLLOWINe DATA.
Subsequent gas bacillus infection j
Degree. 1-2-3
Recovery.
Death.
Autopsy.
INSTRUCTIONS TO ATTENDING
SURGEONS.
Notify bacteriologist in every case developing
gas-gangrene or in v»hich from the niture o( the
injury or the condition of the wound such an
occurence might reasonably be expected. Numer-
als 0-1-2-3 signify respectively absent,
slight, moderate, marked.
flames of anaerobes identified
Unidentihed anaerobes | Absent
Streptococcus haemolyticus j Abi'tnt
INSTRUCTION TO BACTERIOLIGIST
In those cases developing gas-gangrene the
bacteriologist should be guided by instructions
given in Memorandum No. 24, Div. Labor.,
' Prophylactic Serum Treatment against Gas-
Gangrene".
APPENDIX
1085
REMARKS.
- o 0. T3
I
^ i ' I- o
O 3 O- "7
SPECIAL-GASGANGRENE'CARD
TETANUS ANTITOXIN ONLY
OFFICER ADMINISTERING SERUM
(ill in (ollowing data.
Field Hospital No.
Dressing Station No.
Name
(Block letters)
Rank . No.
Regiment or SlafI Corps
o n °- 3^ Tetanus antitoxin administered
°- n 3 on
> I i M A. AV
m ^ =^ S ' ' P-
T, - p s •"«' '"'""y.
•TJ E" > •<
p f r ^
19!
hours
U. S. Army.
SURGEON OPERATINe, FILL IN FOLLOWING
DATA. CHECKING TERMS THAT APPLY
fi'lJ ) Walking ]
Mob.le i {
^^^^ / Hosp. No Stretcher ^
Base ' Resuscitation
DATE WD flOm or ADIHSSIOI
DJTEAIDHOllBOFIKimLOPEIUTIOll _
Local Signs of infection
Simple. 0-1-2-3
Cai bacillui. 0 ■ I ■ 2 ■ 3
Diagnosis of Operating Surgeon.
Date of Evacuation following initial
Subsequent gas bacillus infection ^
Degree. 1-2-3
Recovery.
Death.
Autopsy.
LABORATORT OFFICER
FILL IN FOLLOWING DATA.
Names of anaerobes identified
Unidentified anaerobe
S Pf«cnl
f Absent
Slreplococcns haemolylicus J Abs'ent
Nature of Initial Operation
Complete
Foreign Body
.^Yes
•/No
Present
Amputation J
' No "■"I' No
Yes ty degree oi injury
No ■ , . \ Simple
infection f .
INSTRUCTIONS TO ATTENDING
SURGEONS.
Notify bacteriologist in every case developing
gas-gangrene or in which from the n&ture of the
injury or the condition of the wound such an
occurence might reasonably be cxpeclcd. Nume-
rals 0-1-2-3 signify respectively absent,
slight, moderate, marked.
INSTRUCTION TO BACTERIOLIGIST.
In those cases developing gas-gangrene the
bacteriologist should be guided by instructions
given in Memorandum No. 24. Div. Labor,
"Prophylactic Strum Treatment againtt Gas-
Gangrene".
1086 ADMINISTRATION, AMERICAN EXPEDITION AKV FORCES
GSW Card No.—
Form No. 16.
Classification: Anatomic location of major wound
Group
Identification: Surname Christian
Rank Co Organization
Age Race Service
Aut. No. (CMDL) Aut No. (Orig.)
Pathologist
Hosp
(1) No. of wounds:
Single.
(Penetrating
" [Nonpenetrating .
Multiple__ -1^,^"^*^"'^"^---;
^ [Nonpenetratmg.
(2) Location:
Major wound
(14) Bacteriology:
Wound —
Part ident
Compl. ident
Blood-
Part ident
Compl. ident
(15) Cause of death: (clinical diagnosis)
Principal cause
Minor wounds
Contributory causes
(3) Missile:
I Shrapnel
High explosive
Grenade
I Shrapnel ball
Machine gun
Rifle
Side arms
(4) How received:
In action (I. A.)
Accidental (Acc.)
Self inflicted (S. I.)
Homicidal (H)
Judicial (J)
(5) Battle area:
(6) Date wounded
(7) Date of death
(8) Duration of life
(9) Wound to first operation
(10) First operation
(16) Hospitals through which patient passed:
(17) Location of major wound
(11) First operation to subsequent
(18) Groups:
Group A (gas gangrene).
Group B (other factors with gas
gangrene) .
Group C (pyogenic sepsis).
Group D (tetanus).
Group E (miscellaneous).
Group F (GSW, no connection
with D).
(19) Primary immediate cause of death:
(12) Subsequent operations
(13) Clinical course
(20) Secondary lesions :
APPENDIX
1087
(21) Historical landmarks:
(22) Principal bones injured
(23) Large blood vessels injured
(26) Bacteriolog}-
Wound —
Part ident
Compl. ident
Blood-
Part ident
Compl. ident
(27) Cause of death (anatomic diagnosis) :
Primary immediate cause of death _
Secondary lesions
Historical landmarks
(24) Internal organs injured
(25) Nervous system injured
(28) Opinion of pathologist (as to diagnosis,
and medical treatment,)
13901—27 69
INDEX
Abandonment of hospitals 1041
Accountable office for Medical Department transportation 920
Accountability :
for medical property 1021
for medical supplies 1018
method of closing, upon turnover to French authorities 1054
Accounting, finance and, finance and supply division, chief surgeon's office 408
Accounts:
bureau of, and finance bureau, A. E. F., liaison with finance and accounting
division, A. E. F 414
of civilian personnel, analysis and record of, finance and supply division, chief
surgeon's office 411
Activities:
American Red Cross, hospital centers 487
central Medical Department laboratory 162
collective, of hospital units, hospital center, AUerey 522
general correlation and, division of laboratories and infectious diseases 150
general outline of development and, division of hospitalization, chief surgeon's
office 229
hospital center, Allerey 496
Medical Department, American forces in France 829-831
medical, of territorial sections 447-472
of the surgical services, division of hospitalization, chief surgeon's office 361
personnel division, chief surgeon's office 89
professional, hospital trains 329
recreational, hospital centers 487
Adhesive tape and surgical bandages, misuse of 911
Adjutant, hospital center, Allerey 497
Administration division, chief surgeon's office 85-87
Administration:
hospital center —
Bazoilles 537
Mesves 583
Nantes 588
hospital trains 324
of messes — function of dietitian 931
organization and, hospital center, Beau Desert 549
organization and, of the chief surgeon's office 39
Administrative functions, division of sanitation and inspection, chief surgeon s office,- 134
Administrative details, director's office, division of laboratories and mfectious diseases,
chief surgeon's office .--7
Admission of officers and soldiers to Services of Supply hospitals 936
Advance medical supply depot No. 2 1007
Advance section, medical activities of ^o^'ioe qoI
Aides reconstruction 125, 128, 994
Allerey hospital center. (-See Hospital center, Allerey.) ^ ^ ^
Allied armies. Red Cross allowance for soldiers of, in United States hospitals 920
Allied patients in hospital, commutation for 918
\llies-
billing, for hospital charges, finance and supply division, chief surgeon's office 413
liaison of the Medical Department, United States Army, with the medical services
Qf the
military "atYach^V and' observers, medical officers with special duties, hospital
units and casual personnel, on duty with 13
Allowance: .
for soldiers sick in hospital a' " • k 01 1 noo
Red Cross, for soldiers of the Allied armies in American hospitals 911, 920
Ambulance companies, evacuation 342
1089
1090
INDEX
Page
Ambulances ij^,'.
assembly, salvage, and repair '^^^
dental oog
estimates as to number ^37
procurement
Expeditionary Forces, organization and development, general, of the soq^o?}
forces in France, Medical Department activities 813-819
forces in Germany
hospital trains, British-made
militarv hospitals, report of French patients in
American Red Cross. (See Red Cross, American.)
Amex: ,,0
casque, dental
denture
Analysis and record: , . . 1 - r >
of accounts of civilian personnel, finance and supply division, chief surgeons
office -7- ^11
of disbursements, finance and supply division, chief surgeon s oftce 411
of hospital funds, finance and supply division, chief surgeon s office 411
Anesthesia, gas for
Animals : . „„
sick and wounded, evacuation of
supply of, veterinary service
Anthrax, instructions concerning ^^J-
Antigas clothing and gas masks, requisitions for
Antirabies treatment at Base Hospital No. 57, Paris lw»
Antitetanus serum: _
instructions concerning failure to administer
prophylactic administration of "^"i
Apparatus, technical, purchase of, locally
Appliances:
for fire protection
instructions concerning
Applications for transfer 990
Appointments, recommendations for a"~-~'
Armistice, evacuation of sick and wounded from the port of St. Nazaire, Base Section
No. 1, procedure after signature of — "^9
Army:
divisions in the field, duties of medical officers detailed as psychiatrists in 906
dumps (medical) "^96
laboratories 1^1
laboratory No. 1 and central Medical Department laboratory, discontinuance of. 1050
Nurse Corps 125
members of lOl^
sick leave for nurses 989
nurses —
clothing for 1012
leather jerkins available for issue to 1015
of occupation in Germany 813-827
troops, requisitions for medical supplies for 929
Arrangements for returning important financial and property papers to United
States - 415
Art and museum section, division of laboratories -and infectious diseases, chief sur-
geon's office 221
Artificial eyes, instructions concerning 996
Assembly, salvage, and repair, ambulances 346
Assembly plant, motor, medical supply personnel 400
Assignment:
and pay, nurses' records of 1050
of personnel 995
Assistant judge advocate, hospital center, AUerey 51'
Assistant provost marshal and commandant of guard 517
Association of nurses and enlisted men 1040
Athletics, welfare work, schools, and entertainment, hospital center. Beau Desert. _ 553
Attaches, military, and observers, medical officers with special duties, hospital units
and casual personnel on dutj' with Allies 13, 37
Auditing money vouchers, finance and supply division, chief surgeon's office 411
Auditors, traveling, of hospital funds, finance and supply division, chief surgeon's office. 412
INDEX
1091
Page
Authority to authorize expenditures and approve vouchers on Medical Department
funds 967
Automatic supply, medical supplies 401
Autopsies, instruction concerning 918
Autopsy :
protocols 1041
reports 951
Bacteriologic examinations, form used for 1081
Bacteriological technique for investigation of pneumonia 1075
department ^ 1017
lost, of patients 1019
of patients 1013
Bandages, surgical, and adhesive tape, misuse of 911
Bandaging of mustard gas cases, instructions concerning 931
Bank, hospital center, AUerey 500
Base hospital:
laboratories for base hospitals not operating in centers 179
No. 1 629
No. 2 630
No. 3 630
No. 4 632
No. 5 632
No. 6 633
No. 7 634
No. 8 635, 985
No. 9 636
No. 10 638
No. 11 638
No. 12 L 639
No. 13 641
No. 14 641
No. 15 642
No. 17 643
No. 18 644
No. 19 646
No. 20 646
No. 21 647
No. 22 648
No. 23 649
No. 24 650
No. 25 651
No. 26 652
No. 27 653
No. 28 655
No. 29 655
No. 30 656
No. 31 658
No. 32_
No. 33.
659
660
No. 34 661
No. 35 662
No. 36 663
No. 37 664
No. 38 664
No. 39 665
No. 40.
665
667
No! 42']-^"^]-^"--"------
No. 43 669
No. 44 670
No. 45 671
No. 46 I'i
No. 47 673
No. 48 %\
No. 49
No. 50 gyg
No. 51 gyy
No. 52 />7Q
No. 53_ ^ 678
1092
INDEX
Base hospital — Continued.
?So;a:;:::::;:::::::::::;:::::::::::::::::::="::^ »
No. 56
No. 57 681
No. 58.
No. 59.
No. 60.
No. 61.
No. 62.
No. 63.
No. 64.
684
684
685
686
687
687
No. 65.
No! 66:::::::::::::::::::::::::::::::::::::::-: 689,987
No. 67 690
No. 68 691
No. 69 692
No. 70 693
No. 71 694
No. 72 694
No. 76 695
No. 77 ^96
No. 78 697
No. 79 698
No. 80 699
No. 81 700
No. 82 700
No. 83 701
No. 84 702
No. 85 703
No. 86 705
No. 87 706
No. 88 707
No. 89 707
No. 90 - 708
No. 91 ^- 709
No. 92 - 710
No. 93 711
No. 94 712
No. 95 713
No. 96 714
No. 97 . 715
No. 98 J 716
No. 99 __ .... _ _ . . - 716
No. 100 717
No. 101 . 718
No. 102 . _ . 719
No. 103 . _ . 720
No. 104 ..722
No. 105 . 723
No. 106 . 724
No. 107 . . . . 726
No. 108.. . - . _ . 727
No. 109 _ 728
No. 110 . ... 728
No. Ill . 729
No. 112 730
No. 113 731
No. 114 . 731
No. 115 . 732
No. 116 . 733
No. 117 734
No. 118 735
No. 119 736
No. 120 :: 737
No. 121 738
No. 123 _ 738
No. 131 739
No. 136 740
No. 202 741
INDEX
1093
Base hospital — Continued. Page
No. 204 742
No. 208 743
No. 210 743
No. 214 744
No. 216 745
No. 218 746
No. 236 746
No. 238 - . 747
personnel and casual medical officers, United States Army, who served with the
British Expeditionary Force before the arrival of headquarters, A. E. F 19
type A, plans for 241
Base hospitals 629-748
abandoned 1021
and hospital centers —
construction at 978
no longer operating 1032, 1035
capacitv of 287
light diets in 954
not operating in centers, base hospital laboratories for 179
Services of Supply 285
Base laboratories:
assigned to sections of the Services of Supply 169
for hospital centers, and hospital laboratories serving in centers 171
Base laboratory, Base Section No. 5 170
Base Section:
No. 1—
medical activities of '*i>i
port of St. Nazaire, evacuations of sick and wounded from 797
No. 5—
base laboratory yji
medical activities of 457
Bazoilles, hospital center ^3/
Beau Desert hospital center ^47
Beaune, hospital center
Bed report, dailv and weekly telegraphic 9»7
Beds, ratio of
Billets or shelter tents - - ,- - -
Billing Allies for hospital charges, finance and supply division, chief surgeon s office.- 413
Biologic products, instructions concerning 967
Biological products (human), supply and distribution of y^i
Blades, resharpening qoa.
Blankets, return of, to hospital trains
Blind patients, hospital center, Savenay
Board of officers, patients to be examined by ^'^
Boards, disabilitv: , ^ , , , , okq
instructions to, in regard to classification of mental cases at base ports ^66
passing upon mental and nervous cases, instructions concerning. . - - - - - y-i4
prompt action of, and early disposition of cases classified, instructions pertaining
to ggg
Books and journals, medical -. r"ie~'l~ "f"iV V
British and French patients in A. E. F. hospitals, evacuation of; effects of alhed pa-
tients dying in A. E. F. hospitals r"-~j {'"'^'"{"ffi'r.i:..'
British Expeditionarv Force, base hospital personnel and casual medical officers,
United States Army, who served with the, before the arrival of headquarters,
^ -gj p
British'medicarseVviceV'liaison'of The" Medical Department, United States Army,
with the.
71
951
British patients, evacuation of, instructions concerning
British soldiers in American hospitals
British-made American hospital trains „„„
Buildings occupied for hospital purposes, return of
^"'^finance, and bureau of accounts, A. E. F., liaison with, finance and accounting
division, A. E. F " 1018
Cafeteria svstem of messing patients
1094
INDEX
Camp, convalescent:
hospital center — ^^^^
AUerey 530
Bazoiiles 545
Beau Desert 553
Beaune 555
Langres 573
Limoges 574
Mesves i 587
Nantes 589
Savenay 612
Camp hospital, laboratories 180
Camp Hospital:
No. 1^ 749
No. 2 749
No. 3 749
No. 4 * 750
No. 5 751
No. 7 752
No. 8 752
No. 9 753
No. 10 753
No. 11 753
No. 12 754
No. 13 754
No. 14 755
No. 15 755
No. 19 755
No. 20 756
No. 21 756
No. 22 756
No. 23 757
No. 24 757
No. 25 758
No. 26 758
No. 27 760
No. 28 . . 760
No. 29 . 761
No. 31 762
No. 33 . _ 762
No. 34 __ 763
No. 35 . 764
No. 36 . , . .764
No. 37 764
No. 38 765
No. 39 765
No. 40 . , .765
No. 41 . . 766
No. 42 767
No. 43 " 768
No. 44 768
No. 45 l /. /. l / l _ 768
No. 46 769
No. 47 77Q
No. 48 ~_ " ' 771
No. 49 111
No. 50 . _ _ _ _ - - ] W. \. 772
No. 51 . _ " 772
No. 52 ~_
No. 53 : : ::: :: :: 773
No. 54 773
No. 55 774
No. 56 ~ _ 774
No. 57.
775
No. 59 775
No. 61 77=
No. 62
No. 64
776
777
No. 65 777
No. 66 ?78
INDEX
1095
Camp Hospital — Continued. Page
No. 67 --e
No. 68 III
No. 70 ::::: t/i
No. 72 779
No. 73 ]f
No. 75
No. 76 ll\
No. 77 ll\
No. 78 III
No. 79
No. 82 ll%
No. 85
No. 87 Lli
No. 91 Ll%
No. 92
No. 93 ill
No. 94 :::::::::::::::: ]l\
No. 95
No. 96 ' 78^
No. 97
No. 100 ]ll
No. 101 7or
No. 102 70R
No. 103 70fi
No. 104 V.V/V. 786
No. 105 _ " " " 7C7
No. 106 707
No. 107 707
No. 108 787
No. 109 _ " 788
No. 110 :::::::::::::::::::::::::::::::::::::::::::::: 788
No. Ill 788
No. 118 _ 789
No. 120 789
No. 121 789
No. 122 790
Camp hospitals 749-790
capacity of 288
Services of Supply 287
type B units, plans for 257
Camp Pontanezen:
medical activities of 465
preparation for embarkation 469
Camphor 997
Camps, convalescent 259
Services of Supply 286
Capacity of hospitals 287
Cardiovascular and dermatological diseases, specialists in, hospital centers 481
Carrel-Dakin tubing 976
Carriers :
chronic, of typhoid and paratyphoid, disposition of 1038
diphtheria, diphtheria and, in the Army 1000
of meningococcus and diphtheria bacilli 1041
typhoid, evacuation of 1020
Cars, field laboratory 183
Cases :
classified, early disposition of, and prompt action of disability boards, instructions
pertaining to 953
for evacuation, priority lists in selecting 1019
Casque, amex, dental 118
Casual medical officers. United States Army, base hospital personnel and, who served
with the British Expeditionary Force before the arrival of headquarters, A. E. F 19
Casual personnel, military attaches and observers, medical officers with special duties,
hospital units and, on duty with Allies 13-37
Casuals, Coast Artillery 978
Casualties, and changes, daily reports of 1019
Cemeteries, hospital centers 486
Center, hospital. {See Hospital center.)
Centers: •
base hospital laboratories for base hospitals not operatmg in 179
Centers, hospital. {See Hospital centers.)
1096
INDEX
Central hospital fund: , cc ^ff.i
custodianship of, finance and supply division, chief surgeon s ottice 4lJ
Third Army
Central Medical Department laboratory :
activities
and armv laboratory No. 1, discontinuance of llJoO
division of laboratories and infectious diseases, chief surgeon's office 157
housing facilities
personnel
Central storage for sorting medical supplies . ^92
Cerebrospinal meningitis (cerebrospinal fever), epidemic, instructions concerning 1007
Certificates, clearance, issue of, finance and supply division, chief surgeon's office 413
Chair, folding trench, dental 119
Chancroids, treatment of, before embarkation 1050
Change of station for nurses 986
Changes:
dailv reports of 1019
of hospital personnel and patients, daily reports of changes of 1020
Chaplain, hospital center, Allerey 518
Chaplains, hospital centers 487
Charge for subsistence of civilians sick in hopsital 967
Charges :
for certain classes of dental work, instructions relative to 905
hospital, billing Allies for, finance and supply division, chief surgeon's office 413
Chevrons, nurses' service 931
Chief surgeon, A. E. F., circulars promulgated by 903-1055
Chief surgeon's office:
finance and supph' 387
general organization and development of 39-58
organization and administration of 39-446
Chloride of lime or chlorine products, demands for 936
Chronic carriers of typhoid and paratyphoid, disposition of 1038
Circulars:
Nos. 73 and 75, War Department 1021
promulgated by the chief surgeon, A. E. F 903-1055
Civil population, medical service for, German occupied territory 822
Civilian employ ees 995
for hospital centers 970
medical supply 399
payment of 917
by quartermaster 924
Civilian labor, hospital centers 483
Civilian laborers, instructions concerning 1054
Civilian patients, discharge of, from hospitals 974
Civilian personnel, analysis and records of, finance and supply division, chief sur-
geon's office 411
Civilians:
nurses and 989
report on 913
instructions concerning 912
sick in hospital, charge for subsistence of 967
Claims for damages to French property 989
Class A:
men 1017
patients, returning, to dutv 1015
Class B:
and C men 1019
men " 995
Classification :
and travel orders of patients discharged from hospital 935
improper, of patients in hospital 1017
physical, of officers 1040
Clearance certificates j034
issue of, finance and supply division, chief surgeon's office " 413
Clermont-Ferrand hospital center ^] 555
------'-1111-1"" 960
Clinical records ,
historv and.
1014
instructions concerning gyg
Clinico-pathologic service, division of laboratories and "infections" diseases chief
surgeon s office ' jgy
INDEX
Closure, hospital center:
AUere y
Mesves ]
Nantes llllWlll
Clothing:
and rations for men discharged from hospital
for Army nurses
special articles of, not issued generally
white, for hospital attendants
Coast Artillery casuals
Collection of museum material for medical education and research! ] I ' ' " ]
Collective activities of hospital units, hospital center, AUerey
Colored soldiers
Commandant of guard, assistant provost marshal and, hospital center, Allerey
Commanding officers of hospitals to notify commanding officers of organizations
Commercy, hospital center
Commissions in the Sanitary Corps
Communicable diseases
reports of, when closing hospital formations
Communications
telegraphic and mail
Commutation:
for allied patients in hospital
for patients, rates of
value of the ration
Companies, evacuation ambulance
Compilation of statistical data and financial reports, finance and supply division,
chief surgeon 's office
Conservation of supplies
Construction :
at base hospitals and hospital centers
features, hospital center, Mesves
hospital
hospital center, Allerey
procurement, division of hospitalization, chief surgeon's office
selection of sites and, hospital centers
work, quality of, division of hospitalization, chief surgeon's office
Consultant:
in general medicine, hospital centers i
in general surgery, hospital centers
in maxillofacial surgery, hospital centers
in neurology, hospital centers
in ophthalmology, hospital centers
in orthopedics, hospital centers
in otolaryngology, hospital centers
in roentgenology, hospital centers
in urology, hospital centers
Consultants:
duties of
in the professional services, hospital center, Allerey
surgical —
hospital centers
with tactical units
Contract surgeons
Control of hospital centers
Controlled stores, medical supplies. Services of Supply
Convalescent camp, hospital center:
Allerey
Bazoilles
Beau Desert
Beaune
Langres
Limoges
Mesves
Nantes
Savenay
Convalescent camps
Services of Supply
Convalescent home for nurses at Antibes, near Cannes
Convalescent homes
1098
INDEX
Page
Convalescent officers, visiting places for 932
Cooks, gratuities to : 960
Coordination of civil and military sanitary service, German occupied territory. 822
Correlation and activities, general, division of laboratories and infectious diseases,
chief surgeon's office 137
Correspondence practice, office regulations, etc 916
Courier service, hospital center, Allerey 499
Crisis expansion 288
Criticisms and suggestions in re medical service of the Army 1040
Custodianship of central hospital fund, finance and supply division, chief surgeon's
office 412
Daily report of diseases 915
Damages to French property, claims for 989
Data necessarv for promotion 988
Death:
of officer or enlisted man, telegraphic report to central record office on 1038
of prisoners of war 1035
Debility, in animals 443
Demotion, promotion and, of enlisted men. Medical Department 971
Dental:
ambulance 119
amex casque 118
Corps schools 112
emergency kits 118
equipment and supplies 114
folding trench chair 119
inspection 119
officer, senior, hospital centers 481
Reserve Corps and Medical Reserve Corps, new plan of promotion in the 954
section, chief surgeon's office 105-123
service, A. E. F., organization of the 107
work, instructions relative to charges for certain classes of 905
Denture, Amex 118
Department of sanitation and pubhc health, German occupied territory 821-827
Depot, medical supply, hospital center 484
Mesves J 584
Depots:
distributing, for medical supplies 394
hospital center, for medical supplies 397
Dermatitis, gangrenous, in animals 442
Dermatological and cardiovascular diseases, specialists in, hospital centers 481
Detraining patients 330
Development:
and activities, general outline of, division of hospitalization, chief surgeon's office. . 229
and general organization of the chief surgeon's office 39-58
organization and, general, of the American Expeditionary Forces 21
professional services, division of hospitalization, chief surgeon's office 352
Diaries, medical war 969
Dietitian, function of administration of messes 931
Dietitians 1005
Diets, light, in base hospitals 954
Digestive disorders in animals 444
Dijon, splint repair shop at 921
Diphtheria:
and diphtheria carriers in the Army 1000
and meningitis 903
bacilU and meningococcus, carriers of 1041
instructions concerning 9IO
Directions for giving prophylaxis i042
Director of professional services, address of the 970
Director's office, division of laboratories, and infectious diseases, chief surgeon's officel . 151
Disability boards:
instructions to, in regard to classification of mental cases at base ports. . _ .... 953
passing upon mental and nervous cases, instructions concerning 924
prompt action of, and early disposition of cases classified, instructions pertaining
to ggg
Disbursements, analysis and record of, finance and supplv division chief surgeon's
office. ^
Disbursing, finance and supply division, chief surgeon's office 4IO
INDEX
1099
Discharge of civilian patients from hospitals _ . _ . ^ayl
Discontinuance:
Hospital center —
Bazoilles i-,-.
Beaune
Langres iiiii::::::::::::: 5?3
of finance and accounting division, chief surgeon's office. _ . 414
of hospitals 807-812
evacuation of patients to the United States-.I.I - V -- 11 I llll II 791-812
Discontinued medical forms ~ 004
Diseases: "
cardiovascular and dermatological, specialists in, hospital centers 481
communicable 2gQ
daily report of l . l ll. l 915
epidemic, instructions concerning III 111 111 1012
infectious —
in animals
section of, division of laboratories and infectious diseases, chief surgeon's
office 203
mental, and neuroses, management of, American Expeditionary Forces". ""I""" 945
noninfectious, in animals 443
venereal and skin, and genitourinary surgery I 369
Disinfecting plant, hospital centers ' " 435
Distributing depots for medical suppHes 111 l/_ 394
Distribution :
of medical supplies in the American Expeditionary Forces, outlining lines of
supply and decentralization of both requisitions and supplies 991
of troops, German occupied territory 821
supply and, of biological products (human) 921
Division:
administration, chief surgeon's office 85-87
finance and accounting, chief surgeon's office, discontinuance of 415
finance and supply, chief surgeon's office 387
of hospitalization, chief surgeon's office 229, 241, 283, 317, 351
of laboratories and infectious diseases — ■
chief surgeon's office 137, 157, 167, 203, 213, 958
the more important memoranda promulgated by 1057-1080
of sanitation and inspection, chief surgeon's office 133-136
administrative functions 134
organization 133
personnel, chief surgeon's office 89-104
Division surgeons, report of 940
Divisional laboratories 191
Divisional laboratory unit 1057, 1059
"Don'ts" for guidance of medical officers in gas warfare 938
Dressings, surgical, made-up 992
Drugs, medical supplies and, German occupied territory 823
Dubbin, or shoe polish, hospitals to be furnished with 1021
Dumps (medical), army 396
Duties:
of medical officers detailed as psychiatrists in army divisions in the field 906
of professional consultants 994
special, medical officers charged with —
in France 18
military attaches and observers, hospital units and casual personnel, on
dutv with Allies 13-37
Duty:
return to, of student officers and soldiers from army and corps schools 940
returning men to, with 20th Engineers 966
Echelons, medical supply, and systems of replenishment 402
Economy in use of blank forms 1040
Education, vocational 988
Effects:
of allied patients dying in A. E. F. hospitals 936
of food shortage, German occupied territory 825
Embarkation, preparation for, Camp Pontanezen 469
Emergency kits, dental 118
Emergency medical teams 975
1100
INDEX
Page
Employees, civilian 995
for hospital centers 970
medical supply 399
payment of 917
by quartermaster 922
Engineer officer, hospital center, Allerey 516
Engineer stores, requisitions for, instructions governing 1034
Enlisted men:
Medical Department, promotion and demotion of 971
rating of 976
Entertainment:
athletics, welfare work and schools, hospital center, Beau Desert 553
Medical Department 1039
Epidemic diseases:
change in report of 960
instructions concerning 978-1012
Equipment:
and supplies —
dental 114
laboratory, central Medical Department laboratory 158
functions, organization and, of the Medical Department, report on 835-902
Estimates as to number, ambulances 338
Etiquette of visits to French hospitals 940
Europe, purchases, medical supplies, in 390
Evacuating:
and receiving officer, hospital center, Allerej^ 507
officers and soldiers from hospitals 974
Evacuation:
ambulance companies 342
and mobile hospital laboratories 187
and receiving service, hospital center, Mesves 584
from hospitals, records to accompany patients on 974
hospitalization and — of cases of pulmonarj^ tuberculosis and suspected pulmonary
tuberculosis " 939
of patients with disease or injury of the eye, ear, nose, throat, and maxillo-
facial region, instructions regarding 979
of British patients, instructions concerning 95]
of French and British patients in A. E. F. hospitals; effects of allied patients
dying in A. E. F. hospitals 936
of orthopedic cases 980
of patients to the United States 79 1-806
discontinuance of hospitals 807
instructions pretaining to 952
of prisoners of war from hospitals ' ' IO35
of sick and wounded —
animals 43g
from the port of St. Nazaire, Base Section No. 1, during the period of hos-
tilities _____ 797
from the port of St. Nazaire, Base Section No. 1, procedure after signature of
armistice ygg
of typhoid carriers " 1020
of wounded , systems of ll ll I II 968
priority lists in selecting cases for J llll I 1019
prompt, of class D patients _ " 967
receiving and, hospital center, Bazoilles --!__ __ _ .l//_ II 544
Evacuations, secondary I - - -- --
Examinations: '
and filing of property vouchers, finance and supplv division, chief surgeon's office 413
ot property returns, finance and supply division, chief surgeon's office _ 414
physical, of permissionnaires inqo
Expansion, crisis 2«8
Expeditionary Forces: " ~ "
Arnerican. {See American Expeditionarv Forces.)
British. {See British Expeditionarv Force.)
Expendable property ' qq.
Expenditures ' l"~ _ '_ ~_ q^';
medical supplies " I- - ll.l_l_l dOfi
Experimental work surgical services, division oThosVitalizatiVnVcWeflurg^^^^^^ 363
Eyes, artificial, instructions concerning uigcuu s, umce._ ^0^
INDEX
1101
P'acial surgery, reconstructive, short course in _ _ _ i^"oc
Failure to administer antitetanus serum, instructions concerning qsfi
Farm, hospital center, Savenay "
Farms, hospital centers ' /_ 40^
Fevers, typhoid-paratyphoid, instructions concerning 1022
Field laVjoratory cars \_ ' Vgo
Field medical card, religion of patient to be entered on '_ I 989
Filing, examination and, of property vouchers, finance and" suVph" divis'ionrchief
surgeon s office ' .^o
Final report on Form No. 30- 1^ in^A
Finance:
and accounting —
chief surgeon's office 4Qg
discontinuance of ' ~
preparatory work ' 409
purpose 408
and supply division, chief surgeon's office _ 387-417
bureaus and bureau of accounts, A. E. F., liaison with, finance and supply division,
chief surgeon's office 414
divisions and treasury officials, liaison with, finance and suppfv division^ chief
surgeon's office _' 4j2
Medical Department, American Forces in France I \ 829
papers and requisitions 907
Financial reports and statistical data, compilation of, finance and supply division,
chief surgeon's office 413
Fire:
marshal, hospital center, Allerey 515
protection 975
appliances for 954
First Army, veterinary service ._ 437
Folding trench chair, dental 119
Food:
and nutrition, section of, division of laboratories and infectious diseases, chief
surgeon's office 214, 950, 1066
problem, German occupied territory 824
shortage, effects of, German occupied territory 825
supplies, purchase of, locally, to be charged against hospital fund 930
value of the ration, German occupied territory 825
Foodstuffs, purchase of 978
Forces :
American —
Expeditionary. {See American Expeditionary Forces.)
in France, Medical Department activities 829-831
in Germany 813-819
British Expeditionary. {See British Expeditionary Force.)
Form:
for report as to the character of services and qualifications of Medical Reserve
Corps officers 949
No. 30, final report on 1034
Forms :
blank, economy in use of 1040
discontinued medical 924
the more important, used in the laboratory service, A. E. F 1081-1087
France:
American Forces in. Medical Department activities 829-831
medical officers charged with special duties in 18
Freight cars, unloading 987
French:
and British patients in A. E. F. hospitals, evacuation of; effects of allied patients
dying in A. E. F. hospitals 936
hospitals, etiquette of visits to 940
ladies, visits of, to American wounded 971
medical service, liaison of the Medical Department, United States Army, with the- 75
military patients, reporting of 989
patients in American military hospitals, report of 924
property', claims for damages for . 989
soldiers^ property of 989
trains obtained from the 321
veterinarv liaison, with the 80
1102
INDEX
Front:
Page
hospital facilities at the 284
medical supph^ echelons and systems of replenishment at the 403
Front-line packages
Fuel, method of requisitioning 940
Functions: , a-
administrative, division of sanitation and inspection, chief surgeon s oftice 134
organization, equipment and, of the Medical Department, report on 835-902
Fund:
central hospital — •
custodianship of, finance and supplv division, chief surgeon's office 412
Third Armv 415
hospital.--" 979, 1014, 1018, 1052
Funds:
hospital —
analysis and record of, finance and supply division, chief surgeons oflfice-- 411
collection of amounts due from officer patients 1018
traveling auditors of, finance and supply division, chief surgeon's office 412
Medical Department, authority to authorize expenditures and approve vouchers
on 967
Gangrenous dermatitis in animals 442
Garbage, proceeds of sale of 997
Gas defense, instructions concerning 919
Gas for anesthesia 1016
Gas gangrene:
prophvlatic treatment against 1072
special card - - 1084, 1085
Gas masks, antigas clothing and, requisitions for 960
Gas poisoning 382
care of im wounded cases of 920
hospitalization and treatment 382
instruction 382
supervision 384
Gas warfare, "don'ts" for guidance of medical officers in 938
Gases, irritant, short resume of the symptoms and treatment of poisoning by 941
General medicine, consultant in, hospital centers 479
General Order No. 1, c. s., headquarters. Services of Supph- - 1017
General outline of development and activities, division of hospitalization, chief
surgeon's office 229
General staff, A. E. F., representation of the Medical Department on the 59-69
General surgery . 361
consultant in, hospital center 479
Genitourinary surgery, venereal and skin diseases and 369
German occupied territory, department of sanitation and public health 821-827
German public health service 821
Germany :
American Forces in 813-819
Army of occupation in 813-827
Glanders in animals 442
Gratuities to cooks ggO
Guard, commandant of, and assistant provost marshal, hospital center, Allerey 517
Gum-salt solution:
directions for use of apparatus for intravenous infusion of 1065
preparation of 977
Gunshot wound:
card--- 1086
self-inflicted, transfer of patients with 913
Headquarters, hospital center, Mesves 533
Health conditions, German occupied territory ~ 823
Heating stoves 1 ~ ggl
Historical records, instructions concerning S~_ S'_ 935
Historv :
and clinical records IO14
medical, of the war, material for prospective .S. WW 1039
Home, convalescent, for nurses, at Antibes, near Cannes ' 1015
Homes, convalescent ~ " Qgg
Hospital:
base, laboratories, for base hospitals not operating in centers 179
camp. {See Camp hospital.)
evacuation and mobile, laboratories Igy
Hospital attendants, white clothing for " " g2o
INDEX
1103
Hospital center: p
a typical d8Q_t;or
Allerey llq
activities . / Iqa
adjutant ^
American Red Cross [" 519
assistant judge advocate [./I. 517
assistant provost marshal and commandant of guard^_' . 517
u 500
chaplain gjg
closure
collective activities of hospital units lllll " ' 522
commanding officer I'll^ '_ 496 535
consultants in the professional services . ' 520
convalescent camp [_ 53Q
courier service " 499
engineer officer """""""" 516
fire marshal 5J5
hospital construction ~ 439
inspector 5jq
intelligence officer 5I8
laboratory service 528
medical supply service 5O5
motor transport 504
organization 494
physical characteristics 489
post office 499
psychiatric department • 1021
quartermaster 5OO
railway transportation 5I9
receiving and evacuating officer 507
sanitary inspector 510
signal service 516
Bazoilles 537
administration 537
American Red Cross 545
commanding officer 547
convalescent camp 545
discontinuance 547
laboratory 543
optical and ophthalmological department 543
receiving and evacuation 544
school of roentgenology 543
Beau Desert 547
commanding officer 553
convalescent camp 553
organization and administration 549
welfare work, schools, entertainment, and athletics 553
Beaune 553
commanding officer 555
convalescent camp 555
discontinuance 555
Clermont-Ferrand 555
commanding officer 556
Commercy 556
commanding officer 556
depots, for medical supplies 397
Joue-les-Tours 556
commanding officer 557
Justice, Toul 614
commanding officer 616
Kerhuon 557
personnel 572
Langres 572
commanding officer 573
convalescent camp 573
discontiiuiance 573
Limoges 573
commanding officer 574
convalescent camp 574
13901—27 70
1104
INDEX
Hospital center — Continued. ^"^^
Mars-sur-Allier 575
commanding officer 580
Mesves 580
administration 583
American Red Cross 587
closure 587
commanding officer 587
construction features , 580
convalescent camp 587
headcjuarters 583
laboratory service 586
maxillofacial surgery 586
medical inspector 585
medical service 585
medical supply depot 584
military police 585
motor transportation service 584
ophthalmology and otolaryngology 586
orthopedic service 586
professional services 585
quartermaster 584
railroad transportation service 584
receiving and evacuation service 584
sanitary officer 584
typical laboratory, organization of a 172
units 583
Young Men's Christian Association 587
Nantes 587
administration 588
closure 589
commanding officer 589
convalescent camp 589
Pau 589
commanding officer 590
Perigueux 590
commanding officer 591
Rimaucourt 591
commanding officer 592
Riviera 592
commanding officer 596
Savenay 596
commanding officer 614
blind patients 611
center farm 613
convalescent camp 612
laboratory service 611
neuropsychiatric service " 608
orthopedic division 602
welfare V/^/^S~///^^/////^. 613
Vannes gjy
commanding officer W W W 617
Vichv.
commanding officer 622
laboratory service ~~ yj^
Vittel-Contrexeville ~ g23
commanding officer WWW^ 627
Hospital centers 473-488
American Red Cross activities ~ ' 487
and base hospitals —
construction at g^g
no longer operating -------- "" I" ' '^ i032 1035
base laboratories for, and hospital laboratories serving in centers ^ ' 171
capacity of 2»«
cemeteries fog
chaplains ~~" ^e?
civilian employees for ------I'.]'']" 970
civilian labor
INDEX
Hospital confers — Continued,
consultant —
1105
Page
in general medicine
in general surgery _ _ [ l 479
in maxillofacial surgery 479
in neurology /- //. .I II 481
in ophthalmology
in orthopedics 479
in otolaryngology llllllllllllll 481
in roentgenology ^gQ
in urology H llllllllll/l 480
control
disinfesting plant ■ l.l/lll 485
farms.
fire department ,. ^ 4g5
laboratory service 4g2
medical supply depot 484
motor transportation [ 485
nursing service 482
organization of laboratory service in 1074
other 537-627
outline of organization of laboratory activities in 1057
plans for 253
professional services 478
recreational activities 487
salvage of property 485
sanitary squads 483
selection of sites and construction 473
senior dental officer 481
Services of Supply 286
specialists in cardiovascular and dermatological diseases 481
staffs 478
surgical consultants 363
Hospital charges, billing Allies for, finance and supply division, chief surgeon's office. 413
Hospital construction :
hospital center, Allerey 489
procurement, division of hospitalization, chief surgeon's office 241
Hospital facilities:
at the front 284
in the Services of Supply 285
Hospital fund - 979, 1014, 1018, 1052
central, custodianship of, finance and supply division, chief surgeon's office 412
central. Third Army 415
purchase of food supplies locally to be charged against 930
Hospital funds:
analysis and record of, finance and supply division, chief surgeon's office 411
collection of amounts due from officer i)atients 1018
traveling auditors of, finance and supply division, chief surgeon's office 412
Hospital laboratories:
camp 180
serving in centers, and base laboratories for hospital centers 171
Hospital personnel and patients, daily reports of changes of 1020
Hospital trains 317, 967
administration 324
British-made American 319
extemporized, messing of patients on 330
ordre de transport for movements made by 924
patients dying on, instructions concerning 970
personnel 324
procurement 318
professional activities 329
provision for repairs 333
regular, messing of patients on 330
return of blankets to ^24
subsistence 329
suitability of 336
supplies-- 323
Hospital facilities:
at the front
in the Services of Supply
Hospital treatment, prolonged active ^'^
1106
INDEX
Hospital units: . I'-'se
and casual personnel, military attaches and observers, medical officers witli
special duties, on duty with Allies 13-37
collective activities of, hospital center, Allerey 522
Hospitalization :
American forces in France 831
and evacuation of cases of pulmonary tuberculosis and suspected pulmonary
tuberculosis 939
and evacuation of patients with disease or injury of the eye, ear, nose, throat,
and maxillofacial region, instructions regarding 979
and treatment, gas poisoning 382
division of, chief surgeon's office 229, 241, 283, 317, 351
of sick and wounded - 283
progress in; location of hospitals 293
Hospitals 473-790
abandonment of 1041
American —
British soldiers in 980
military, report of French patients in 924
American Red Cross 288
base. {See Base hospitals.)
not operating in centers, base hospital laboratories for 179
camp 749-790
type B units, plans for 257
capacity of 287 -
commanding officers of, to notify commanding officers of organizations 1017
discontinuance of 807-812
disposal of records of 1006
disposition of surplus subsistence on disbanding of 1034
evacuating officers and soldiers from 974
evacuation —
of French and British patients in; effects of allied patients dying in 936
of patients to the United States 791
of prisoners of war from 1035
French, etiquette of visits to 940
German occupied territory 823
instructions to registrars of 974
location of; progress in hospitalization 293
military, Y. M. C. A. patients in 1015
Services of Supply, admission of ofl^icers and soldiers to 936
shoe-shining and tailoring establishments in 1040
to be furnished with dubbin, or shoe polish 1021
veterinary 434
Housing facilities, central Medical Department laboratory 157
Identification:
disks of prisoners of war patients 1043
tags I'llllllllll 986
Infectious diseases:
division of laboratories and, chief surgeon's office 137, 157, 167, 203 213
in animals
441
section of, division of laboratories and infectious diseases, chief surgeon's office 203
Influence of transportation on the medical supply situation _. __ _ 406
Influenza, in animals "
Information for units sailing for the United States__ ^llll.l I I ~ 998
Initial, middle, or number, to be given in reports ] 989
Inspection ^'tr
^1 4. , 976
dental
division of sanitation and, chief surgeon's office-__I~"I"'~~"~]~~]'~]~"]~~]]^~133_136
of laboratories, division of laboratories and infectious diseases - --- •
Inspector:
hospital center, Allerey r.Q
medical, hospital center, Mesves 585
sanitary, hospital center, Allerey "I" "I 510
Inspectors, medical supply onq
Instruction, gas poisoning. _ 009
Instructions: '^^'^
concerning the treatment in orthopedic conditions, including fractures and joint
iiij uncs ^ A*?!
for guidance of medical officers. . I 1 1 ~ I Qn^'oi'? qql
for the use of the Lyster water sterilizing bag ' ' qoi
general, governing abandoned units.. -^QgJ
INDEX
1107
Instructions — Continued. Page
regarding hospitalization and evacuation of patients with disease or injury of the
eye, car, nose, throat, and maxillofacial region 1 979
relative to charges for certain classes of dental work 905
Instrument repair shop 1006
medical supph' personnel 400
Instruments, surgical 996
and typewriters, repair of 924
Intelligence officer, hospital center, Allerey 518
Introduction 13-37
Inventions and licenses, records of 1036
Issue of clearance certificates, finance and supply division, chief surgeon's office 413
Italian medical service, liaison of the Medical Department, United States Armv, with
the 82
Jerkins, leather, available for issue to Army nurses 1015
Joue-lcs-Tours, hospital center 556
Journals and books, medical 998
Judge advocate, assistant, hospital center, Allerey 517
Justice hospital center, Toul 614
Kerhuon, hospital center 557
Kits, emergency, dental 118
Labor, civilian, hospital centers 483
Laboratories :
and infectious diseases, division of, chief surgeon's office 137, 157, 167, 203, 213
army 181
base —
assigned to sections of the Services of Supply 169
for hospital centers, and hospital laboratories serving in centers 171
camp hospital,. 180
divisional 191
German occupied territory 823
hospital, serving in centers, and base laboratories for hospital centers 171
inspection of, division of laboratories and infectious diseases 168
mobile 181
section of, division of laboratories and infectious diseases 167
stationary, division of laboratories and infectious diseases 169
technical work of 194
Laboratory :
activities in hospital centers, outline of organization and administration of 1057
and X-ray supplies, requisitions for 930
base. Base Section No. 5 170
cars, field 183
central Medical Department, division of laboratories and infectious diseases,
chief surgeon's office 157
equipment and supplies, central Medical Department laboratory 158
Hospital center, Bazoilles - 543
of surgical research, division of laboratories and infectious diseases, chief surgeon s
oflice 226
organization, typical, of a hospital center (Mesves) 1'^
Lal)oratory service:
hospital center —
AUerev 528
Mesves
Savenav ,iT
Vichy _: 174
hospital centers 1074
organization of in8i_in«7
the more important forms used m the j^*'
Laboratorv unit, divisional ^^^^^
Laboratorv work accomplished in the American Expeditionary Forces during the
month of January, 1919, consolidated report of
Laborers, civilian, instructions concerning ^^Z:
Ladies, French, visits of, to American wounded
Langres*, hospital center
Laundry: 332
iiospital trains 1036
patients' iaic
Leather jerkins available for issue to Army nurses ^^^g
Leave, charging excess, against nurses - - - - - - ; , " ' qcq
Lectu;es, surgical services, division of hospitalization chief surgeon s office 363
Legal reference library, finance and supply division, chief surgeon s oflice 414
1108
INDEX
Page
Lenses, prescriptions for 951
Letters and telegrams, official, instructions concerning 950
Liaison :
finance and supply division, chief surgeon's office with bureau of accounts and
finance bureau, A. E. F - 414
medical supply, with the United States 406
meetings and, division of sanitation and inspection, chief surgeon's office 135
of the Medical Department, United States Army —
with the British medical service 71
with the French medical service 75
with the Italian medical service 82
with the medical services of the Allies 71-84
veterinary, with the French 80
with finance divisions and Treasury officials, finance and supply divisions, chief
surgeon's office 412
Library, legal reference, finance and supply division, chief surgeon's office 414
Lice, instructions concerning 1007, 1015
Licenses and inventions, records of 1036
Limoges, hospital center 573
Lipovaccine:
pneumoooccus 999
typhoid 999
Lipovaccines:
discontinuance of use of 1043
instructions concerning 969
Location of hospitals; progress in hospitalization 293
Loss of sick and wounded reports 1038
Lousiness, scabies and, instructions concerning 922
Lyster water sterilizing bag, instructions for the use of 931
Mail 967
address, correct 1034
addressed to patients in hospitals which are to be continued 1035
Management of mental diseases and neuroses in the American Expeditionary Forces. _ 945
Mange, in animals 441
Manual for the Medical Department to govern preparation of sick and wounded
reports after embarkation for the United States 1041
Manual, sick and wounded reports 921
Mars-sur-Allier hospital center 575
Material:
and supplies, sale of unserviceable 1051
for prospective medical history of the war 1039
Maxillofacial surgery 367
consultant in, hospital centers 479
hospital center, Mesves 5gg
Measles, instructions concerning gjO
Medical activities of territorial sections 447-472
Medical Corps, permanent, vacancies in 1012
Medical Department:
activities, American forces in France 829-831
entertainment IQW
funds, authority to authorize expenditures and approve vouchers on 967
laboratory, central, division of laboratories and infectious diseases, chief surgeon's
office 1^57
organizations, orders for returns of, to the United States. _ . _ \ 1019
personnel, strength of g2
property . _ . . " - 1 ] 997
of organizations changing stations 1006
report on organization, equipment, and functions of the . 835-902
representation of the, on the general staff, A. E. F _ _ ' 59-69
transportation ' j^^y
United States Army, liaison:
with the British medical service 7I
with the French medical service y y 75
with the Italian medical service g2
with the medical services of the Allies Hill llllV 71-84
veterinary service as part of / ~ ' ^oq
Medical field supplies, salvage -I- -l\H__ 1 nnfi
Medical forms, discontinued q',?
Medical inspector, hospital center, Mesves . ^c-
Medical journals and books ~ J
INDEX
1109
Medical offi
cers: Page
casual, United States Army, base hospital personnel and, who served with the
British Expeditionary Force before the arrival of headquarters, A. E. F 19
charged with special duties in France 18
detailed as psychiatrists in Army divisions in the field, duties of 906
instructions for guidance of 905, 913, 934
with special duties, hospital units and casual personnel, military attaches and
observers, on duty with Allies 13-37
Medical organizations under orders for return 1036
Medical property :
accountability for 1021
disposition of unserviceable 1043
sales of excess 1018
Medical Reserve Corps:
and Dental Reserve Corps, new plan of promotion in the 954
officers, form of report as to services and qualifications of 949
promotion in 948
recommendations for promotions in the ' 966
Medical service:
American forces in Germany 813
British, liaison of the Medical Department, United States Army, with the 71
for the civil population, German occupied territory 822
French, liaison of the Medical Department, United States Army, with the 75
hospital center, Mesves 585
Italian, liaison of the Medical Department, United States Army, with the 82
of the Army, criticisms and suggestions in re 1040
Medical services:
division of hospitalization, chief surgeon's office 375
of the Allies, liaison of the Medical Department, United States Armv, with the.- 71-84
Medical supplies 387,1006
accountability for 1018
American Red Cross 407
and drugs, German occupied territory 823
automatic supply 401
central storage for sorting 392
disposition of. 1048
distributing depots for 394
distribution of, in the American Expeditionary Forces, outlining lines of supply
and decentralization of both requisitions and supplies 991
expenditures 406
for army troops, requisitions for 929
hospital center depot for 397
method of closing accountability for, upoti turnover to French authorities 1054
property accountability 405
purchase of ^oon
in Europe -
requisitions for ---
statistical studies 402
storage space
useof____
warchousmg '^^^
Medical supply: „„„
civilian employees "^^^
depot—
hospital centers 't°rl
No. 2, advance - ^^"^
echelons and svstems of replenishment 4"^
at the front
inspectors .^c
liaison with the United States
personnel crjc
servicc, hospital center, AUerey
situation, influence of transportation on the
Medical war diaries ^-q
Medicine, general, consultant in, hospital center .
Meetings and liai.son, division of sanitation and inspection, chief surgeon s oflice.. 135
Memorandrthe more important, promulgated by the division of laboratories ajd^_^^^^
infectious diseases, A. E. F
1110 I^'PEX
, , Page
classes B and "C ^^19
evacuated —
from base hospitals, proper papers to accompany jUl^
without service records
Meningitis: „
diphtheria and :
epidemic cerebrospinal (cerebrospinal fever), instructions concernmg 1U07
instructions concerning
Meningococcus and diphtheria bacilli, carriers of : 1^41
Mental and nervous cases, disabilitv boards passing upon, mstructions concerning.-. 924
Mental cases at base ports, instructions to disability boards in regard to classifica-
tion of
Mental diseases and neuroses in the American Expeditionary Forces, management of. 945
Mess kits, manner of washing ^29
Mess officer, chief
Mess service to patients cw^a
Messengers, instructions concerning ^66
Messes, administration of, function of dietitian 931
Messing:
patients —
cafeteria system of lOlH
on extemporized hospital trains 330
on regular hospital trains 330
Mesves:
hospital center 580
typical laboratory organization of a hospital center 172
Middle initial or number to be given in reports 989
Military attaches and observers, medical officers with special duties, hospital units
and casual personnel on duty with Allies 13-37
Military observers and military attaches 13
Military police:
hospital center, Mesves 585
recruiting of 1019
Misuse of adhesive tape and surgical bandages 911
Mobile and evacuation hospital laboratories 187
Mobile laboratories 181
Money vouchers, auditing, finance and supply division, chief surgeon's office 411
Monthly reports, sick and wounded 1016
Motor assembly plant, medical supply personnel 400
Motor transportation :
hospital center, Allerey 504
hospital centers 485
Motor transportation service, hospital center, Mesves 584
Mounts, public and private, quarantine of, for return to the United States 444
Movements made by hospital trains, ordre de transports for 924
Museum and art section, division of laboratories and infectious diseases, chief sur-
geon's office 221
Museum material for medical education and research, collection of 961-996
Mustard gas cases, bandaging, instructions concerning 931
Names, nurses 986
Nantes, hospital center 587
Narcotics 1018
Nervous and mental cases, disability boards passing upon, instructions concerning 924
Neurological surgery ^ 363
Neurology, consultant in, hospital centers 481
Neuropsychiatric patients 1017
Neuropsychiatric service, hospital center, Savenay 608
Neuropsychiatrists 1015
Neuroses, mental diseases and, in the American Expeditionarv Forces, management
of; 1 945
Noninfectious diseases, in animals 443
Nonperishable subsistence stores, supply of 912
Number:
of ambulances, estimates of 338
or middle initial to be given in reports 989
Nurse Corps, Army 125
members of 1019
INDEX
nil
Page
i\urses 988, 1016, 1034
and civilians 989
and enlisted men, association of 1040
Army —
clothing for 1012
leather jerkins available for issue to 1015
Nurse Corps, sick leave for 989
change of station for 986
charging excess leave against 920
convalescent home for, at Antibes, near Cannes 1015
instructions concerning 976
rest rooms for 975
to pay their own expenses 1006
worker's permits for all 940
Nurses' :
names 986
records of assignment and pay 1050
regulation uniforms 936
service chevrons 931
uniforms 989
Nursing sections; reconstruction aides, chief surgeon's office 125-131
Nursing service, hospital center 482
Nutrition and food section:
division of laboratories and infectious diseases, chief surgeon's office 214
inspection data 1066
Observers, military attaches and medical officers with special duties, hospital units
and casual personnel on duty with Allies 13-37
Occupation, Army of, in Germany 813-827
Occupied territory, German, department of sanitation and public health 821-827
Office:
control, division of sanitation and inspection, chief surgeon's office 134
regulations, correspondence practice, etc 916
supplies, general 1013
Officer:
receiving and evacuating, hospital center, AUerey 507
senior dental, hospital centers 481
Officer patients, collection of amounts due from, hospital funds 1018
Officers:
admitted, evacuated, discharged, or died, report of 1039
and soldiers —
admissions of, to Services of Supply hospitals 936
evacuating, from hospitals 974
student, from army and corps schools, return to duty of 940
casual medical. United States Army, base hospital personnel and, who served
with the British Expeditionary Force before the arrival of headquarters,
A. E. F 10
convalescent, visiting places for 932
medical — •
charged with special duties in France — - 1°
with special duties, hospital units and casual personnel, military attaches and
observers, on duty with Allies ^'^oon
on duty in the chief surgeon's office, alphabetical list 99||
phvsical classification of n^i,
Officiarrelations between medical and veterinary personnel
Operations, surgical qcu)
instructions concerning 7- Zjl^
Ophthalmological and optical department, hospital center, Bazoilles 04^
Ophthalmologv
and otolaryngology, hospital center, Mesves J»o
consultant in, hospital centers I" ""^>"'"-n -^q
Optical and ophthalmological department, hospital center, BazoiUes o4.5
Optical division, medical repair shop in Pans ^'^^^
Optical shop, medical supply personnel - ^^'f
Optical units, auxiliary, supplying and repairing of spectacles
Opticians, soldiers qualified as. __
^'^^Tor return of Medical Department organizations to the United States 1019
involving travel of over 10 persons -^^
Ordnance,' reports of issues of,' to paYients dischaVged from hospital '976
1112
INDEX
Pago
Ordnance eciuipinent q^*'
disposition of, instructions concerning
Ordnance property
disposition of ^"^o
Ordre de transport
for movements made by hospital trains y^"*
Organization :
and administration —
hospital center, Beau Desert ^49
of the chief surgeon's office
and develoi)ment, general —
of the American Expeditionary Forces ^1
of the chief surgeon's office. ^o?
and personnel of veterinary service 431
division of sanitation and inspection, chief surgeon's office 133
equipment, and functions of the Medical Department, report on 835-902
general, division of laboratories and infectious diseases, chief surgeon's office 150
hospital center, AUerey 494
of professional services, Medical Department, A. E. F 926
of the dental service, A. E. F 107
professional services, division of hospitalization, chief surgeon's office.--- 351
scope of, finance and accounting, finance and supply division, chief surgeon's office. 410
typical lat)oratory, of a hospital center (Mesves) 172
Organizations :
Medical Department, orders for return of, to the United States 1019, 1036
retvirning, records of 1034
Orthopedic :
cases, evacuation of 980
conditions, including fractures and joint injuries, instructions concerning the
treatment in 971
division, hospital center, Savenay 602
surgery 365
Orthopedics, consultant in, hospital centers 479
Other hospital centers 537-627
Otolaryngology 373
and ophthalmology, hospital center, Mesves 586
consultant in, hospital centers 481
Oxygen tanks, instructions concerning 954
Pail collection system 980
Papers:
for publication 961
important financial and propertv, arrangements for returning, to the United
States 415
original, on the surgery of the war 990
proper, to accompany men evacuated from base hospitals 1013
Paratyphoid and typhoid fevers:
disposition of chronic carriers of 1038
instructions concerning 1017-1020
vaccination against ^ 1015
Pathological specimens, instructions concerning 917
Patients:
allied, in hospital, commutation for 918
and personnel, hospital, daily reports of changes of 1020
baggage of 1013
British, evacuation of 951
cafeteria system of messing 1018
civilian, discharge of, from hospitals 974
class A, returning, to duty 1015
class D —
instructions concerning 951
prompt evacuation of 967
detraining 330
discharged from hospital —
reports of issues of ordnance to 976
travel orders and classification of 935
dying on hospital trains, instructions concerning 970
evacuated, service records of 1039
evacuation of, to the United States 791-806
discontinuance of hospitals 791-812
INDEX
1113
Patients — Continued.
French —
and British, in A. E. F. hospitals, evacuation of; effects of allied, dving in Page
A. E. F. hospitals ' 936
in American military hospitals 924
military, reporting of 989
in hospital, improper classification of 1017
instructions pertaining to evacuation of, to United States 952
lost baggage of 1019
mess service to 1005
messing of —
on extemporized hospital trains 330
on regular hospital trains 330
neuropsychiatric 1017
officer, collection of amounts due from, hospital funds 1018
personal property of, instructions concerning 974
prisoners of war, identification for 1043
rates of commutation for 1034
records accompanying, on evacuation from hospitals 974
religion of, to be entered on field medical card 989
remaining in hospital December 31, 1918, instructions concerning 996
to be examined by board of officers 978
with disease or injury of the eye, ear, nose, throat, and maxillofacial region,
instructions regarding hospitalization and evacuation of 979
with self-inflicted gunshot wounds, transfer of 913
Y. M. C. A., in military hospitals 1015
Patients' laundrj- 1036
Pau, hospital center 589
Pay and assignment, nurses' records of 1050
Payment of civilian employees by quartermaster 924
Pay rolls and vouchers, instructions concerning 940
Perigueux, hospital center 590
Permissionnaires, physical examination of 1038
Permits, workers', for all nurses 940
Personnel :
and organization of veterinary service 431
and patients, hospital, daily reports of changes of 1020
assignment of 995
available for transfer 998
base hospital, and casual medical officers, United States Army, who served with
the British Expeditionary Force before the arrival of headquarters, A. E. F_ 19
casual, military attaches and observers, medical officers with special duties,
hospital units and, on duty with Allies 13-37
central Medical Department laboratory 158
chief surgeon's office 56, 136
civilian, analysis and record of accounts of, finance and supply division, chief
surgeon's office 411
Dental Corps HI
finance and accounting of, finance and supply division, chief surgeon's office 409
hospital trains . 324
liaison . °2
list of B and C class y85
medical and veterinary, ofl^cial relations between 975
Medical Department —
American forces in France 829
shoes for distribution to 920
medical suppiv - — x i ^7
project for transferring certain American Red Cross, to Sanitary Corps 101
quartermaster ^qIm
shortage of
strength of Medical Department 92
Y. IVC C. A.-
reports of.
treatment of onVnl
Personnel division, chief surgeon s office i^*
activities — - — -- ^cq
Phvsical characteristics, hospital center, Allerey 469
Phvsical examination of permissionnaires
1114
INDEX
Plans: ^"^^
for a base hospital, type A '-241
for camp hospitals, type B units 257
for hospital centers 253
Plant :
disinfecting, hospital centers --- 485
motor assembly, medical supply personnel 400
Pncumococcus:
lipovaccine 999
vaccine 1035
Pneumonia:
bacteriological technique for investigation of 1075
instructions concerning 910
diagnosis of 953
its prevention and management 981
Poisoning by irritant gases, short resum^ of sj^mptoms and treatment of 941
Police, military:
hospital center, Mesves 585
recruiting of 1019
Pontanczen, Camp, medical activities of 465
Population, civil, medical service for, German occupied territory 822
Port of St. Nazaire, Base Section No. 1, evacuation of sick and wounded from the 797
Po.st office, hospital center, AUerey ■ 499
Preoperative train 363
Preparation of embarkation. Camp Pontanezen 469
Preparatory work, finance and accounting, finance and supply division, chief sur-
geon's office 409
Prescriptions for lenses 951
Prest-O-Lite tanks, empty 912
Priority lists in selecting cases for evacuation 1019
Prisoners of war 969
death of 1035
evacuation of, from hospitals 1035
patients, identification disks for 1043
Procurement :
ambulances 337
division of hospitalization, chief surgeon's office 266
hospital construction, division of hospitalization, chief surgeon's office 241
hospital trains 31S
Professional activities, hospital trains 329
Profe.ssional divisions, chief surgeon's office 904
Professional reports 1017
Professional services:
consultants in, hospital center, Allerey 520
division of hospitalization, chief surgeon's office 351
activities of 361
development 352
medical services ^ 375
organization 35I
hospital center, Mesves 5g5
hospital centers . 473
organization of. Medical Department, A. E. F 926
Progress in hospitalization; location of hospitals 293
Project for transferring certain American Red Cross personnel to Sanitary Corps. 101
Promotion :
and demotion of enlisted men. Medical Department 97 1
data necessary for ggg
in the Medical Reserve and Dental Reserve Corps, new plan of I I I . I I 954
in the Medical Reserve Corps 94g
Promotions ggQ
in American Expeditionary Forces llllllllllll. 1052
in the Medical Reserve Corps, recommendations for 966
Sanitary Corps iq2
Property . . I _ I ' _ I ~ ' ' . ^ ] ] " ^ ' ] 1 052
accountability ~ ggQ
medical supplies l l l l l _ _ 405
expendable ~ qg.
French, claims for damages for llll 989
instructions concerning ■\f)Oe,
issued from depots, authority to drop, from returns. - ' "II" 1051
INDEX
1115
Property — Continued.
medical — P^ee
accountability for 1021
sales of excess 1018
Medical Department 997
of organizations changing station 1006
of French soldiers 989
ordnance 980, 1019
disposition of 1036
personal, of patients, instructions concerning 974
returns, examination of, finance and supply division, chief surgeon's office 414
sale of 1 1054
salvage of, hospital centers 485
unserviceable medical, disposition of 1043
vouchers, examination and filing of, finance and supply division, chief surgeon's
office 413
Prophylactic serum treatment against gas gangrene 1072
Prophylactic stations, prophylaxis and 1042
Prophylaxis:
and prophylactic stations 1042
directions for giving 1042
Protocols, autopsy 1041
Provision for repairs, hospital trains 333
Provost marshal, assistant, and commandant of guard, hospital center, AUerey 517
Psychiatric department, hospital center, Allerey 1021
Psychiatric, pulmonary tuberculosis, and war neuroses cases, disposition of 932
Psychiatrists in army divisions in the field, duties of medical officers detailed as 906
Psychiatry 378
Public health and sanitation, department of, German occupied territory 821-827
Public health service, German 821
Publications 1013
Pulmonary tuberculosis, psychiatric, and war neuroses cases, disposition of 932
Purchase:
of food supplies locally to be charged against hospital fund 930
of medical supplies 1014
of technical apparatus locally 930
vouchers, forwarding 930
Purchases, medical supplies, in Europe "^90
Purpose, finance and accounting, finance and supply division, chief surgeon's office. _ 408
Qualifications and services of Medical Reserve Corps officers, form of report as to the_ _ 949
Quality of construction work, division of hospitalization, chief surgeon's office 258
Quarantine of public and private mounts for return to the United States 444
Quartermaster:
hospital center —
Allerey ^00
Mesves
payment of civilian employees by -im^
personnel in'ifi
Quartermaster Department material, salvage of ^^^^
Railroad transportation service, hospital center, Mesves oS4
Railway transportation, hospital center, Allerey
Rates of commutation for patients
Rating of enlisted men 2gg
Ratio of beds
Ration: 1012
commutation value of the ^.q^^
food value of the, German occupied territory.-
Rations and clothing for men discharged from hospital
Receiving and evacuation:
hospital center — 544
Bazoilles 1 584
Mesves III III 507
officer, hospital center, Allerey
Recommendations: 935
for appointments qr«
for promotions in the Medical Reserve Corps :::::'i28, 994
Reconstruction aides ' ' 125^131
nursing section, chief surgeon s ottice
1116
INDEX
Record: p^^,^
analvsis and — .... e >
"of accounts of civilian personnel, finance and supply division, chief surgeon s
office
of hospital funds, finance and supply division, chief surgeon s ofhee_ . ------ 411
of disbursements, analysis and, finance and supply division, chief surgeon s office. 411
Records :
accompanying patients on evacuation from hospitals 974
clinical, history and \r}t
disposition of if"-""j '052
for final separation of oflficers and enlisted men from the service of the United
States Army, preparation of 1041
of assignment and pay, nurses 10^0
of hospitals, disposal of lOOiy
of inventions and licenses 1036
of returning organizations 10.34
service —
men evacuated without 1041
of evacuated patients 1039
sick and wounded, American forces in France 831
Recreational activities, hospital centers 487
Recruiting of militarj^ police 1019
Red Cross:
allowance for soldiers of the allied armies in A^merican hospitals 911, 920
American —
activities, hospital centers 487
hospital center, Allerey 519
hospital center, Bazoilles 545
hospital center, Mesves 587
hospitals 288
medical supplies 407
personnel, project for transferring certain, to Sanitary Corps 101
requisitions upon the 930
Reference hbrary, legal, finance and supply division, chief surgeon's office 414
Registrars 1016
of all hospitals, instructions of 974
Religion 960
of patient to be entered on field medical card 989
Remount service, veterinary service as part of 419
Repair :
assembly, salvage and, ambulances 346
of surgical instruments and typewriters 924
of typewriters 966
Repair shop:
instrument 1006
medical supply personnel 400
No. 1, Medical Department, shipments to 929
splint, at Dijon 921
Repairs :
hospital trains, provision for 333
or installation of X-ray apparatus 998
Replacement battalions, class A men for 973
Replenishment, systems of, medical supply echelons and [ 402
Report :
as to the character of services and qualifications of Medical Reserve Corps officers,
form for 949
bed, daily and weekly telegraphic 987
consolidated, of laboratory work accomplished in the American Expeditionarv
Forces during the month of January, 1919 . _ " 1078
daily, of diseases " 915
final, on Form No. 30 \ iq-^^
monthly statistical, section of wound bacteriology 1082
of division surgeons _~ 940
of epidemic diseases, change in " " 960
of French patients in American mihtary hospitals ]^ 924
of officers admitted, evacuated, discharged, or died __ I. ^ 1039
on civilians gj.^
on organization, equipment, and functions of the Medical Department ^ I ~ 835-902
on suppHes received not properlv marked qio
Reporting of French militarv patients . . . 939
INDEX
1117
Page
Reports 978, 980, 1020
and returns, instructions concerning 960
autopsy 951
daily —
of casualties and changes , 1019
of changes 1019
of changes of hospital personnel and patients 1020
financial and statistical data, compilation of, finance and supply division, chief sur-
geon's office " 413
monthly, sick and wounded 1016
of communicable diseases when closing hospital formations 1051
of issues of ordnance to patients discharged from hospital 976
of Y. M. C. A. personnel 951
on civilians, instructions concerning 912
professional 1017
sick and wounded 1038, 1053
for the American Expeditionarv Forces, instructions concerning 932
loss of ■ 1038
manual 921
maiuial for the Medical Department to govern preparation of, after embar-
kation for the United States 1041
telegraphic 976
to central records office, on death of officer or enlisted man 1038
Representation of the Medical Department on the general staff, A. E. F 59-69
Requisitions:
and finance papers, instructions concerning 907
for antigas clothing and gas masks 960
for engineer stores, instructions governing 1034
for laboratory and X-ray supplies 930
for medical supplies 986, 990
for army troops 929
for X-ray supplies 975
instructions concerning 914
medical supplies. Services of Supply 405
upon the Red Cross 930
Research, surgical ^- '^^2
laboratory of, division of laboratories and infectious diseases, chief surgeon's
office -^26
Rest rooms for nurses '
Return :
of buildings occupied for hospital purposes -197
of Medical Department organizations to the United States, orders for 1019
to duty of student officers and soldiers from army and corps schools 940
Returns:
and reports, instructions concerning r ~
property, examination of, finance and supply division, chief surgeon s oftice 414
Rimaucourt, hospital center
Riviera, hospital center
Roentgenograms, instructions concerning ^^^^
Roentgenology
consultant in, hospital centers
school of, hospital center, Bazoilles ^^'^
Sale: 1054
of property ' iq-i
of unserviceable material and supplies ^^'^^
Sales of excess medical property
Salvage: 346
assembly, and repair, ambulances - ^^^^
medicaffield supplies _ 485
of propertv, hospital centers j^^g
of nuartermaster department material-------- .- ' .
of supplies belonging to the British and French medical services 101b
Salvarsan (arsenobenzol) , instructions concerning - - -
1118
INDEX
Page
Sanitary inspector, hospital center; Allerey
Sanitary officer, hospital center, Mesves — '^i^f
Sanitary service, coordination of civil and military, German occupied terntory
Sanitary squads, hospital centers ^J^''
Sanitary supervision of trains ''"'^
Sanitation:
American forces in France
and inspection, division of, chief surgeon's office
and public health, German occupied territory, department of 821-82/
instructions concerning
Savenay, hospital center
Scabies:
and lousiness, instructions concerning "1^2
instructions concerning -^J^
Scarlet fever, instructions concerning 910
School of roentgenology, hospital center, Bazoilles 543
Schools:
army and corps, return to duty of student officers and soldiers from 940
Dental Corps 112
entertainment, athletics, and welfare work, hospital center. Beau Desert - 553
Scope of organization, finance and accounting, finance and accounting division, chief
surgeon's office 410
Second Army, veterinary service 439
Secondary- evacuations 334
Section :
advance, medical activities of 447
base —
No. 1, medical activities of 451
No. 5, medical activities of 457
museum and art, division of laboratories and infectious diseases, chief surgeon's
office 221
of food and nutrition, division of laboratories and infectious diseases 214
of infectious diseases, division of laboratories and infectious diseases, chief sur-
geon's office 203
of laboratories, division of laboratories and infectious diseases 167
of water supplies, division of laboratories and infectious diseases, chief surgeon's
office 213
of wound bacteriology, division of laboratories and infectious diseases 209
Sections, territorial, medical activities of 447-472
Selection of sites and construction, hospital centers 473
Self-inflicted gunshot wounds, transfer of patients with 913
Senior dental officer, hospital centers 481
Separation, final, of officers and enlisted men from the service of the United States
Army, preparation of records of 1041
Serum, antitetanic, prophylactic administration of 969
Serum treatment, prophylactic, against gas gangrene 1072
Service:
British medical, liaison of the Medical Department, United States Army, with._ 71
clinico-pathologic, division of laboratories and infectious diseases, chief surgeon's
office 197
French medical, liaison of the Medical Department, United States Army, with
the 75
Italian medical, haison of the Medical Department, United States Army, with
the _■ 82
laboratory —
hospital center, Vichy 174
hospital centers 482
nursing, hospital centers 482
rendered, dental section, chief surgeon's office 120
veterinary 419-446
Service records:
of evacuated patients 1039
of men evacuated without 1041
Services:
and quahfications of Medical Reserve Corps officers, form of report as to__ _ _ 949
medical —
division of hospitalization, chief surgeon's office 375
of the Allies, haison of the Medical Department, United States Army with
the 7i_g4
INDEX 1119
Services — Continued.
of Supply — Page
base laijoratories assigned to sections of the I59
controlled stores, medical supplies 4O3
hospitals, admission of officers and soldiers to 936
hospital facilities in the 285
medical supphes , 403
professional —
consultants in the, hospital center, Allerey 520
division of hospitalization, chief surgeon's office 351
hosj)ital centers 478
Medical Department, A. E. F., organization of 926
surgical, activities of, division of hospitalization, chief surgeon's office 361
Shelter tents or billets 95O
Shipments to Medical Department repair shop No. 1 929
Shock teams 978
Shoe polish, or dubbin, hospitals to be furnished with 1021
Shoe-shining and tailoring establishments in hospitals 1040
Shoes for distribution to Medical Department personnel 920
Shop:
instrument repair, medical supply personnel 400
optical, medical supply personnel 400
Shortage:
food, effects of, German occupied territory 825
of personnel 968
Sick and wounded:
evacuation of, from the port of St. Nazaire, Base Section No. 1 , 797
hospitalization of 283
monthly reports 1016
of American Expeditionary Forces on duty with British Expeditionary Force,
dispo^tion of 952
records, American forces in France 831
reports 1038-1053
after embarkation for the United States, Manual for the Medical Depart-
ment to govern preparation of 1041
for the American Expeditionary Forces, instructions concerning 932
loss of 1038
manual 921
Sick leave:
for nurses. Army Nurse Corps 989
of absence -- 998
Signal service, hospital center, Allerey 516
Sites, selection of, and construction, hospital centers 473
Skin and venereal diseases and genitourinary^ surgery ^ 369
SHghtly wounded men, proper handhng and disposition of 950
Smallpox, instructions concerning 910
Soldiers :
British, in American hospitals - 9^0
colored 1019
French, property of
officers and — •
admission of, to Services of Supply hospitals J3b
evacuating from hospitals ^' f
student, from army and corps schools, return to duty of _ 940
of the Allied armies in American hospitals, Red Cross allowance for ^1^'
qualified as opticians -^^Y
sick in hospital, allowance for
Sorting medical supplies, central storage for '^^^
Space, storage, medical supplies "^T^
Special units, medical supply C"~■V^ ~"V ^oV
Specialists in cardiovascular and dermatological diseases, hospital centers 481
Spectacles, auxiliary optical units supplying and repairing
Splint repair shop at Dijon ^^^^
Splints, broken .c'o
Squads, .sanitarv, hospital centers — WWi' ~^Vu -70-7
St. Nazaire, porVof, Base Section No. 1, evacuation of sick and wounded from the... /97
Staffs of hospital centers 986
Station for nurses, change of j." icn
Stationary laboratories, division of laboratories and infectious diseases 169
13901—27 71
1120
INDEX
Statistical data and financial reports, compilation of finance and supply division, Vapv
chief surgeon 's office '^^•|
Statistical section, American, address of f^J)
Statistical studies, medical supply 4^2
Statistics, vital, German occupied territory 82;i
Storage:
central, for sorting medical supplies 392
space, medical supplies 390
Stores, controlled, medical supplies, Services of Supply 403
Stoves, heating 9''1
Strength :
of Medical Department personnel 92
of the Sanitary Corps 100
Student officers and soldiers from army and corps schools, return to duty of 940
Students, instructions concerning 960
Subsistence:
hospital trains 329
of civilians sick in hospital, charge for 967
stores, supply of nonperishable 912
surplus, disposition of, on disbanding of hospitals 1034
Suitability of hospital trains 336
Supervision :
gas poisoning 384
sanitary, of trains 331
Supplies:
and equipment, dental 114
and material, sale of unserviceable 1051
belonging to the British and French medical services, salvage of 1016
conservation of 976
general office 101
hospital trains 323
laboratory — •
and X-ray, requisitions for 930
equipment and, central Medical Department laboratory 158
medical 387, 1006
accountability for 1018
American Red Cross 407
and drugs, German occupied territory 823
Department, American forces in France 830
disposition of 1048
distribution of, in the American Expeditionary Forces, outlining lines of
supply and decentralization of both requisitions and suppHes 991
for army troops, requisitions for 929
method of closing accountability for, upon turnover to French authorities 1054
purchase of 1014
requisitions for 986, 990
received not properly marked, report on 913
salvage, field 1006
use of 912
X-ray, requsitions for 975
Supply:
and distribution of biological products (human) 921
automatic, medical supplies 401
medical, liaison with the United States 406
of animals, veterinary service 436
Services of —
hospital facilities in the 285
medical supplies 493
Supply depot:
medical —
hospital center, Mesves 534
hospital centers ~ 434
No. 2, advance medical _ [ \ 1007
Supply echelons, medical, and systems of replenishment _ y_l[ 402
Supply service, medical, hospital center, Allerey " 505
Supply situation, medical, influence of transportation on the 406
Surgeons of territorial sections
INDEX 1121
Surgery : Page
general 361
consultant in 479
genitourinary, venereal and skin diseases and 369
maxillofacial 367
, consultant in, hospital center 479
u* hospital center, Mesves 586
neurological 363
of the war, original papers on 99O
orthopedic 365
reconstructive facial, short course in 1038
Surgical bandages and adhesive tape, misuse of 911
Surgical consultants:
hospital centers 363
with tactical units 362
Surgical dressings, made-up 992
Surgical instruments 996
Surgical operations, instructions concerning 950
Surgical research 372
laboratory of, division of laboratories and infectious diseases, chief surgeon's
office 226
Surgical services, activities of the division of hospitalization, chief surgeon's office 361
Surgical teams 362
Surplus subsistence on disbanding of hospitals, disposition of 1034
Systems of replenishment, medical supply echelons and 402
Tactical units, surgical consultants with 362
Tags, identification 986
Tailoring and shoe-shining establishments in hospitals 1040
Tape, adhesive, and surgical bandages, misuse of 912
Teams :
emergency medical - ^^J^
surgical
Technical apparatus, purchase of, locally 930
Technical work of laboratories 1^4
Technique of Wassermann test lObZ
Telegrams:
and letters, official, instructions concerning
numbered serially
Telegraphic reports innfi
Telephone calls, long-distance
Tentage
Territorial sections: 447-472
medical activities of
personnel of
Third Army: ^^r,
Central hospital fund
veterinary service ggQ
Tobacco, instructions concerning
Toul, Justice hospital center — "
Trachoma, instructions concerning
Train: 332
movements 3§3
preoperative
Trains, hospital. {See Hospital trains.) 32 ^
obtained from the French 33^
sanitary supervision of
Transfer: 990
apphcations for " ... 913
of patients with self-inflicted gunshot wounds . _ . . 998
personnel available for ^ 977
Transfusion sets
Transport: 912
ordre de r " r " u ' ' " -V T T-.V 924
for movements made by hospital trains -
■"'TnCnce S;. on the medical supply «ua«on IT-
Medical Department 920
accountable office for S31
American forces in France 455
motor, hospital centers
1122
INDEX
Piige
Transportation — Continued. _ (j^q
of wounded in trucks r^|(j
railway, hospital center, AUerey
service — rui
motor, hospital center, Mesves '
railroad, hospital center, Mesves ^
Travel, of over 10 persons, orders involving -^^
Travel orders — 7 -- 'qoc
and classification of patients discharged from hospital
to individuals or units forwarded to the advance section . ,- - -----
Traveling auditors of hospital funds, finance and supply division, chief surgeon s ottice. 412
Treasury officials, liaison with iinance divisions and, finance and supply division,
chief surgeon's office
Treatment: 00,^
hospitalization and, gas poisoning JJ'J'^
of Y. M. C. A. personnel
Troops:
armv, requisitions for medical supplies for
distribution of, German occupied territory ^■^^
Trucks, transportation of wounded in -^i^
Tuberculosis
pulmonary, hospitalization and evacuation of cases of -''^-i
Typewriters :
repair of-
960
H^jvcm vyi ~ . QOd.
surgical instruments and, repair of
Typhoid :
and paratyphoid fever —
disposition of chronic carriers of l^d*
instructions concerning lOu, 1020
vaccination against inon
carriers, evacuation of aaa
lipovaccine ^■ff
Typhoid-paratyphoid fevers, instructions concerning 1022
Typhus fever, cases of, instructions concerning 1045
Tvpical hospital center . 489, 535
Typical laboratory organization of a hospital center (Mesves) 172
Uniform, nurses ^^9
Uniforms, nurses' regulation 936
Unit, divisional laboratory 1057, 1059
United States:
evacuation of patients to the 791-806
discontinuance of hospitals 791-812
medical supply liaison with the 406
Units:
abandoned, general instructions governing 1037
hospital, and casual personnel, military attaches and observers, medical officers
with special duties, on duty with Allies 13-37
hospital center, Mesves 583
hospital, collective activities of, hospital center, Allerey 522
special, medical supply 400
Urology, consultant in, hospital centers 480
Vacancies in permanent Medical Corps 1012
Vaccination against typhoid and paratj^phoid fevers 1015
Vaccine, pneumococcus 1035
Vaccines, saline, return of 1043
Vannes, hospital center 617
Venereal and skin diseases and genitourinary surgery 369
Venereal disease, instructions concerning 1046
Venereal rate 1052
Veterinary liaison with the French 80
Veterinary service 419-446
as part of Medical Department 430
organization and personnel 431
as part of remount service 419
First Army 437
hospitals 434
Second Army 439
Third Army 44O
Vichy, hospital center q18
laboratory service I74
Visiting places for convalescent officers 932
INDEX 1123
Visits: Page
of French ladies to American wounded gyj
to French hospitals, etiquette of g^Q
Vital statistics, German occupied territory g23
Vittel-Contrexcville, hospital center g23
Vocational education ggg
Vouchers:
and pay rolls, instructions concerning g4Q
instructions concerning g31
money, auditing, finance and supply division, chief surgeon's office 411
property, examination and filing of, finance and supply division, chief surgeon's
office 1 413
l)urchase, forwarding 93O
War diaries, medical ggg
War neuroses, psychiatric, and pulmonary tuberculosis cases, disposition of 932
Warehousing, medical supplies 392
Washing mess kits, manner of 929
Wassermann test, techniciue of 1062
Water:
sterilizing bag, Lyster, instructions for the use of 931
supplies, section of, division of laboratories and infectious diseases, chief sur-
geon's office 213
Welfare :
hospital center, Savenay 613
work, schools, entertainment, and athletics, hospital center. Beau Desert 553
White clothing for hospital attendants 920
Work:
preparatory, finance and accounting, finance and supply division, chief surgeon's
office
tjuality of construction, division of hospitalization, chief surgeon's office
technical, of laboratories
Worker's permits for all nurses
Wound bacteriology:
monthly statistical report on
section of, division of laboratories and infectious diseases
Wounded :
American, visits of French ladies to
and sick —
evacuation of, from the Port of St. Nazaire, Base Section No. 1
hospitalization of
of American Expeditionary Forces on duty with British Expeditionary
Force, disposition of
slightly, men, proper handling and disposition of
systems of evacuation of
transportation of, in trucks
W^ounds, self-infiicted gunshot, transfer of patients with
X-ray:
apparatus, repairs or installation of
supplies —
laboratory and, requisitions for
requisitions for
therapy
tubes, replacement of
Young Men's Christian Association:
hospital center, Mesves
patients in military hospitals.. _
personnel —
reports of
treatment of
258
194
940
1082
209
971
797
283
952
950
968
970
913
998
930
975
985
935
587
1015
951
976
o
3NI3IOJW JO isvuan ivnouvn
3NOia3w JC
Bridgeport
National
Bindery, Inc
iO XMVlign IVNOUVN
Live Music
Archive
Librivox
Free Audio
Metropolitan Museum
Cleveland
Museum of Art
Internet
Arcade
Console Living Room
Open Library
American
Libraries
TV News
Understanding
9/11